Rankings revisited: What makes a hospital the “best”?

U.S. News & World Report recently published their annual ranking of the country’s “Best Hospitals.” But what does it mean for a hospital to be top-ranked? 

Last year, Lown staff members Judith Garber and Shannon Brownlee published a piece in the Health Affairs Blog, analyzing the ranking process and criteria. They found several shortcomings of the ranking system, which are still as the methodology for this year’s ranking is virtually unchanged compared to last year’s. Here’s what’s wrong with the ranking:

The ranking emphasizes specialty care over care for chronic illness.

Although chronically ill patients make up the bulk of hospitalizations, the U.S. News ranking places much more weight on hospitals’ performance in specialties and on serious or complex medical procedures. Of the 448 total points a hospital can get toward its total “Honor Roll” score, 340 points come from specialty scores. While this could be helpful for the few patients who can actually shop around for a hospital for a complex procedure or problem, the overall rankings could be misleading for the majority of consumers, who are dealing with complications due to chronic issues.

There is too much weight on expert opinion. 

More than 25% of each specialty score comes from expert opinion, measured by a physician survey. This has turned the ranking largely into a popularity contest, with hospitals encouraging their physicians to sign up for Doximity to try and boost their scores.

The ranking does not take overtreatment into account. 

Nowhere does the U.S. News give hospitals credit for cutting unnecessary services. The ranking system rewards hospitals for having more advanced technologies, but has no measurement for whether these technologies are being used judiciously. U.S. News rewards hospitals that can perform the most complex procedures without harming the patient, but does not address the question of whether hospitals should perform these procedures.

The ranking ignores social mission. 

The U.S. News ranking has no examination of how much a hospital gives back to their community through funding local non-profits, no information on whether they have a free clinic and how many community members are served, and no statistics on the proportion of women or people of color on staff.

This is becoming increasingly important as hospitals are consolidating and expanding rapidly, growing their market share in their communities but offering little in the way of real community benefit. The “best” hospital should be one that pays their staff a living wage and works to reduce health disparities in their community, not one that receives tax benefits while the surrounding community suffers. 

We need a system to identify the real best hospitals, that takes into account social as well as medical risk, uncompensated care, multiple risk-adjusted outcomes, and overuse.