Methodology: U.S. News & World Report 2017-18 Best Hospitals: Specialty Rankings
U.S. News & World Report began publishing hospital rankings in 1990, as “America’s Best Hospitals,” to identify the medical centers in various specialties best suited to patients whose illnesses pose unusual challenges because of underlying conditions, procedure difficulty, advanced age or other medical issues that add risk.
The specialty rankings have appeared annually since 1990 and their focus on identifying hospitals that excel in treating particularly difficult patients has not changed. To address patients in relatively low-acuity procedures and conditions, a new complementary set of ratings, “Best Hospitals for Common Care,” was introduced in 2015. Hospital performance was evaluated in coronary artery bypass surgery, hip replacement, knee replacement, treatment of congestive heart failure and treatment of chronic obstructive pulmonary disease. The ratings were renamed “Best Hospitals: Procedures and Conditions” in 2016, and abdominal aortic aneurysm repair, aortic valve surgery, colon cancer surgery and lung cancer surgery were added. (Details of these ratings are available at http://health.usnews.com/health-care/best-hospitals/articles/faq-how-and-why-we-rank-and-rate-hospitals.)
The Best Hospitals specialty rankings assess hospital performance in 16 specialties or specialty areas, from Cancer to Urology. In 12 of these, whether and how high a hospital is ranked is determined by an extensive data-driven analysis combining performance measures in three primary dimensions of healthcare: structure, process/expert opinion, and outcomes. In the four other specialties, ranking relies on hospital reputation, determined by U.S. News surveys of physicians.
The structural measures include hospital volume, nurse staffing and other resources that define the hospital environment. The data source for most structural measures is the American Hospital Association (AHA) Annual Survey. Additional resources include the National Cancer Institute’s list of NIH-designated cancer centers and the American Nurses Credentialing Center’s roster of Nurse Magnet hospitals.
Process is represented by two factors. One is a hospital’s reputation for developing and sustaining a system that delivers high-quality care, as determined by the surveys of board-certified physicians cited above (i.e., expert opinion). The other, shared with the outcomes dimension, is an indicator of patient safety. The basis for this is that the extent to which patients are protected from preventable death and harm is largely a function of the processes in place. When a patient needlessly dies or suffers injury, this reflects not only an evident outcomes result but also a failure of appropriate hospital processes.
Assessment of outcomes performance relies mostly on survival (i.e., risk-adjusted mortality). The Standard Analytical Files (SAF), maintained by the Centers for Medicare & Medicaid Services (CMS) and also referred to as the Medicare claims files, provide detailed claims data, including mortality, for beneficiaries in fee-for-service Medicare.
The SAF databases are also the source of patient safety data other than for hospitals in Maryland. For Maryland hospitals, patient safety data were taken from the state Health Services Cost Review Commission (HSCRC) all-payer database; analysis was limited to fee-for-service Medicare beneficiaries to be equivalent to the patient population in the SAF.
No application, data submission or other action is required for Best Hospitals consideration. All facilities in the AHA universe of community hospitals are automatically considered but must meet a series of eligibility requirements.
Initial eligibility requires that a hospital must meet at least one of the following four conditions:
It is a teaching hospital, or
It is affiliated with a medical school, or
It has at least 200 beds, or
It has at least 100 beds and offers at least four medical technologies from a list of eight that U.S. News deems significant for a Best Hospitals patient population.
Ranking in a particular specialty imposes a second eligibility requirement. Hospitals must meet a volume/discharge threshold that varies by specialty. Setting discharge minimums ensures that ranking-eligible hospitals have demonstrable experience in treating a set number of complex cases in a given specialty. A hospital that does not meet the minimum requirement in a specialty is still eligible, however, if it was nominated by at least 1% of those who responded to the most recent three years of national physician surveys.
Rankings in Ophthalmology, Psychiatry, Rehabilitation, and Rheumatology do not depend on hard data. In these four specialties, hospitals are ranked solely on reputation as determined by the physician survey cited above.
For the 2017-18 rankings, 152 of over 4,500 evaluated U.S. hospitals were ranked in at least one specialty.
Since 1990, the Best Hospitals Honor Roll has recognized a small group of hospitals with high rankings in multiple Best Hospitals specialties. It was extensively revised in 2016-17 to reduce the effect of reputation and to unify the rankings and ratings by incorporating Best Hospitals Procedures and Conditions ratings. No further changes were added for 2017-18. See section V. Honor Roll for more details.