FAQ: How and Why We Rank and Rate Hospitals

2021-22 Best Hospitals: An Overview

How are the procedure and condition ratings different from the specialty rankings?

The Best Hospitals rankings are broken into two subcomponents. Understanding which one is more relevant to you depends on the medical condition for which you’re seeking hospital quality information.

The Best Hospitals specialty rankings are meant for patients with life-threatening or rare conditions who need a hospital that excels in treating complex, high-risk cases. These rankings are helpful if you’re looking for information about a rare condition or difficult diagnosis that isn’t treated at many facilities.

Hospitals are ranked from 1 to 50 in each specialty, with any hospitals not in the top 50 but still in the top 10% of all rated hospitals receiving a “high performing” designation. Remember, even if a hospital isn’t in the top 10 or high performing, it’s one of the best hospitals in the country for that specialty by virtue of being rated at all. Our strict eligibility criteria ensure we’re only evaluating hospitals that regularly treat complex cases and therefore have the experience to provide high-quality care.

The Best Hospitals procedure and condition ratings focus on specific and more commonly required individual procedures and conditions, such as hip replacement and heart failure, rather than on broader specialties like orthopedics and cardiology. The goal is to evaluate how well hospitals perform in each procedure or condition — and not just with the most difficult cases, as with the specialty rankings, but with the full range of patients.

Because the procedures and conditions evaluated are performed at many more hospitals than the specialties, the evaluations produce ratings, not numerical rankings. Hospitals that treated enough patients to be evaluated are rated one of three ways for each procedure or condition: high performing, average or below average.

Based on your personal health situation, it might make more sense to go to an average hospital that’s closer to you or within your insurance network than a high performing hospital that isn’t.

As always, these ratings should be taken as a starting point. All care decisions should be made in conjunction with medical professionals.

2021-22 Best Hospitals Specialty Rankings, Published July 2021

You’ve been informed by your doctor that you’re about to take your place among the roughly 33 million patients a year who are admitted to U.S. hospitals for a procedure or other care. The hospital the doctor suggested for you might be just right for you, but maybe not.

Checking the U.S. News Best Hospitals specialty rankings in whichever of the 15 specialties applies to you is in order if your care calls for special expertise or if age, physical ailments or a chronic condition could add a layer of risk.

This FAQ explains how the Best Hospitals specialty rankings are produced and addresses questions of interest to media and health care professionals. A formal methodology report, available as a downloadable PDF, provides much more detail.

A note on COVID-19: The data in the 2021-22 Best Hospitals rankings and ratings come from a period predating the COVID-19 pandemic and were not affected by the pandemic’s impact on hospitals. In future years, modifications to our analytic methods will likely be appropriate to account for the pandemic’s impact on the measures U.S. News evaluates.

What are the specialties in which hospitals are ranked?

U.S. News evaluates 15 specialty areas of care. In 12 of the specialty areas, rankings are derived from data sources, such as Medicare: cancer; cardiology & heart surgery; diabetes & endocrinology; ear, nose & throat; gastroenterology & GI surgery; geriatrics; gynecology; neurology & neurosurgery; orthopedics; pulmonology & lung surgery; rehabilitation; and urology.

In the remaining three specialties — ophthalmology, psychiatry and rheumatology — ranking is determined entirely by expert opinion, based on responses from three years of surveys of physician specialists who were asked to name the hospitals to which they would be inclined to refer their sickest patients.

The rankings name the top 50 hospitals for complex care in each of the 12 data-driven specialties and roughly a dozen in the three expert-opinion-based specialties.

Why does U.S. News rank hospitals?

U.S. News estimates that nearly 2 million hospital inpatients a year face the prospect of surgery or special care that poses either unusual technical challenges or significantly heightened risk of death or harm because of age, physical condition or existing conditions. The rankings are a tool that can help these patients find sources of especially skilled inpatient care.

Who might be a patient like this?

Someone in their 80s or 90s with pancreatic cancer would be one of many examples. Most hospitals would reject this patient — as indeed they should if their surgeons lack the expertise to remove the cancer without harming the rest of the fragile pancreas.

But multiple investigations by U.S. News have found that some hospitals without the requisite skills would go ahead, possibly at considerable risk. This patient would be better served by one of the hospitals in the Best Hospitals cancer rankings, many of which see a steady stream of similarly complex patients.

How are the rankings organized and updated?

The 15 Best Hospitals national specialty rankings are updated annually. As noted, rankings in 12 of the 15 rely largely on objective data. Each specialty showcases the 50 top-scoring hospitals, in most specialties based largely on survival rates for particularly challenging patients, patient experience and other measures of performance that can be assessed using hard data. All evaluated hospitals and their results and overall scores are displayed online, but rankings are only displayed for the top 50.

