Yes. Patients have to do their own research. We also appreciate that families also have to consider the stress and expense of traveling to another city, as well as the willingness of an insurer to pay for care at a hospital outside its network.
How many hospitals were analyzed for the 2013-14 rankings? Were teaching hospitals the only ones considered?
For the 12 data-driven rankings, we started with virtually all nonfederal community hospitals in the U.S. of any size, a universe that comprised 4,806 hospitals. (We would be delighted to include military and VA hospitals but have been unsuccessful in persuading the federal government to release the necessary data.)
It is not true, as is often proclaimed by "experts" even in the professional literature, that we only look at teaching hospitals. From the starting pool of 4,806, a hospital had to meet any of four possible criteria to qualify for consideration in the data-driven specialties: teaching-hospital status, medical school affiliation, bed size of 200 or more, or bed size of 100 or more plus availability of four or more specific types of medical technology such as a PET/CT scanner and certain precise radiation therapies. This year 2,262 hospitals, or 47 percent of the initial number, met the test.
In the four specialties in which ranking was determined only through the physician survey, even meeting this test was not required. Any hospital with enough nominations over the last three surveys was ranked.
How many hospitals were ranked or regional high performers?
Across all 16 specialties, only 147 U.S. hospitals performed well enough to be nationally ranked in one or more specialties. Another 591 were regional high performers. Just 18 qualified for a spot on the Honor Roll by ranking at or near the top in six or more specialties (more on the Honor Roll below).
What was the process following the initial screening?
Hospitals next had to show that they treated enough patients to be eligible for specialty ranking. The required volume varied by specialty. The threshold was a certain number of Medicare inpatients discharged from 2009 to 2011 who had had certain specialty-related procedures and conditions, each at a specifically defined level of severity and complexity. The threshold for gastroenterology & GI surgery, for example, was 561 patients, 151 of whom had to be surgical cases. For pulmonology the total was 968 with no required surgical minimum. 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 2011, 2012 and 2013 reputational surveys. That left a total of 1,894 hospitals eligible in at least one specialty.
What determined whether a hospital was ranked?
We examined the performance of each hospital through the lens of various categories of data. Some of the statistics came from the federal Centers for Medicare & Medicaid Services' MedPAR data base. Other information came from the American Hospital Association and professional organizations. The connection with quality and safety is evident for some of the statistics used, such as death rates. For other categories, such as the number of patients and the balance of nurses and patients, the link may be less obvious but is nevertheless supported by ample research. The physician survey also played a role, though it accounted for less than a third of each hospital's score (more on that below).
In the four reputational specialties, most care is delivered on an outpatient basis, and so few patients die that mortality data, which carry heavy weight in the 12 other specialties, mean little. Hospitals therefore are ranked solely based on reputation.
How were the different factors combined?
Each candidate in the 12 data-driven rankings received an overall score from 0 to 100 that was based on four elements: reputation, patient survival, patient safety, and care-related factors such as the amount of nurse staffing and the breadth of patient services. The hospitals with the top 50 scores in each specialty were ranked. Scores and data for all eligible hospitals in each specialty are also posted. The four elements and their weightings, in brief:
Corrected on : Clarification 8/6/13: This story has been updated to clarify the rules by which hospitals’ state and metro area rankings are determined.