The most well-known of a series of hospital rankings is a powerful marketing tool, but one observer says he is troubled that none of the various "rating schemes" use state and federal inspection data in their evaluations.
U.S. News & World Report released its much anticipated 24th annual Best Hospitals ranking Tuesday with familiar hospitals holding the coveted top spots.
The only drama came when Johns Hopkins Hospital reclaimed the No. 1 spot on the magazine's honor roll, a distinction it had held from 1991 through 2011, but which it lost last year to Massachusetts General Hospital. Mass General had to settle for silver this year, dropping to No. 2 on the list. The Mayo Clinic in Rochester, MN came in third.
Johns Hopkins Hospital officials were positively giddy with the news and issued a press statement crowing that the Baltimore hospital was "back on top."
"Given the competitive, rapidly changing health care environment and the realization that U.S. News evaluated more than 4,806 hospitals, we hope you share our incredible pride in achieving this top-tier ranking among the best hospitals in the United States," said a joint letter to employees and staff from Paul B. Rothman, MD, dean of the medical faculty and CEO of Johns Hopkins Medicine, and Ronald R. Peterson, president of The Johns Hopkins Hospital and Health System and executive vice president of Johns Hopkins Medicine.
Mass General officials took solace in noting that the Boston hospital was ranked No. 2 in the nation, No. 1 in New England, and placed highly in all of the 16 specialty areas identified by U.S. News.
"Of the nearly 5,000 hospitals evaluated, Mass General has consistently placed among the top hospitals on the Honor Roll since the survey began in 1990," the hospital said in its media release.
U.S. News ranks up to 50 hospitals in each of 16 medical specialties. Just 147 out of nearly 5,000 hospitals earned national ranking in one or more of the specialties, the magazine said.
"The mission of Best Hospitals is to help guide patients who need a high level of care because they face a particularly difficult surgery, a challenging condition, or added risk because of other health problems or age," Avery Comarow, U.S. News Health Rankings Editor said in a media release.
"Patient survival and safety data, the adequacy of nurse staffing levels and other objective data largely determined the rankings in most specialties." Comarow said another factor was a national survey that asked physicians in each of the 16 specialties to name the hospitals they consider best for the toughest cases in their specialty.
More impartial observers say that the U.S. News rankings are simply the most well-known of a series of hospital awards, all of which have their good and bad points.
"The problem is there are a number of awards given out to hospitals. There is Health Grades and U.S. News, and LeapFrog [Group] and Consumer Reports and they don't always match with one another," says Charles Ornstein, senior reporter at ProPublica, the nonprofit news organization, and president of the board of the Association of Health Care Journalists.
"Oftentimes they strongly disagree with one another and there are a number of cases where they recognize hospitals that are in serious violation of federal and state regulations related to quality of care. It is a concern that there is such a proliferation of rankings that they have almost become hard to decipher."
Ornstein says the U.S. News rankings in particular present "a great marketing tool for hospitals that are recognized."
"It is a name consumers recognize. And hospitals are looking for independent validation of their quality. So, this is something which, even though they may criticize the methods and especially criticize it if their ratings go down, they definitely want to make the list of top hospitals in their area or in the country," he says.
Ornstein says he is troubled that none of the various "rating schemes" use state and federal inspection data in their rankings.
"They certainly use quality measures from Hospital Compare and other places. But they aren't taking into account the findings that regulators have when they go into a facility and use their five senses to identify problems with quality of care, medication errors, wrong side surgeries, and other types of mistakes," he says. "So, it is really important that these rating systems figure out a way to include regulatory findings in the reports."
"Also, whether we like it or not, a lot of the numbers are self-reported by the institutions," Ornstein says. "There are places that have been found to have up-coded their billing to make their patients look sicker than they are, or provided unnecessary surgeries, whether they are stents or back surgeries. And the rating systems don't have a mechanism to take into account those types of things."
Ornstein says the various ranking surveys would better serve consumers if they started using independently verified measures available on Hospital Compare and other Web sites, such as Why Not The Best?, which provide historical information on quality metrics.
"They should look at our Web site, HospitalsInspections.org, which incorporates information about federal deficiency reports against hospitals. There is also information available in every state on state inspections of those hospitals," he says.
"So, if you have an acute condition you are not going to do a ton of research. You are going to call 9-1-1 and be taken to the nearest hospital. But if you are looking for a hospital for a knee replacement or a hip replacement or some elective procedure, there is an array of sites that are trying to draw attention to patient safety at hospitals. That has to be something that is very much in the mix as you think about what hospital you want to go to."
Richard "Buz" Cooper, MD, a healthcare economist at the University of Pennsylvania, calls the U.S. News list "an old game, but it has some merit for what it actually measures."
"It lists the hospitals in which various specialties are highly regarded nationally, and the one with the most is #1. These are places where specialists elsewhere in the country trained, and they hold them in high regard. They are also places that specialists and generalists refer their most complex patients. So, they deserve recognition," Cooper said in an email exchange with HealthLeaders Media.
"But other hospitals are just as good in the vast majority of circumstances. Yet even there, there is a pecking order. For a serious problem, the highly developed community hospital is a better place to go than the 20-bed rural hospital."
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U.S. News & World Report Best Hospitals List Shifts Methodology
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.