Your 'Best Hospitals' Questions Answered

Comments and questions have piled up since the release of the latest America's Best Hospitals rankings and articles. I'll respond to some of them here.

I take issue with using reputation as a benchmark. Many "reputations" are falsely inflated or are the result of professional or academic alignments.
It would be wrong if reputation was all we considered, but it is only one third of the score in most of the ranked specialties. Because we (a) only survey board-certified physicians, (b) emphasize that we want their recommendations for hospitals for the most difficult patients and procedures in their specialty, and (c) ask them not to consider location or expense when naming a hospital, we believe the survey is a decent form of peer review. We also request that the physicians not name hospitals where they have privileges, and when we match up respondents with their hospitals, it seems that the majority comply.

How is it possible to rank these hospitals without a score for emergency medicine?

This is a good question that comes up repeatedly, along with wondering why we don't have separate ER rankings. Those with long memories may recall a blog post from last year. I'd summarize the thinking this way: The rankings are for patients who need the highest and best care but who also have a little time to shop around to find it and, if necessary, travel some distance to get it. Emergencies, obviously, don't permit that kind of shopping. And while many hospital patients are admitted through the ER, it is unclear whether or how the quality of ER care relates to the quality of inpatient care. Data standards differ around the country, so making valid statistical comparisons would be problematic.

Why was accreditation not considered?
Because there's almost no such thing as an unaccredited hospital. Few health insurers would cover expenses for care at a hospital that isn't accredited by the Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations), which is congressionally chartered to set standards and manage the accrediting process. Even if a hospital is threatened with loss of accreditation because of substandard care, its fully accredited status is almost always regained after the hospital shows that the problems have been addressed. Years ago, we did use JCAHO accreditation as one of the elements, and found that the results did not change whether it was in or out, so we dropped it.

What is Thomson's 100 Best Hospitals, and how does it compare to the Best Hospitals in U.S. News?
The Thomson Reuters 100 Top Hospitals takes financial and operational information into account, such as profit margin and cash-to-debt ratio, in addition to clinical performance. U.S. News focuses exclusively on medical results and data.

We live in Indiana, and I feel that we have one of the best children's hospitals—James Whitcomb RileyHospital saved my grandson's life. But for some reason it didn't make your list.
The brand-new rankings cover adult specialties only. Our latest "America's Best Children's Hospitals" rankings appeared last month; Riley Hospital for Children in Indianapolis was ranked in five of the six specialties.

It is only a "best hospital" if there is a zero infection rate; there is a zero mistake rate; RNs who have a minimum of a BSN degree and understand nursing theory take care of me; and medical care is provided by doctors who value patient input and a patient/provider team approach.
I wish infections and errors could be eliminated—it should be a goal, but I don't see how it is possible at a big hospital any more than costly mistakes can be entirely prevented at any large company. I'm not sure I think that a nursing degree and an understanding of nursing theory necessarily define a good nurse. And while I completely agree that I don't want anyone charting my course in a hospital without making sure I am involved every step of the way, my first priority, as a patient, is getting the right numbers: how many patients the doctor has seen in the last year who are like me, and the death and complication rates for those patients. Will I live, or will I die? All other considerations take second place.