U.S. News & World Report recently published its annual “Best Hospitals” issue, which the magazine claims is the “global authority in hospital rankings.” That may be no exaggeration, given the more than two million Google results that appear with the search term “U.S. News hospital rankings” along with the flurry of self-congratulatory tweets posted and banners hung each year by the hospitals whose names appear at the top of the list. While the top-ranked hospitals were patting themselves on the back, we wondered if the magazine’s ranking system actually measures what matters to patients, or for that matter to anybody who is worried about the cost and quality of US health care. So we took a closer look at how U.S. News measures hospital quality and—just as important—what factors its analysis leaves out.

Treating Specialty Care As Beauty Contest

According to its detailed methodology report, the U.S. News & World Report’s ranking places much more weight on hospitals’ performance in specialties and on serious or complex medical procedures than on care for chronically ill patients, the population that makes up the bulk of hospitalizations. Of the 448 total points a hospital can get toward its total “Honor Roll” score, 340 points come from specialty scores. Within the specialty scores, only outcomes from “challenging or critical” procedures are included. 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 consumers, most of whom will be hospitalized not for specialty procedures but rather for exacerbations of such chronic illnesses as heart failure and diabetes.

More than 25 percent of each specialty score comes from expert opinion, measured by a survey of physicians. The survey asks doctors to supply the names of up to five hospitals in their specialty that provide the best care to patients with serious conditions. In past years, some have argued that the emphasis on expert opinion turns the ranking into a popularity contest. In 2010, the U.S. News rankings aligned almost exactly with rankings based solely on reputation, and a 2017 study confirmed that reputation had a larger impact on hospitals’ scores than more objective measures. The magazine has disputed these charges, but apparently hospitals themselves seem to think this part of the ranking methodology matters. They try to influence their scores by encouraging their physicians to sign up for Doximity, the physician membership organization U.S. News samples from for its survey.

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Image via Flickr  Some rights reserved by ell brown

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