The 31st annual version of the widely read rankings features mostly the same top 20 hospitals that made the list in years past.
For the fifth straight year, Mayo Clinic sits atop the 20 Best Hospitals rankings published Tuesday by U.S. News & World Report.
The 31st annual version ofwidely read rankings, which emphasizes outcomes, patient experience and risk adjustment, featured mostly the same top 20 hospitals that make the list in year's past.
The hospitals were ranked on 26 adult specialties, including: cancer, cardiology and heart surgery, diabetes and endocrinology, ear, nose and throat, gastroenterology and GI surgery, geriatrics, gynecology, nephrology, neurology and neurosurgery, ophthalmology, orthopedics, psychiatry, pulmonology and lung surgery, rehabilitation, rheumatology, and urology.
The study evaluated nearly every community hospital in the nation. Only 134 hospitals out of more than 4,500 were nationally ranked in one specialty, while 563 were ranked among the Best Regional Hospitals in a state or metro area based on their performance in delivering complex and common care, U.S. News said.
The data used in this year's rankings predates the COVID-19 pandemic and were not affected by the pandemic's impact on hospitals.
Here’s the 2020-21 Best Hospitals Honor Roll. The numbers in parentheses are the 2019-20 rankings.
1. Mayo Clinic, Rochester, Minnesota (1)
2. Cleveland Clinic (4)
3. Johns Hopkins Hospital, Baltimore (3)
4. New York-Presbyterian Hospital-Columbia and Cornell, New York (tie) (5)
4. UCLA Medical Center, Los Angeles (tie) (6)
6. Massachusetts General Hospital, Boston (2)
7. Cedars-Sinai Medical Center, San Francisco (8)
8. UCSF Medical Center, San Francisco (7)
9. NYU Langone Hospitals, New York, N.Y. (9)
10. Northwestern Memorial Hospital, Chicago (10)
11. University of Michigan Hospitals-Michigan Medicine, Ann Arbor (11)
12. Brigham and Women’s Hospital, Boston (13)
13. Stanford Health Care-Stanford Hospital, Palo Alto, California (12)
14. Mount Sinai Hospital, New York (14)
15. Hospitals of the University of Pennsylvania-Penn Presbyterian, Philadelphia (18 tie)
16. Mayo Clinic-Phoenix (18 tie)
17. Rush University Medical Center, Chicago
18. Barnes-Jewish Hospital, Saint Louis (tie)
18. Keck Medical Center of USC, Los Angeles (tie) (16)
CMS reported that 10.7 million consumers had gained coverage through the Exchanges in February 2020.
Federal Health Insurance Exchange enrollment in early 2020 held steady for the third year in a row, with the number of consumers who paid for coverage in February 2020 up 1% compared to February 2019, the Centers for Medicare & Medicaid said.
CMS reported that 10.7 million consumers had effectuated enrollment through the Exchanges in February 2020, which means they selected a plan, paid their first month's premiums, and had coverage in February 2020.
Those 10.7 million consumers represent 94% of the 11.4 million consumers who picked a plan in the 2020 enrollment period.
The average monthly premium for Exchange enrollees in February 2020 was $576.16, a drop of 3% from the February 2019's average premium of $594.17, CMS said.
About 9.2 million (86%) of Exchange enrollees in February received Advance Premium Tax Credit, a decrease of 1 percentage point from February 2019. The average monthly APTC fell by 4% from February 2019, to $491.53.
The Trump administration has maintained that CMS has the authority to impose payment cuts as a way to reduce unnecessary and costly increases in hospital procedures.
Hospital plaintiffs said Friday they will ask a federal appeals court in to reconsider its ruling last week that reversed a lower court ruling and upheld the Trump administration's legal authority to impose site-neutral payments under the Outpatient Prospective Payment System final rule.
OPPS had reduced reimbursement rates for clinic visits at hospital-owned outpatient provider departments by 40%, to match the rates paid for clinic visits in physician offices. The Centers for Medicare & Medicaid Services estimates that the OPPS final rule could save the Medicare program about $760 million in 2020.
In AHA v. Azar, the U.S. Court of Appeals for the District of Columbia Circuit ruled unanimously in favor of the Department of Health and Human Services, reversing district judge's ruling last September that CMS acted in a way that was "manifestly inconsistent with the statutory scheme" when it finalized the site-neutral payment as part of the OPPS final rule for 2019.
