The methodology that determines the Best Hospitals rankings goes through revisions every year. In the months that follow each new release, we confer with our Best Hospitals contractor, RTI International, about how to improve the rankings methodology in light of the latest thinking about hospital quality and safety.
The 2013-14 national rankings, which will be published online July 16, will include two such improvements worthy of attention. They are adjustments, not upheavals — we don't alter the Best Hospitals methodology casually — but like all changes, they will have an impact. While they are explained in the 130-page methodology report, we wanted to give the hospital community and other interested readers a plain-language summary. A third change affects the way in which hospitals are ranked regionally, by state and metro area.
One of the two changes pertaining to the national rankings affected most of the hospitals that were analyzed in the 12 Best Hospitals specialties in which hard data determine most of a hospital's overall score. (In four other specialties, scores are based solely on the results of a reputational survey of specialty physicians.) The change relates to a safety component that we have built into hospital scores since 2009. It shows the incidence of six types of preventable events that can harm Medicare patients, such as incisions that reopen after surgery and deaths of inpatients who had serious but treatable complications.
For the 2013-14 rankings, a new version of the federal Agency for Healthcare Research and Quality's programming tool, which enables us to extract safety-related data and provides us with data on these cases, allowed us to exclude patients who were admitted to the hospital with conditions that made them susceptible to injury. Someone who was still recovering from pneumonia, for example, would be at risk for respiratory problems after surgery, one of the six types of events we tabulate. Removing these present-on-admission cases, or POAs, from the data means that a hospital is not unduly penalized for patients who were at risk before they entered.
The change boosted patient safety scores for many hospitals where data may have been previously confounded by POAs. Some hospitals achieved higher overall scores as a result and rose in the rankings, or moved into the rankings and displaced 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. There is room to grow in this regard, according to RTI. Hospitals that do not diagnose all POAs or that code them inaccurately get no benefit from the change, and in fact are penalized relative to hospitals that do a good job of picking up these patients when they come through the door and taking them out of the Best Hospitals equation.
The other change only affects hospitals in Neurology & Neurosurgery. To reflect contemporary practice patterns, spinal fusion cases will no longer be counted in this specialty. We received feedback from hospitals and health care experts that neurologists and neurosurgeons play a minimal role in diagnosing a need for these procedures and performing them. Spinal fusion cases will now count only in the Orthopedics rankings, where they were already included.
A third methodology change this year primarily affects a small number of specialty hospitals that U.S. News evaluates together with other hospitals. In some cases, we evaluate two separate hospitals as a unit in a particular specialty when they function as a single facility. Previously, when the combined entity was nationally ranked or recognized as high performing, each hospital in the pair was eligible for regional ranking; in effect we handed out two awards for one joint performance. For 2013-14 that is no longer the case.
In Orthopedics and Rheumatology, for example, the Hospital for Joint Diseases and NYU Langone Medical Center were nationally ranked in 2012-13 as one entity but each also had its own regional ranking in New York state and the New York metropolitan area. In the 2013-14 rankings, the Hospital for Joint Diseases, along with similar hospitals in other such pairings, will be noted in their regions but not ranked.