Broadening the Mission of Best Hospitals

U.S. News plans to evaluate hospitals on how well they deliver routine care.

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In the coming months, this column will open a window into a new Best Hospitals initiative: to rate hospitals according to their success at providing specific types of routine care, such as labor and delivery, total hip replacement, and heart bypass surgery. We will offer up our thoughts and invite comments.

Data are improving and becoming more available, and it is time to broaden the mission of Best Hospitals. Widespread misperceptions aside, Best Hospitals has never been about pointing the way to centers where everybody should go to get heart surgery, say, or cancer treatment. The aim, rather, has always been to identify outstanding sources of care for hospital patients at the upper end of the difficulty curve—someone who needs the right surgical team to peel away a spinal tumor, for example, or who is desperate to have years of stomach pain diagnosed and treated. Or someone whose advanced age, or comorbidities like obesity or diabetes, add significant risk to an otherwise ordinary hospital procedure. Helping patients like these decide where to go has been our focus for 23 years.

We will continue to pursue that mission, even as we make it part of a new and broader one. We want to bring the same analytical, data-supported rigor to identifying top providers of routine care as we do in evaluating referral centers that take the sickest patients. Hospitals that do well with high-intensity patients don’t automatically excel at routine care. And when patients are asked after they are discharged how satisfied they were with their care, everyday community hospitals tend to beat out referral centers.

To succeed in our new endeavor, we need data that is recent and decent, as I like to put it when I talk with healthcare quality and safety experts. The only national data that comes close to meeting that standard, however, come from the MedPAR database, which covers only Medicare inpatients. We use it for the Best Hospitals rankings. But in looking at routine care, we may want to assess hospital performance for conditions and procedures that apply to patients younger than 65, to outpatients, or to both. Where will the missing data come from?

One tantalizing possibility would be the states, which routinely collect data from hospitals (as well as from physicians and other health providers) that could readily provide raw material for judgments about performance. For all the talk about the need to inform consumers, however, few states release these data beyond selective sets, and fewer still reach out to the public by providing timely, meaningful hospital data in a form that is clear and understandable to consumers. Resistance by hospitals, political counterpressure, and staff and budget constraints at health agencies are a few of the reasons for the mere trickle of data flowing from the stockpile. Hence “tantalizing.”

But states that do make the effort at least give us starting points for thinking about how to construct analytical methods for evaluating routine care. To promote an ongoing dialogue, we will periodically showcase data made available to the public in states such as Virginia for labor and delivery, New York for heart surgery, and Pennsylvania for orthopedic surgery, for the purpose of conducting open thought experiments about methodological approaches that U.S. News might use. 

As the process unfurls, please be forthright and prolific with your thoughts and suggestions. A constructive back-and-forth will only make the end product better.