The Trump administration has maintained that CMS has the authority to impose payment cuts as a way to reduce unnecessary and costly increases in hospital procedures.
The American Hospital Association, the Association of American Medical Colleges, Olympic Medical Center in Port Angeles, Washington, Mercy Health in Muskegon, Michigan, and York Hospital in York, Maine, said that the appeals court did not strictly construe the statutory authority that binds the agency, "unaccountably deferring to impermissible agency decisions."
"These illegal cuts directly undercut the clear intent of Congress to protect hospital outpatient departments because of the many real and crucial differences between them and other sites of care," the plaintiffs said in a joint statement.
"These hospital outpatient departments are held to higher regulatory standards and are often the only point of access for patients with the most severe chronic conditions, all of whom receive treatment regardless of ability to pay. We look forward to a prompt rehearing of our case to overturn these unlawful cuts," the plaintiffs said.
The blood test, called PanSeer, detected cancer in 91% of people who had been asymptomatic when the samples were collected.
Researchers from China and the United States say they've developed a noninvasive blood test that can find five common cancers in people four years before the disease can be diagnosed with existing methods.
The blood test, Called PanSeer, detected cancer in 91% of people who had been asymptomatic when the samples were collected and were diagnosed with cancer one to four years later.
The test, which detects stomach, esophageal, colorectal, lung and liver cancer, also found cancer in 88% of samples from 113 patients who were already diagnosed when the samples were collected, and recognized cancer-free samples 95% of the time, according to the study, which was published this week in Nature Communications. .
"The ultimate goal would be performing blood tests like this routinely during annual health checkups," said study corresponding author Kun Zhang, a professor and chair of the Department of Bioengineering at the University of California San Diego.
"But the immediate focus is to test people at higher risk, based on family history, age or other known risk factors," he said.
Zhang said the study is unique because researchers could access blood samples from patients who were asymptomatic and undiagnosed. This allowed the researchers to develop a test that can find cancer markers much earlier than conventional diagnosis methods.
The samples were collected under a 10-year longitudinal study begun in 2007 by Fudan University in China.
The study is a collaboration between UCSD Jacobs School of Engineering, Fudan University and Singlera Genomics, a San Diego- and Shanghai-based startup.
The researchers said the PanSeer test can't predict which patients will later develop cancer, and is better suited to identifying patients who already have cancerous growths but who remain asymptomatic under existing detection methods.
The researchers said more and larger longitudinal studies are needed to confirm their findings.
UCLA researchers found that the antibodies against SARS-CoV-2 decreased by half every 73 days.
The prevalence of antibodies for people recovering from a mild case of COVID-19 dropped precipitously after less than three months, according to a research letter published this week in The New England Journal of Medicine.
UCLA researchers wrote that a small study of 34 patients, with a median age of 43, found that the antibodies against SARS-CoV-2 — the virus that causes the disease — decreased by roughly half every 73 days, and would likely disappear entirely within a year at such a rate.
The findings could have implications for the long-term effect of potential vaccines and could also affect the ongoing debate in the public health and policy arenas about the merits of "herd immunity."
The study followed 20 women and 14 men who recovered from mild cases of COVID-19. Antibody tests were taken 36 days and 82 days after the symptoms of infection.
"Our findings raise concern that humoral immunity against SARS-CoV-2 may not be long lasting in persons with mild illness, who compose the majority of persons with Covid-19," the researchers wrote.
"It is difficult to extrapolate beyond our observation period of approximately 90 days because it is likely that the decay will decelerate," they wrote.
"Still, the results call for caution regarding antibody-based 'immunity passports,' herd immunity, and perhaps vaccine durability, especially in light of short-lived immunity against common human coronaviruses."
Report warns that without more government money, half of all hospitals may be operating in the red in the second half of 2020.
The American Hospital Association on Tuesday issued a stark new analysis projecting that the nation's hospitals will book margins of -7% for the second half of 2020 unless the federal government steps in with more emergency funding.
AHA President and CEO Rick Pollack said hospitals were already challenged financially before the coronavirus pandemic flattened patient volumes.
"This pandemic is the greatest financial threat in history for hospitals and health systems and is a serious obstacle to keeping the doors open for many," Pollack said.
