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What makes a hospital the “best”?

Every year, U.S. News & World Report puts out a ranking of the country’s “Best Hospitals.” But what does it mean for a hospital to be top-ranked? In this week’s Health Affairs Blog, Lown staff members Judith Garber and Shannon Brownlee analyze the ranking process and find more than a few problematic elements in the U.S. News‘ criteria:

 

  • Emphasizing 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. 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.
  • 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.
  • Not taking 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.
  • Ignoring 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.

 

Garber and Brownlee conclude that we need a ranking system that can identify the real best hospitals. “We need a ranking that doesn’t rely on reputation among physicians, includes multiple risk-adjusted outcomes, and takes cost of care, social mission, and high-value care into account,” they write.

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