An overwhelming majority of hospital chief medical officers responding to a newly released national survey by U.S. News & World Report support a broad expansion of the U.S. News Best Hospitals rankings. The U.S. News rankings should evaluate individual hospital performance in routine care across a wide range of individual medical conditions and procedures, according to 93 percent of the respondents. Obstetrics, transplant medicine, palliative care, trauma and emergency medicine were among the areas of care that respondents indicated U.S. News should examine.
Responses to other questions in the survey, conducted for U.S. News by RTI International, shed light on how hospital leaders view the role of reputation in the Best Hospitals rankings, on the validity of using measures such as patient satisfaction scores, and on consumers' use of hospital rankings and data.
The survey is the most recent example of the tools U.S. News editors have used through the 23-year history of Best Hospitals to draw feedback from medical experts and to unearth new ideas for improvements. In the early years, for example, the rankings relied on the reputation hospitals had among medical specialties; today, reputation accounts for less than one-third of each hospital’s score in most specialties.
Mount Sinai Medical Center in New York, N.Y., provided financial support for this year’s survey. It played no role in the conduct of the survey or the analysis of the results.
Among the survey’s findings:
- Evaluating routine care. As indicated, 93 percent of respondents said U.S. News should evaluate routine care. Most of them said the extended rankings should cover a wide range of routine conditions and procedures. The rankings currently cover 16 adult specialties and 10 pediatric specialties, with a focus on determining which hospitals perform at the highest level when treating patients with usually complicated or challenging medical conditions.
- Reputation. More than 86 percent of respondents felt that hospital reputation in each respective specialty, as determined by U.S. News’s nationally representative annual survey of physician specialists, should continue to be a factor in the Best Hospitals ranking methodology. Nearly all of them, however, felt that it should be a minor component. Separately, 86 percent said that reputation should be given no more weight than it now gets in most specialties.
- Potential new measures. Responses were mixed about the validity of several performance measures on the table for possible inclusion in future rankings. For example, 84 percent said complications and hospital-acquired conditions such as infections should be incorporated into future rankings; a smaller majority—64 percent—supported the use of patient satisfaction measures. The U.S. News survey also asked about electronic medical records (EMR), which U.S. News recognizes by identifying the Most Connected Hospitals but does not currently fold into the Best Hospitals rankings methodology; 46 percent supported incorporating EMR usage into the methodology.
- Impact of the hospital rankings. More than 75 percent of respondents said rankings motivate hospitals to improve clinical quality. But only 46 percent agreed that "the rankings help patients make better-informed decisions about hospitalization." In response to another question, 87 percent of CMOs said that public reporting of hospital performance data encourages productive debate about quality metrics.
- Stakeholders in developing quality metrics. Respondents overwhelming said that medical specialists, hospitals associations and coalitions, professional medical organizations, and the federal government have important roles to play in developing and implementing hospital quality metrics. For example, 89 percent felt the role of hospital associations and coalitions is "extremely important," "very important" or "moderately important."
U.S. News contracted with RTI to design and conduct the survey during the spring and summer of 2012. Based on their status at one or more of the 1,961 hospitals that met U.S. News’s eligibility requirements for the Best Hospitals 2012-13 rankings, CMOs at 1,848 hospitals were invited to participate and 287 (15.5 percent) responded. The full results will be published in this column in coming weeks.
Rankings summit. The survey was keyed to a summit on hospital rankings to be held tomorrow, September 27, at Mount Sinai Medical Center. Titled "Shaping Health Care Decisions: An Inside Look at Hospital Rankings," the summit will be moderated by U.S. News Editor and Chief Content Officer Brian Kelly and will feature three panels of distinguished hospital leaders. Dr. Kenneth L. Davis, President and CEO of Mount Sinai Medical Center, will welcome participants and invited attendees at 8:30 a.m. and deliver concluding remarks at 12:40 p.m. tomorrow. The event will be webcast live at www.mountsinai.org/besthospitals.