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.
Each candidate in the 12 data-driven rankings received a U.S. News score from 0 to 100 that was based on four elements: reputation, patient survival, patient safety, and care-related factors such as nursing and patient services. The hospitals with the top 50 scores in each specialty were ranked. Hospitals with slightly lower scores that nevertheless fell in the top 25 percent of the range in a given specialty are recognized as high-performing in that specialty. (For more about what it means to be a high-performing hospital, see How U.S. News Selected the Best Regional Hospitals.) Scores and data for all of the eligible hospitals in each specialty are also posted. (Use of electronic health records was not factored in, but see our separate list of Most Connected Hospitals.) The four elements and their weightings, in brief:
Survival score (32.5 percent). A hospital's success at keeping patients alive was judged by comparing the number of Medicare inpatients with certain conditions who died within 30 days of admission in 2008, 2009, and 2010—the three latest years for which data are available—with the number expected to die given the severity of illness. Hospitals were scored from 1 to 10, with 10 indicating the highest survival rate relative to other hospitals and 1 the lowest rate. Software used by many researchers (3M Health Information Systems Medicare Severity Grouper) took each patient's condition into account.
Patient safety score (5 percent). Harmful blunders occur at every hospital; this score reflects how hard a hospital works to prevent six of the most egregious types. Injuries during surgery and major bleeding afterwards are two examples of the six categories of medical mishaps that were factored in. A hospital among the top 25 percent in this regard earned a score of 3, those in the middle 50 percent scored a 2, and those in the lower quartile scored a 1.
Reputation (32.5 percent). Each year, 200 physicians per specialty are randomly selected and asked to list the hospitals they consider to be the best in their specialty for complex or difficult cases without considering location or expense. To reduce the possibility that year-to-year shifts in physician perspective will skew the rankings, U.S. News each year bases the reputational score on the combined results of three years of surveys. The figure published for each hospital is the average percentage of specialists in 2010, 2011, and 2012 who named the hospital. (In the four specialties where rank relies only on reputation, hospitals were ranked if they were cited by at least 5 percent of physicians who responded to the most recent three years of U.S. News surveys.)
Other care-related indicators (30 percent). These include nurse staffing, technology, and other measures that have been found to be related to quality of care. The main source was the American Hospital Association's 2010 survey of all hospitals in the nation.
The rankings were produced for U.S. News by RTI International, a leading research organization based in Research Triangle Park, N.C. Be sure to add your own fact-gathering to ours and to consult with your doctor or other medical professional; no hospital is best for every patient.
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