Your 'Best Hospitals' Questions Answered

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In the rankings each hospital, and each specialty, is given a score for "Advanced Technologies" and "Patient Services" but the score is simply (for example) 5 out of a possible 8 under Patient Services. While it's possible to view the 8 patient services being examined, what isn't possible is to see WHICH of the Patient Services or Advanced Technologies the hospital in question actually has, or does NOT have. Is this information available anywhere? It is frustrating to have scores like this tossed out but not be able to evaluate what that score actually means in terms of the hospitals around you.
For example, I live in Northern Florida and have elderly parents who are high risk for strokes, and therefor will be needing a neurology dept sooner rather than later. Based on the information available I don't fell that I really have enough information to evaluate whether Baptist Medical Center in Jacksonville or Shands at the University of Florida will provide the services that might be needed. Shands is higher ranked overall, but scored only a 5 out of 8 for Patient Services, though a 7 or 7 for Advanced Technologies. Baptist scored a 6 of 8 for Patient Services, and 6 of 7 for Advanced Technologies.
What Patient Services doesn't Shands offer, what doesn't Baptist offer? What Advanced Technology doesn't Baptist offer? The answers to these questions might be more useful to most people than your rankings.

Avery Comarow answers:

Credit for elements of Patient Services and Advanced Technologies provided by specific hospitals comes from an annual survey by the American Hospital Association. We can report "x out of y" but not the individual elements, unfortunately.

From your description, it doesn't seem that your parents need high-level neurological care at the moment. If they are at high risk of stroke, you may want to check the Joint Commission (www.jointcommission.org), which certifies hospitals as primary stroke centers. Click on "certification programs," then "disease-specific care."

Best of luck to you.

Elizabeth Bair of FL 9:58AM August 12, 2008

I think exposing how poor some hospitals are performing will always have its public appeal. However, it is the positive performances and outcomes that people so often overlook.
That being said, one of our local hospitals made the list, and I would assume it is due to its patient care and not marketing ploys. It really is great that hospitals such as the University of Tennessee Medical Center are listed in such a report with big players such as Mayo and Cleveland. The Knoxville area has many hospitals to choose from, and it speaks volumes for UT Medical Center to represent its area.
Thank you for the great listings each year and insight into our health care providers.

Stephie of TN 5:04PM July 21, 2008

Hospitals in the non-federal sector have been characterized by by anti/counter terrorism experts as the "weakest link in the Homeland Security Chain" It is troublesome to see some of the most vulnerable hospitals in the nation designated as "Best or Top or safest etc. The healthcare clinical community unders stands that the safety in quality and safety does not refer to facility safety and security. Ask the person on the street what safety and security means to them. In urban medical center environments or suburban hospitals where demographics are rapidly encroaching on the the Emergency Room, the majority answer " I won't be shot, or have my valuables stolen, or a host of other non-clinical dangers. This sector has eschewed adoption of "mother of all vulnerability mitigation measures" Design and Construction. Unlike its federal counterpart,the sector has opted to build structures with great glass atria and customer-friendly access. Waiting for the "evidence-based terrorist event" to join the reat of the nation in a proactive strategy for protection of its defenseless stakeholders. JB violent events in teh nation nation

Jim Blair of GA 2:40PM July 17, 2008

I am an Registered Nurse who worked in acute care hospital speciality areas for over 20 years. I am now a health care consumer only with occasional urgent medical care needs for myself and my family members. I am writing U.S. News because I am extremely concerned about the ability of our country's Emergency Departments to meet my family's needs with quality care as well as the needs of the huddled masses I see filling the waiting areas to overflowing. I am utterly dismayed in what I perceive as a precipitous decline of care provided by the Emergency Departments in some of the hospitals which are on your Top 100 Hospital list. This is true in my current place of residence, the Dallas- Fort Worth, Texas metroplex, as well as Emergency Department care and quality in my former location, the Atlanta, Georgia metroplex. Both areas are, of course, major cities which should have excellent emergency care facilities and staff. I am deeply concerned that " excellence" will soon mean " getting out alive".
I would like to issue a challenge to U.S. News: Standardize your criteria- based evaluations and ratings for hospital Emergency Departments and add them to your 2010 study. I am a former employee of a Top 100 Hospital. I am sure you are aware that hospitals definitely use U.S. News' criteria to define and improve in-house Quality Management and take great pride in making "THE List".
It is my opinion that U.S. News can help effect change in the quality of care in our national system of hospital Emergency Departments. While realizing that the JCAHO provides minimum standards of care required to maintain accredidation, no system exists to recognize Emergency Department excellence.
It is no secret that our nation's emergency care is in crisis. Could your excellent publication please try to be a part of the solution by setting benchmarks way above the bare minimums of the JCAHO?
It has been my personal experience that qualitative goals with a stated outcome (in this case- potential recognition of excellence and inclusion in the Top 100 Hospital Emergency Department ranking) are positive motivating factors in the hospital workplace, from top management to the part-time service workers. Being a " Top 100 Hospital" was definitely an honor which we strove to maintain from day to day and year to year.
Every one of your readers, every hospital, and every Emergency Department will benefit should your publication team choose to accept the monumental but critically needed challenge and resulting published findings.
Thank you.
Sincerely,
Amanda A. Turnock, R.N.

