Us News Hospital Rankings: What Factors Decide?

U.S. News & World Report ranks the best hospitals in the United States annually, evaluating nearly 6,000 hospitals—more than any other public hospital ranking. The rankings are based on various factors, including patient outcomes, the complexity of care, the number of patients treated, and the hospital's commitment to best practices, infection control, and advancing equity, diversity, and inclusion. The ratings also consider outpatient measures and include more than 1.5 billion medical claims over a 5-7 year period across 12 specialties and 20 unique procedures or treatments. While the methodology changes each year, the focus remains on patients, providing them with valuable information to make informed healthcare decisions.

Survival rates and patient experience

U.S. News ranks the best hospitals in the United States by specialty, state, and more. The rankings are meant to help guide patients to the right hospital when they need care. Each specialty showcases the top 50 scoring hospitals, based primarily on survival rates for challenging patients, patient experience, and other measures of performance that can be assessed using hard data.

Survival rates are determined by how well patients survived or recovered after treatment. Patient experience is assessed through an annual survey that asks pediatric specialists and subspecialists to name the hospitals where they would send the sickest patients without considering location or expense. Responses are combined from the three latest surveys.

The selection of hospitals is determined by membership in the Children's Hospital Association, nomination from expert advisers, or a hospital's request to be considered. U.S. News also considers a hospital's willingness to engage in public reporting and the size and scope of its pediatric program.

While U.S. News rankings have been criticized for their reliance on expert opinion and inpatient care, they have evolved to include more outpatient measures, a greater focus on data, and expanded consideration of health equity. The rankings also exclude patients admitted with COVID-19 in 2020 to account for the pandemic's impact on hospitals.

Physician surveys

The US News hospital rankings evaluate nearly 6,000 hospitals annually, the most of any public hospital ranking. The rankings are determined by various factors, including survival rates for challenging patients, patient experience, and other performance measures. One important aspect is the expert opinion of physicians, gathered through surveys.

The Doximity Expert Opinion survey is a key tool for gathering physician feedback. Qualified physicians registered with Doximity are eligible to participate in the survey, sharing their insights on hospitals' capabilities and the quality of care they provide. The survey covers various specialties, such as ophthalmology, psychiatry, and rheumatology, and the results contribute to the hospitals' "process" scores.

In addition to the Doximity survey, US News also conducts an annual survey of pediatric specialists and subspecialists. This survey asks physicians to name up to 10 hospitals in their specialty where they would send the sickest patients, regardless of location or expense. The responses from the three latest surveys are combined, accounting for 10% of a hospital's overall score (5% in cardiology and heart surgery rankings).

While physician surveys are a significant factor in the rankings, US News has received some criticism for relying too heavily on expert opinion in the past. There has been a shift towards more objective measures and data analysis in recent years. However, US News defends the inclusion of expert opinion, acknowledging that some domains of care lack well-validated objective measures of quality.

The US News hospital rankings, driven in part by physician surveys, play a crucial role in helping patients make informed decisions about their healthcare. With millions of consumers referring to these rankings, it empowers patients to actively engage in their care and choose the best hospitals for their specific needs.

Compliance with best practices

Compliance with widely endorsed "best practices" is a key factor in determining US News hospital rankings. This includes adherence to specific protocols such as conducting regular morbidity and mortality conferences to review unexpected deaths or complications. Additionally, hospitals are assessed on their commitment to infection control, including the employment of certified infection prevention specialists and the monitoring of antibiotic usage before surgery.

The rankings also consider hospitals' efforts to promote equity, diversity, and inclusion among patients and staff. While programs in these areas are important, their effectiveness is also evaluated. For example, in the cardiology and heart surgery rankings, 5% of a hospital's score is based on the opinions of pediatric specialists and subspecialists, who are surveyed annually to identify the hospitals they would recommend for critically ill patients, regardless of location or cost.

US News evaluates nearly 6,000 hospitals annually, making it the most extensive public hospital ranking in the country. The eligibility criteria are rigorous, encompassing factors such as the complexity of patient care, the volume of patients treated, and the hospital's capacity to deliver care. The evaluation process involves analyzing data from over 67 million Medicare beneficiaries and approximately 1.5 billion medical claims over a 5-7 year period, covering 12 medical specialties and 20 unique surgical procedures or treatments.

The US News rankings are intended to guide patients and their doctors in making informed decisions about healthcare services. They provide insights into various specialties, including cancer care, orthopedics, and heart bypass surgery. The rankings are unbiased and based on a combination of patient outcomes, patient experiences, and the hospital's ability to meet staffing needs.

Diversity and inclusion efforts

Hospitals that actively promote diversity and inclusion are recognised and valued. For instance, Forbes' survey of employers who received the most recommendations and had the most diverse boards and executive ranks, featured SSM Health (ranked 63rd) and The Children's Hospital of Philadelphia (ranked 96th) in their top diversity rankings. Similarly, in the U.S. News Best Hospitals rankings, diversity and inclusion efforts are considered, with a portion of the score relying on the opinions of specialists and subspecialists regarding where they would send the sickest patients.

The importance of diversity and inclusion in healthcare is undeniable, as it ensures that healthcare systems can deliver culturally competent services to diverse communities. This includes addressing linguistic, cultural, and social needs, thereby reducing care disparities. It also involves actively dismantling barriers to equity for both patients and healthcare providers.

To demonstrate their commitment to diversity and inclusion, hospitals implement various initiatives and strategies. These may include appointing senior leaders dedicated solely to overseeing diversity, inclusion, and equity efforts. Additionally, hospitals may focus on sharing their diversity and inclusion initiatives publicly, showcasing their proactive approach to fostering an inclusive environment.

While the specific criteria considered by U.S. News for their rankings are subject to change, it is evident that diversity and inclusion efforts play a significant role in hospital evaluations. By prioritising these aspects, hospitals strive to create an equitable environment for patients and staff, ultimately enhancing the overall quality of care they provide.

Hospital size and scope

The size and scope of a hospital's patient population are also considered in the rankings. U.S. News evaluates nearly 6,000 hospitals each year, the most of any public hospital ranking, and considers factors such as the complexity of care patients require, the number of patients treated, and the level of care provided. Their data analysis includes a vast number of Medicare beneficiaries and medical claims over several years, covering a wide range of specialties and surgical procedures or treatments.

In addition, U.S. News considers the size and scope of a hospital's performance in various specialties. The rankings are based on survival rates for challenging patients, patient experience, and other performance measures backed by hard data. The top 50 hospitals in each specialty are showcased, and physician surveys are also factored in, with doctors naming the top hospitals for complex cases in their field.

While U.S. News has received some criticism for its heavy reliance on Medicare data, which primarily covers patients 65 and older, they have expanded their scope in recent years to include more outpatient measures and a greater focus on health equity. The COVID-19 pandemic has also been a complex factor, with adjustments made to exclude patients admitted with COVID-19 in 2020 and risk-adjust data for 2021.

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