Here's your situation: You are about to be hospitalized and your condition, or the procedure you need, is especially challenging. Should you simply trust the hospital that your doctor recommends? The Best Hospitals rankings give you a tool that might help you find a better one.
Now in its 23rd year, Best Hospitals' central mission remains unchanged: to help those who need an unusual degree of skilled inpatient care decide where to get it, especially when there's time to make a choice. Other ratings and rankings typically examine how well hospitals perform fairly routine procedures, such as hernia repair and uncomplicated heart bypass surgery, and how successfully they manage relatively unthreatening conditions such as mild heart failure. That's fine for most hospital patients—in any given year, hardly anyone who visits a hospital spends a single night there. (There are about 20 outpatient visits for every hospital admission.) But for patients whose surgery or other care poses a technical challenge, or whose age, physical condition, or infirmities multiply the risk, good may not be good enough.
To be nationally ranked, a hospital must excel across a range of tough cases within a given specialty. For example, a hospital nationally ranked in cardiology and heart surgery—one of 16 specialties in which U.S. News evaluates medical centers—can be expected to have doctors with the talent and experience to replace a faulty heart valve in a patient well into his or her 90s. Most hospitals would decline to perform major surgery on such elderly patients, as they should if they aren't up to speed on the special techniques and precautions involved and don't see many such patients. A hospital ranked in gastroenterology can offer the most appropriate care to a patient whose severe inflammatory bowel disease flares up. At hospitals ranked in neurology and neurosurgery, surgeons face more spinal tumors in a couple of weeks than most community hospitals see in a year.
This year, only 148 of the 4,793 hospitals evaluated met such criteria and performed well enough to rank in even one specialty. And of the 148, just 17 qualified for a spot on the Honor Roll by ranking at or near the top in six or more specialties.
In 12 of the 16 specialties, a hospital's ranking depends largely on objective data, much of which comes from the federal government. Many categories of data go into the rankings. The importance of some data points are self-evident, such as a hospital's death rates. Others, such as the number of patients and the balance of nurses and patients, are important for less obvious reasons, but are backed by solid medical research. A survey of physicians, who are asked to name hospitals they consider tops in their specialty, produces a reputation score that is also factored in.
Hospitals in the four remaining specialties—ophthalmology, psychiatry, rehabilitation, and rheumatology—are ranked solely on their reputation among specialists. Most of the care in these specialties is delivered on an outpatient basis, and such a small number of patients die that mortality data, which are weighted heavily in the 12 other specialties, mean little.
To be eligible for ranking in any of the 12 data-dependent specialties, a hospital first has to satisfy at least one of four criteria: It has to be a teaching hospital, or be affiliated with a medical school, or have at least 200 beds, or have at least 100 beds and offer at least four of eight specific medical technologies, such as a PET/CT scanner and certain precise radiation therapies. This year a total of 2,227 hospitals, or 46 percent of the initial universe, made it through this first door.
The hospitals next have to meet a volume requirement to be eligible in a particular specialty. The threshold is a certain number of Medicare inpatients who were discharged from 2008 to 2010 after having had certain procedures or specific conditions related to the specialty. The number differs for each specialty. For 2012-13 the minimum number of heart patients, for example, was set at 1,308, of whom at least 500 had to have had a surgical procedure; in orthopedics the required number was 303 total, 275 of them surgical. A hospital that fell short still could make it through the gate if nominated by at least 1 percent of the physicians in a specialty who responded to the 2010, 2011, and 2012 reputational surveys. That left 1,868 hospitals eligible to be ranked. Fewer than 1 in 12 of them performed well enough to be ranked in any specialty.
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