In these 12 specialties, results from the three most recent years of an annual expert-opinion survey of specialized physicians are also factored in. Surveyed physicians are asked to name up to five hospitals they consider the best for difficult cases in their specialty.

Except in rehabilitation, ear, nose & throat, and gynecology, hospitals that are not nationally ranked but scored high enough in a specialty to put them in the top 10% of the analyzed centers are recognized as high performing. Hospitals that are nationally ranked in at least one data-determined specialty, or that earned at least six ratings of high performing and few or no low performing ratings across the 17 Best Hospitals procedures and conditions, are further designated as Best Regional Hospitals within their state, metro area or other region.

In the three Best Hospitals expert-opinion-based specialties, national ranking is based on the latest three annual physician surveys referenced above. Those receiving nominations from a weighted average of at least 5% of the respondents are nationally ranked Best Hospitals. Those nominated by at least 3% but below 5% of physicians are high performing. Each physician’s response is assigned a weight that ensures the weighted averages are representative of the overall opinion of all specialists nationally, not simply those who responded.

The 20 hospitals with the most and highest rankings and the greatest number of high performing procedure and condition ratings are recognized in the Honor Roll.

Are the highest-ranking hospitals always the best choices?

Not necessarily. Hospitals are evaluated across a wide range of conditions and procedures. Within that range, hospitals can and do perform differently. In pulmonology & lung surgery, for example, a hospital might rank below another one but do better at treating patients with chronic obstructive pulmonary disease.

So the rankings should just be a starting point?

That’s right. Patients still have to do their own research and talk with their doctors. We also understand that families have to consider such factors as the stress and expense of travel and lodging in another city and their insurer’s willingness to pay for care if a hospital is out of network.

How many hospitals were analyzed for the 2021-22 rankings?

For consideration in the 12 data-driven rankings, the 2021-22 rankings started with 4,523 hospitals, which represent virtually all U.S. community inpatient facilities.

Are only teaching hospitals eligible for the rankings?

No. That misconception persists, even in articles in medical journals that make the assertion, which has never been true. Teaching status or medical-school affiliation are only two of the four ways in which a hospital can be a rankings candidate.

Many hospitals become part of the eligible pool through the two other pathways:

In the 2021-22 rankings, a hospital qualified for consideration in the 12 data-driven specialties if it satisfied any of four criteria:

— It was a teaching hospital.

— It was affiliated with a medical school.

— It had at least 200 beds set up and staffed.

— It had at least 100 beds and offers at least four out of eight advanced technologies associated with high-quality care, such as a PET/CT scanner and certain precision radiation therapies.

This year, 2,295 hospitals, just over half of the total number in the initial pool, met one of the four standards. Eligibility standards for the rehabilitation rankings were slightly different. In the three specialties in which ranking was determined only through the physician survey, any hospital with enough nominations over the last three surveys was ranked.

Does U.S. News evaluate and rank VA and military hospitals?

No. Claims data for VA and military hospitals are not available in Medicare claims data and are largely unavailable. If these data do become publicly available, we will consider evaluating them.

What happens after determining initial eligibility?

Hospitals had to show that they treated a given number of patients who had specifically defined conditions or procedures. The threshold number, which varied by specialty, was based on traditional fee-for-service Medicare inpatients who were discharged during the three years from 2017 to 2019 (2019 is the most recent year of available data).

Because the rankings focus on challenging care, only patients who had particular procedures or conditions at a defined level of severity and complexity were included. The minimum in cardiology & heart surgery, for example, was 1,814 patients, 800 of whom had to be surgical. In orthopedics, the minimum was 266 patients, 236 of them surgical.

A hospital that fell short was still evaluated if it was nominated by at least 1% of the physicians in a specialty who responded to the 2019, 2020 and 2021 physician surveys.

A total of 1,880 hospitals met these standards and qualified for further consideration in at least one specialty.

For a schematic overview of the eligibility process for the rankings complete with this year’s hospital population data, you can refer to page 11 of the 2021-22 U.S. News Best Hospitals Specialty Rankings methods report.

How many hospitals were ranked in 2021-22?

Across all 15 specialties, only 175 U.S. hospitals performed well enough to be nationally ranked in one or more specialties.

What determined whether a hospital would be ranked?

We evaluated each hospital’s performance using a variety of measures. Some data came from the federal Centers for Medicare & Medicaid Services’ Standard Analytical File database. Other information came from the American Hospital Association and from professional organizations.

We put the heaviest reliance on outcomes because of the self-evident connection between a patient’s outcomes, including survival, and the quality of their care. Other data, such as the number of patients and the ratio of nurses and patients, are less obviously related to quality, but ample research supports the connection. The physician survey also played a role, although it accounted for only slightly more than one-fourth of each hospital’s score (see below).

