US News’ annual rankings of the nation’s “best” hospitals by specialty is out, and hospital execs and PR staff around the country are either studiously ignoring the release or aggressively trumpeting their selection. Expect to see more billboards, especially around Baltimore, where Johns Hopkins got the top rank, Rochester MN (Mayo Clinic), Florida and Ohio (Cleveland Clinic).
There are several good things about this highly public presentation of “quality”. First, it gets people’s attention. Second, it gets hospital execs’ attention. Third, it provides a somewhat objective review of providers’ quality. Any time the industry is forced to focus on quality, however defined, that is a good thing. While we can, and I will, argue that one set of criteria is flawed, or another is somehow unfair or biased, in the larger scheme the attention paid to “quality” is just as, if not more, important than the actual criteria used. I’m sure I’ll get some heated email on this, but the point is we do not pay enough attention to “quality”, so any device, however cumbersome, that increases focus on quality is good.
So here are my complaints. First, the characterization of “best” is misleading. The criteria used do not provide a solid enough basis for claiming that facilities are “best”. Here’s what USNews’ website said about this.
“The mission, unchanged over 17 years, has been to identify centers that take on and excel at tough procedures and conditions–rare cancers, worsening heart failure, seemingly untreatable leg-artery blockages. That is why most of the institutions ranked are referral centers, where the sickest patients are sent for advanced care. Such hospitals follow–and often pioneer–new treatment guidelines. They conduct bench-to-bedside research. And they exploit the latest advances in imaging, surgical devices, and other technologies.”
That objective does not square with the term “best”. I’m not sure I want to go to a referral center for a routine procedure, when I’ll be surrounded by residents and students, potentially subjected to “new treatment guidelines” or “bench to bedside research”, or exposed to the latest advances in surgical techniques. Do your research on someone else, thanks.
Second, criteria for selection are somewhat limited, and limiting. One third of the score is from a survey of random physicians’ ratings of facilities; another is a severity-adjusted mortality rate, and the final third incorporates quality of care measures. Notably, several specialties were “reputation-only”, including ophthalmology, pediatrics, psychiatry, rehabilitation, and rheumatology.
Third, a hospital pretty much has to be a teaching facility to be included. While that may be a bit of an exaggeration, the list is dominated by teaching facilities, and the criteria certainly are biased in this direction. There are lots of really good hospitals that are not teaching facilities, and therefore will suffer in comparison if consumers use this survey without considering the criteria. As they will.
What does this mean for you?
It’s good that more light is directed towards quality, and we’ll get better at focusing the light with more practice.
Joe, I’m in complete agreement. I’m here in Chicago and the hospital ads at the local malls are everywhere. I agree that the methodology is necessarily skewed, but that the attention it brings is constructive. I’d love to see them go a step further and add more categories: i.e. best community hospitals, best Level II, Level III hospitals, etc…
Health care is such a complicated business that any rating system is either too simple to be meaningful or too complicated to be understood.
Take open heart surgery: a hospital or surgeon can deliberately avoid high risk patient, and thereby get great rating. Is this good service, and No if you are a high risk patient that get turned down.
Joe,
I’m totally in agreeance on the US News report not being a true indicator of a hospitals quality. Having worked both in a hospital and in a capacity to measure quality on behalf of a payor (a state government), I have observed dozens of far better measurements that don’t get a lot of exposure. Just one example is the accreditation scores given by JCAHO or AOA (or both). Those aren’t whole measures either, but are more comprehensive than the US News survey.
I believe this is the case of easier public understanding of a study designed for public consumption (and to sell copy), than a highly technical, dry, and not so easy to read accreditation report.
Several years ago, I used to see a lot of billboards in the area I live that bragged about the great JCAHO scores local hospitals received – not so any more. I have to wonder if it was a lack of effectiveness due to public unawareness of what it meant?
I’ve run the U.S. News rankings since they began in 1990. I appreciate the rare public praise from Joe. But (you knew that was coming) I’d also appreciate a bit more attention paid to our stated mission.
Joe said: “I’m not sure I want to go to a referral center for a routine procedure, when I’ll be surrounded by residents and students, potentially subjected to ‘new treatment guidelines’ or ‘bench to bedside research,’ or exposed to the latest advances in surgical techniques. Do your research on someone else, thanks.”)
You know what? I completely agree that the routine stuff can be done perfectly well at a primary-care hospital, and without the sturm und drang of a major medical center. In fact, the first paragraph of the explanation Joe quoted from starts off:
“Good hospital care probably is around the corner if you need a routine procedure–sometimes even major surgery.” Then there’s a reference to a story we did in this year’s Best Hospitals package that goes into chapter and verse about how great community hospitals can be.
We want people going to the big guns only when they need to, in other words. Why drive 100 or 200 or 500 miles if you don’t have to for the privilege of having your history taken 10 times and the increased risk of picking up an antibiotic-resistant infection?
I also agree that our criteria are limited and limiting, but I’d love to hear your views concerning how this is so. Please note that we don’t ask just any random slice of docs for their opinions–only docs boarded in the specialty of interest; i.e., only cardiologists and thoracic surgeons are asked to name hospitals where they would send their sickest patients.
Just a couple of my own randomly selected thoughts in the wake of pushing this ocean liner to sea once more.
–Avery Comarow
I really appreciate this information. How do I go about finding the best hospital to try and get into? I have had several doctors tell me that it’s time to go to the mainland (I live on Hawaii), to some research hospital where a team of doctors can help find out what’s wrong with me. I hope to hear from you soon!