Amanda R. Turnock of TX 2:19PM July 17, 2008

Is there a breakdown of hospital ratings in geographic areas? I am interested in ratings of hospitals in the Washington, D. C. area. I want to go to the Hospital for Special Surgery for knee replacement because I am petrified of infection (I got one in the past) and everyone here says I am crazy to go so far for a surgery done every day in the D. C. area hospitals.
Avery Comarow responds:
Infections after joint replacement are rare, but as you probably know from experience, very nasty when they occur. No center, even one such as HSS, is immune. If I were considering knee replacement, I would contact the orthopedics departments at major D.C.-area hospitals, find out which surgeon does the largest number of these procedures, and ask how many he/she did in the past year, the mortality rate, and the complication rate. I would also ask specifically about the infection rate, and about functional success in addition to surgical success.
Within any of our 16 specialty rankings (such as orthopedics), you can search for hospitals by metro area (including Washington, D.C.), by state, and by distance from your Zip code on the Best Hospitals search page:
http://health.usnews.com/sections/health/best-hospitals/index.html

Diana Littlefield of MD 11:54AM July 17, 2008

I value your article on Best Hospitals since I will be needing aortic valve replacement surgery. Do you know where I could get information on how many on that surgery a particular hospital or surgeon has performed and their mortality rates? I live in New Jersey and am considering a hospital in New Jersey or New York City.I would appreciate any information you could provide.
Thanks in advance.
Avery Comarow responds:
New Jersey requires that hospitals report their performance data for open-heart surgeries. You can find it at http://www.state.nj.us/health/healthcarequality/cardiacsurgery.shtml#CSR
It does not break out aortic valve replacement, the data is four years old, and replacing an aortic valve is something that needs to be done by a very experienced surgeon. So you still need to ask any physician who might do the surgery about numbers: how many of these procedures he/she did in the past 12 months, and what were the death and complications rates.
Hospitals in New York state must report far more data, including volume and death rate for aortic valve replacement; see http://www.health.state.ny.us/diseases/cardiovascular/heart_disease/docs/2003-2005_adult_cardiac_surgery.pdf
Good luck with your surgery!

Joanne Behrens of NJ 10:52AM July 17, 2008

Ken Schields wrote:
...The simple fact that a hospital pays big bucks to join some of the surveys invalidates the legitimacy of the ranking.
Avery Comarow says:
There is a hefty pricetag attached to some surveys, in particular those addressing patient satisfaction. In others, the major expense comes afterwards, for exclusive rights to market a top rating or for consulting services to remedy unsatisfactory results. The Best Hospitals rankings do not impose fees or charges of any kind.
[At the end of the day, the vast majority of patients will go to the hospital where their doc sends them....]
Most patients needing relatively routine care will be fine if they go where their doc sends them. The Best Hospitals rankings, however, are geared to people who need the highest and best care because of a particularly difficult condition or needed procedure.
[However, please continue to share the positive outcomes and performances of our hospitals. And, instead of, or in addition to, "top this and top that" how about an expanded number of articles about the many, many good health care workers and programs at these hospitals.]
If you haven't already, do read the article about Vanderbilt and check out the photo essay on a triage nurse at Montefiore in New York. I think both of them are the kind of story you want.

Acomarow of DC 2:21PM July 16, 2008

Unfortunately, too many of the Top 100 lists are nothing more than marketing strategies used by hospital Marketing V.P's to justify their jobs. Health Care Marketing 101, "Make the CEO, Other Top Administrators and The Hospital Board Look Good and Safeguard Your Job." The simple fact that a hospital pays big bucks to join some of the surveys invalidates the legitimacy of the ranking.
How many hospitals in the USA are on someone's Top 100? 100, 500, 1000, more?
At the end of the day, the vast majority of patients will go to the hospital where their doc sends them. I also doubt that there are many truly bad hospitals. That question being raised, why not evaluate and/or expose the bad ones?
However, please continue to share the positive outcomes and performances of our hospitals. And, instead of, or in addition to, "top this and top that" how about an expanded number of articles about the many, many good health care workers and programs at these hospitals.

Ken Schields of FL 11:09AM July 16, 2008