In the three expert-opinion-based specialties, most care is delivered on an outpatient basis. The number of outpatients who die in these specialties is so low that risk-adjusted mortality rates, heavily weighted in 11 of the 12 other specialties, are not significantly tied to quality of care. Hospitals in these specialties are therefore ranked solely on expert opinion.

How were the different factors combined?

Each hospital analyzed in 11 of the 12 data-driven rankings received an overall score from 0 to 100 based on four elements:

— Outcomes (including survival rate and rate at which patients were able to return home rather than needing additional institutional care).

— Patient experience.

— Care-related factors such as the intensity of nurse staffing and the breadth of patient services.

— Expert opinion obtained through the physician survey. (The specialty of rehabilitation used a unique methodology, as described in the methodology report.)

The hospitals with the 50 highest scores in each specialty were ranked. Scores and data for all eligible hospitals in each specialty are also posted. The four elements and their weightings, are, in brief:

Patient Outcomes (37.5%). A hospital’s success at keeping patients alive accounted for 30% of its score and was judged by comparing the number of Medicare inpatients with certain conditions who died within 30 days of admission in 2017, 2018 and 2019 with the number who would be expected to die given the severity of illness.

Hospitals were scored from 1 to 5, with 5 indicating the highest statistical likelihood that survival rate was better than expected, and 1 indicating the highest likelihood that it was worse than expected. U.S. News’ calculation of each hospital’s expected deaths factored in the age and sex of each patient; what kind of care he or she needed; what other illnesses (known as comorbidities) were present; whether he or she received Medicaid benefits (which is a measure of socioeconomic status); and other risk factors known to influence patients’ outcomes.

Patient experience (5%). This score reflects the percentage of patients who responded positively to a survey about the overall quality of their hospital stay known as the Hospital Consumer Assessment of Healthcare Providers and Systems. Most hospitals are required to assess patients’ satisfaction using the HCAHPS survey.

Other care-related indicators (30%). These include nurse staffing, patient volume, certain clinically proven technologies and professional and specialty-specific recognition. The 2019 American Hospital Association Annual Survey was the primary source.

Expert opinion (27.5%). Each year, board-certified physicians in the relevant specialties are invited to list up to five hospitals, ignoring location and cost, that they consider to be the best in their area of expertise for complex or difficult cases.

The figures displayed in the rankings represent the average percentages of responding specialists in 2019, 2020 and 2021 who named the hospitals. More than 31,000 physicians responded in 2021.

In two specialties, cardiology & heart surgery and neurology & neurosurgery, expert opinion received a reduced weight to accommodate public transparency metrics. Expert opinion receives a weight of 24.5% in cardiology & heart surgery and 25.5% in neurology & neurosurgery, with 3% and 2% weight respectively determined by the extent to which a hospital is publicly transparent about certain heart-care-related performance metrics. Expert opinion is weighted 50.0% in rehabilitation and 27.5% in most other data-driven specialties.

Does reputation determine which hospitals are ranked?

No. Many ranked hospitals have very low, even zero, reputational scores but are strong clinical performers. In the 2021-22 orthopedics rankings, to take this specialty as one of many examples, 27 of 50 ranked hospitals had reputational scores below 2%.

How are hospitals ranked in the three specialties without objective data?

In the three reputationally determined specialties, ranked hospitals had to be cited by an average of at least 5% of the physicians who responded to the latest three years of U.S. News surveys of specialists. That resulted in lists of 13 hospitals in ophthalmology, 11 hospitals in psychiatry and 11 in rheumatology.

What methodology changes were made in the 2021-22 rankings?

Acting on input from patients, clinicians, researchers, and hospital leaders, several targeted methodological revisions were implemented this year. These and other revisions to the methodology are described in this blog post.

Equity. In the face of widespread and persistent disparities affecting the health of historically underserved populations, U.S. News believes equity is an important objective for all health care providers to pursue. Measurement and public reporting of health disparities may help hospitals make targeted interventions that advance health equity among the patients and within the communities they serve. Therefore, U.S. News has developed measures of certain aspects of health equity that appear alongside the rankings and ratings. These novel measures are not factored into this year’s rankings

Nephrology. There is no longer a ranking in adult nephrology. The new kidney failure rating, which covers nearly all of the same hospital admissions, replaces that specialty ranking.

Rehabilitation. This year’s rehabilitation ranking employed new methodology described here. Nearly 1,000 hospitals were included in the analysis.

