Mass General Reclaims 'Best Hospital' Top Ranking

Other perennial top hospitals on this year's U.S. News and World Report "Honor Roll" include Mayo Clinic, Johns Hopkins Hospital, UCLA Medical Center, and Cleveland Clinic.

Massachusetts General reclaimed the coveted No. 1 spot among the nation's Best Hospitals, in the 26th annual survey and ranking from U.S. News & World Report.

The Boston-based hospital, ranked No. 2 in last year's widely read survey, leads a list of 15 blue chip providers that each year swap chairs at the head table. Other perennial top hospitals on this year's U.S. News "Honor Roll" include Mayo Clinic, Johns Hopkins Hospital, UCLA Medical Center, and Cleveland Clinic.

Best Hospitals features national rankings in 16 specialties, and the Honor Roll includes hospitals that rank at or near the top in at least six specialties, says Ben Harder, Managing Editor at U.S. News, and the magazine's chief of health analysis. In addition, 137 hospitals performed well enough to rank in one or more complex care specialties.

"The specialty rankings are designed to answer specific questions, each one around a specific specialty," Harder says. "But even within that we are not saying the No. 1 cancer hospital is best at treating all cancers. It is best at treating the most complex patients. That is what our methodology for the specialty rankings has always been designed to do. The rankings of each of the Top 50 hospitals in each of the specialties are designed for the rare patient who needs something more than the typical level of hospital care."

Annual hospital rankings by U.S. News, The Leapfrog Group, Consumer Reports, and Healthgrades have come under criticism for their often wildly divergent results. Harder says that is to be expected because each of the survey groups is using different metrics.

"Our focus is on specific areas where patients need decision support, [and] guidance driven by data," he says. "Our rankings are those that look at complex care in 16 different specialties. The ones we published a few weeks ago look at hospitals that excel in these more common surgeries and procedures. We also published last month rankings in pediatric care. Hospitals that do well in one of those domains don't do well in others."

Accuracy of Quality Measures Questioned
Peter Pronovost, MD, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine in Baltimore, is skeptical of the various hospital rankings surveys because he says their data sources and reporting standards are subjective and fuzzy.

"It's surprising, but there are no standards for the accuracy of healthcare quality measures," says Pronovost, who studied the discrepancies in the rankings in a report published this spring by Health Affairs.

"In other words, for a lot of these different ranking systems, there is no threshold that says 'does it have to be 90% accurate or 50% accurate,' and there is no auditing of performance data."

Pronovost says the wild divergence in the hospital ranking surveys suggests that healthcare needs to adopt rigorous reporting and accounting standards similar to that of financial institutions and other businesses. 

"Ironically, we audit for financial data, but not for potentially preventable deaths," he says. "The problem with healthcare [quality rankings] is there are no rules or standards. You could make a performance measure and there is no transparency about how accurate or inaccurate it is."

"The people who make these rankings push back and say that is because we use different measures. Perhaps, but I don't think the public gets that nuance. You could go into virtually any town in America and you're on somebody's top list. With most of them you have to pay to say you are on their top list."

'Too Much Variation' in U.S. Healthcare
Harder doesn't necessarily disagree with Pronovost's assessment, but he says there are other factors in play.

"You could have written a Health Affairs study on the discordance in the U.S. News rankings," he says "That is important because a patient shouldn't necessarily choose a hospital for orthopedics that is good at cancer, and that is a great deal of what you are seeing."

"The other organizations pose different questions, so of course they get different answers," he says. "That is to a large extent a reflection of the fact that healthcare in America is full of too much variation. It'd be nice if hospitals that were good were consistently good across every specialty. It would make choosing a hospital much easier. But what we see is hospitals that are good at one thing might not be so good at something else. Patients need as much advice and decision support as they can muster."