With 460 beds and more than 25,000 admissions a year, Sinai Hospital of Baltimore is no pipsqueak. But it is overshadowed by the city's two major teaching centers 15 minutes away. The 702-bed University of Maryland Medical Center is nationally ranked in nine of 16 U.S. News Best Hospitals specialties, and Johns Hopkins Hospital, a 918-bed behemoth, ranks at or near the top in all 16. Sinai doesn't crack the national rankings. Yet it's not just another decent community hospital. As part of Best Hospitals, the annual rankings in their 22nd year, U.S. News now evaluates hospitals metropolitan area by metropolitan area. The metro rankings show that Sinai approaches national stature in 12 specialties, meaning that for all but the most difficult cases, Baltimoreans can turn to Sinai for high-quality care in those specialties.
The metro area rankings, expanded for 2011-12 to 94 metro areas with at least half a million residents (from 52 metro areas with a minimum of 1 million residents previously), recognize that while some patients need every ounce of skill medicine has to offer because of the delicacy of a procedure or challenge of an unusual condition, most will do just as well at hospitals that may not be in the topmost tier but are close to home and more likely to be in the health insurer's network than one 500 miles away.
In addition to 140 nationally ranked Best Hospitals, U.S. News has identified 587 hospitals in the 94 metro areas that meet standards for strong performance in one or more of the 16 Best Hospitals specialties.
The standards came from the same methodology used for the 2011-12 national rankings. In 12 specialties in which ranking was based mostly on hard data (ranking in the other four specialties relied solely on reputation), the starting point was all 4,825 U.S. hospitals, whittled down in individual specialties to much smaller numbers—870 in cancer and 1,591 in orthopedics, for instance—that met stringent benchmarks for patient volume and other indicators.
After all hospitals that met the benchmark in a specialty were scored, the top 25 percent, including the nationally ranked hospitals, were identified. Hospitals in the top 25 percent but not ranked nationally were recognized as "high-performing." In the four specialty rankings based only on reputation—ophthalmology, psychiatry, rehabilitation, and rheumatology—hospitals were designated high-performing if at least 3 percent of the physicians responding to a U.S. News survey named them as a source of high-quality care for difficult conditions or procedures.
Hospitals within each metro area with a population of 500,000 or more were then ranked based on the number of specialties in which each was nationally ranked or high-performing. In each metro area, hospitals are ordered first by the number of specialties in which they were nationally ranked, then by the number of specialties in which they were high-performing.
No upper or lower limit was placed on the number of hospitals ranked in a metro area. If no hospital in a metro area was nationally ranked or high-performing in any specialty, no hospital was listed, even if the metro area population met the 500,000 population standard.
Just seven of the 140 nationally ranked Best Hospitals lie outside the 94 selected metro areas. Another 242 hospitals outside those metro areas scored at a high-performing level in one or more specialties. They are recognized as high-performing hospitals but are not ranked.
Children's hospitals are not included in the metro rankings. Few metro areas have more than one or two, making decisions about where to take a sick child more straightforward and ranking unnecessary.
Almost all metro areas were defined in accordance with the U.S. Census Bureau's list of Metropolitan Statistical Areas. In a few cases, U.S. News used Combined Statistical Areas, which extend somewhat farther, so that smaller cities that are within easy driving distance and have nationally ranked hospitals would be included. They are Detroit (to add Ann Arbor), Greensboro-High Point, N.C. (to add Winston-Salem), Raleigh-Cary, N.C. (to add Durham and Chapel Hill), and Salt Lake City (to add Ogden).
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