Reputation with specialists (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. The figure displayed is the average percentage of responding specialists in 2011, 2012 and 2013 who named the hospitals. A statistical adjustment is made to keep a small number of hospitals with very high reputational scores from swamping the rest of the field in the final rankings. The adjustment allows hospitals with low reputational scores but strong clinical numbers to outrank centers with higher reputations. Many hospitals in the rankings have very low and even zero reputational scores.
Survival (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 2009, 2010 and 2011 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 (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.
Other care-related indicators (30 percent). These include nurse staffing, patient volume, certain clinically proven technologies and other measures related to quality of care. The American Hospital Association's 2011 survey of all hospitals in the nation was the main source.
In the four specialties where rank relies only on reputation, ranked hospitals had to be cited by a total of at least 5 percent of the physicians in a specialty who responded to the most recent three years of U.S. News surveys. That resulted in lists 16 hospitals long in ophthalmology and psychiatry and 17 long in rehabilitation and rheumatology.
Were there changes in the 2013-14 Best Hospital methodology?
Two that are worth noting (and were first noted in this Second Opinion column). A revised version of a programming tool created by the federal Agency for Healthcare Research and Quality to assess safety-related hospital data enabled us to exclude patients from the patient-safety calculation who were admitted to the hospital with conditions that predisposed them to harm. That kept a hospital from being penalized if someone still recovering from pneumonia, for example, was admitted for surgery and had respiratory problems afterwards. (Postsurgical respiratory failure is one of the six categories of events we tabulate.)
Extracting these present-on-admission cases, or POAs, from the case mix boosted patient safety scores for hospitals where such cases had previously exacted a penalty. Some hospitals achieved higher overall scores as a result and rose in the rankings, or displaced ranked hospitals that had been less affected by POAs and therefore gained less from the methodology change. Taking advantage of the POA exclusion requires hospitals to be diligent about identifying such patients and coding them appropriately. Hospitals that do not diagnose all POAs or that code them inaccurately not only derive no benefit from the change, but are penalized relative to hospitals that do better.
The other significant Best Hospitals change only affected hospitals in neurology & neurosurgery. Spinal fusion procedures ceased to be counted in this specialty. Hospitals and health care experts told us that, because of recent clinical trends neurologists and neurosurgeons now play a minimal role in recommending and performing the procedures. Spinal fusion cases this year counted only in orthopedics, where they were also included in past years.
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.