Without federal funding, hospital margins would have been -15% in Q2. Margins are still expected to drop to -3% in Q2. Before COVID-19, the median hospital margin was 3.5%.
In the best-case scenario, which assumes a slow and steady decrease in COVID-19 cases, median margins could be -1% by Q4.
Under a more dire scenario of periodic COVID-19 surges, margins could sink to -11%.
So far, the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act have doled out more than $175 billion in relief funds to hospitals and other providers, especially those disproportionately affected by the pandemic, including a $10 billion aid package that the Department of Health and Human Services began disbursing on Monday.
"While we appreciate the support from the Administration and Congress, we need further help to stay afloat to continue our mission of caring for patients and communities," Pollack said.
Payments from the $10 billion distribution will go to more than 1,000 hospitals across the nation beginning Monday.
The Department of Health and Human Service on Monday will begin distributing another $10 billion in emergency funds for more than 1,000 hospitals in the nation's COVID-19 hotspots.
"The top priority for HHS's administration of the Provider Relief Fund has been getting support as quickly as possible to providers who have been hit hard by COVID-19," HHS Secretary Alex Azar said.
"Because we've carefully targeted support, we can make payments to areas most in need as the pandemic evolves, like we are doing with this round of funds," he said.
In early June, HHS told hospitals it would distribute a second round of funding for hospitals in COVID-19 hotspots and asked them to submit data on their COVID-19 positive-inpatient admissions from January 1 through June 10.
Those submissions determine eligibility and the share of the second round of the funding being announced today.
So far, the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act have doled out more than $175 billion in relief funds to hospitals and other providers, especially those disproportionately affected by the pandemic.
In May, HHS announced the first round of high impact funding totaling $12 billion that was shared by 395 hospitals. So far, the two rounds of hotspot funding from the Provider Relief Fund program is more than $20 billion, almost 12% of the $175 billion program.
The latest funding formula identified hospitals with more than 161 COVID-19 admissions between January 1 and June 10, or one admission per day, or that experienced a disproportionate intensity of COVID admissions (exceeding the average ratio of COVID admissions/bed). Hospitals will be paid $50,000 per admission, HHS said.
The first round of funding distributed funds to hospitals with 100 or more COVID-19 admissions between January 1 and April 10 and paid $76,975 per admission.
The previous high impact payments were also taken into account when determining each hospital's payment in this second round distribution.
American Hospital Association President and CEO Rick Pollack thanked HHS for the latest funding measure, but said more help will be needed.
"Since this distribution of funding for 'hot spots' does not take into account the latest spike in cases and hospitalizations in some parts of the country, we look forward to working with the Administration to ensure that additional relief will be distributed to 'hot spots' and all hospitals," he said.
The government watchdogs are calling on the Centers for Medicare and Medicaid Services to collect the money from hospitals.
The estimates come from an OIG random audit of 200 severe malnutrition diagnosis code claims filed by hospitals in fiscal years 2016 and 2017. The auditors found that only 27 of the claims were filed correctly, while the remaining 173 claims were not.
"For nine of these claims, the medical record documentation supported a secondary diagnosis code other than a severe malnutrition diagnosis code, but the error did not change the (diagnostic related group) DRG or payment," the audit said.
"For the remaining 164 claims, hospitals used severe malnutrition diagnosis codes when they should have used codes for other forms of malnutrition or no malnutrition diagnosis code at all, resulting in net overpayments of $914,128," the audit said, adding that based on their sample, "we estimated that hospitals received overpayments of $1.024 billion for FYs 2016 and 2017."
CMS concurred with OIG's recommendations and said it would instruct its contractors to recover the overpayments. However, CMS noted that the overpayments represent less than .5% of the overall payments made for inpatient services during the two-year span.
In a letter to OIG, CMS Administrator Seema Verma said that Medicare has since the audit implemented new fraud prevention measures that identify upcoding.
"Additionally, CMS has taken action to prevent improper Medicare payments by educating health care providers on proper billing," Verma said
Nutritional marasmus (diagnosis code E41) and unspecified severe protein-calorie malnutrition (diagnosis code E43) are two types of severe malnutrition. They are each classified as a type of major complication or comorbidity (MCC), which can result in higher payments
In 2016 and 2017, Medicare paid $3.4 billion for 224,175 claims that contained a severe malnutrition diagnosis code and for which removing the diagnosis code changed the diagnosis-related group (DRG). The OIG random sample of 200 found payments totaling $2.9 million.
The auditors sent the 200 claims to medical and coding review to determine whether the services were medically necessary and properly coded.
"Of the claims that we reviewed, 82% were not correctly billed, which we maintain is significant and needs to be addressed," OIG said. "We continue to recommend that CMS review all claims in our sampling frame that were not part of our sample but were within the reopening period and work with the hospitals to ensure they correctly bill Medicare when using severe malnutrition diagnosis codes."
Earlier OIG audits of severe malnutrition found that hospitals had incorrectly billed Medicare by using severe malnutrition diagnosis codes when they should have used codes for other forms of malnutrition or no malnutrition diagnosis code at all.
Critics say a move this week to bypass the CDC's role in reporting hospital data on COVID-19 volumes could "severely weaken" the quality and availability of data.
The Trump Administration's abrupt decision this week to bypass the Centers for Disease Control and Prevention from collecting daily hospital COVID-19 data is "troubling" and could "undermine our nation's public health experts," the Infectious Diseases Society of America said Wednesday.
"COVID-19 data collection and reporting must be done in a transparent and trustworthy manner and must not be politicized, as these data are the foundation that guide our response to the pandemic," said IDSA President Thomas M. File, Jr., MD. "Collecting and reporting public health data is a core function of the CDC, for which the agency has the necessary trained experts and infrastructure."
Instead, hospital data would be sent directly to HHS, using a private company, TeleTracking, which has compiled data for HHS since April. Initially, no explanation was given for why the CDC was bypassed. However, as the announcement gained traction in the media, HHS and CDC issued a joint statement defending the switch.
"We have not changed the data ecosystem; we have merely streamlined the data collection mechanism for hospitals on the frontlines," CDC Director Robert Redfield said. "This reduces the reporting burden—it reduces confusion and duplication of reporting. Streamlining reporting enables us to distribute scarce resources using the best possible data."
"All elements of our public health system are being stretched right now, and streamlining the hospital reporting system allows the National Health Safety Network to concentrate its COVID-19 activity on the high-priority area of protecting the vulnerable in nursing homes," he said.
File was not appeased.
"Placing medical data collection outside of the leadership of public health experts could severely weaken the quality and availability of data, add an additional burden to already overwhelmed hospitals and add a new challenge to the U.S. pandemic response," he said.
HHS's move to bypass the CDC comes as critics note the increasing attempts to demonize anyonewho contradicts the Trump administration's messaging, most notably, Anthony Fauci, MD, the government's top infectious disease expert.
"At this critical time when many states are experiencing surges, reliable, comprehensive data are essential to inform the distribution of supplies and treatment," File said. "The administration should provide funding to support data collection and should strengthen the role of CDC to collect and report COVID-19 data by race and ethnicity, hospital and ICU capacity, total number of tests and percent positive, hospitalizations and deaths."
The American Hospital Association and other hospital associations have stayed quiet on the new mandate, other than then AHA issuing an advisory to its members informing them of the changes.
That may be because hospital associations continue to press the federal government for emergency funding to offset massive losses brought on by the pandemic.
AHA reports total community benefits for nonprofits were 13.8% of total hospital expenses in 2017.
The nation's more than 2,764 tax-exempt hospitals provided $100 billion in total benefits to their communities in 2017, the most recent year for which data is available, according to a report from the American Hospital Association.
The analysis also shows that tax-exempt hospitals' and health systems’ total community benefits were 13.8% of their total expenses in 2017.
Nearly half of that total, came in the form of financial aid for patients and hospitals eating losses from Medicaid and other "underpaying" government programs, AHA said.
"Hospitals and health systems of all sizes and types deliver a wide range of benefits, activities, services and programs on a daily basis to meet the varied needs of their patients and communities," AHA President and CEO Rick Pollack said. "This new analysis shows that improving the health of their communities remains at the heart of the mission of hospitals and health systems."
The community benefits were fairly consistent across the board, with variations found based on size, location, and patient mix. Urban/suburban hospitals generally reported larger community benefits as a percentage of total expenses (13.6%), versus rural hospitals (10.1%).
Pediatric hospitals generally reported higher percentages of community benefits (15.9%) from total expenses.