Transparency. A measure of public transparency is incorporated into three of this year’s ratings — heart attack, heart failure and stroke — based on each hospital’s public reporting status in relevant clinical registries. To receive credit for the transparency measure in the heart attack and heart failure ratings, a hospital had to have voluntarily opted to publicly report via at least one of the American College of Cardiology’s registries or at least one of the American Heart Association’s cardiology-related registries; the same criteria were used this year to determine which hospitals receive credit for transparency in the cardiology & heart surgery rankings. To receive credit for transparency in the stroke rating, a hospital had to have voluntarily opted to publicly report via the American Heart Association’s stroke registry, following the same criteria U.S. News introduced last year to determine transparency credit in the neurology & neurosurgery rankings.

Discharge to home. In calculating risk-adjusted rates of discharge to home, we added several exclusions. For example, patients admitted from nursing facilities and patients discharged to home hospice are no longer included in this measure.

Nurse staffing. In calculating each hospital’s level of nurse staffing, we used three years of data reported to the American Hospital Association. This smooths large year-to-year fluctuations in nurse staffing reported at some hospitals, often smaller hospitals.

Best Regional Hospitals. To be recognized as a Best Regional Hospital this year, a hospital had to provide general medical and surgical services; receive at least six high performing ratings across the 17 procedures and conditions or a national ranking in at least one of 11 data-driven adult specialties; and receive at least three more high performing ratings than below average ratings across the procedures and conditions. In determining the Best Regional Hospitals, each hospital’s performance in aortic valve surgery and transcatheter aortic valve replacement (TAVR) were combined into a single rating, since these two procedures are used to treat the same medical condition. Neither rehabilitation nor nephrology factored in Best Regional Hospitals this year. Nationwide, 531 hospitals were identified as Best Regional Hospitals, compared with 563 last year.

Overuse. Overtreatment and low-value care may cost more than $100 billion per year. In the new back surgery (spinal fusion) rating, we incorporate a measure of overuse that was calculated for U.S. News by data scientists at the Lown Institute, a nonpartisan think tank. This measure is also a component of the overuse metric of the Lown Institute Hospitals Index. Because a pattern of overuse or low-value care is not compatible with being a high-quality provider, U.S. News will explore additional opportunities to incorporate measures of value in future editions of Best Hospitals.

How does U.S. News decide what changes to make to its methodology?

Each year RTI International and U.S. News revisit the methodology based on the medical literature and input from hospitals and health care experts in specialty-specific working groups. U.S. News approves all methodology changes.

2021-21 Best Hospitals Honor Roll, Published July 2021

What is the Honor Roll?

The Best Hospitals Honor Roll recognizes 20 hospitals with unusual competence taking into account the full range of adult inpatient care — both performance in the Best Hospitals specialty rankings and in the Best Hospitals procedures and conditions.

How were points awarded?

Hospitals were awarded points by being nationally ranked in the 12 Best Hospitals specialty rankings, driven primarily by hard data or in the three expert-opinion-based specialty rankings or by being rated as high performing in the 17 procedures and conditions.

In each of the 11 data-driven specialties (excluding rehabilitation), all 50 ranked hospitals received points. The No. 1-ranked hospital received 25 Honor Roll points, No. 2 received 24 points and so on. All hospitals ranked 21 through 50 received five points. The maximum number of points across these 11 specialties is therefore 275, but no hospital was or has ever been No. 1 in all 12 specialties.

In rehabilitation and the three Best Hospitals specialty rankings based entirely on expert opinion (ranked hospitals were recommended by at least 5% of respondents to annual U.S. News physician surveys), the number of ranked hospitals varies year by year and specialty by specialty. The No. 1-ranked hospital received 10 Honor Roll points, No. 2 received nine points and so on; all hospitals ranked from 10 to the final ranked hospital received one point. If a hospital had ranked at the top in all four specialties (none was), it would have received 40 points.

In 15 of the 17 Best Hospitals procedures and conditions ratings, hospitals received 12 Honor Roll points for each “high performing” rating; “high performing” status in AVR and TAVR resulted in six points each because these procedures are alternative treatment approaches to the same underlying condition.

Hospitals that achieved a rating of high performing in all 17 procedures and conditions, as 11 did, received 192 points. In some circumstances, where a health system with multiple hospitals had consolidated a certain service at a regional center of excellence, we reassigned Honor Roll points for that service from the system’s center of excellence to the system’s so-called flagship hospital.

The Best Hospitals for Maternity ratings were not included in the 2021-22 Honor Roll calculation as it was published later in the year.

The 20 hospitals that earned the most points out of the 507 possible comprise the

2021-21 Best Hospitals Honor Roll, Published July 2021

. 2021-22 Honor Roll

In a typical year, U.S. hospitals admit an estimated 33 million patients. More than 1 million will have a knee or hip replaced and about 400,000 will undergo heart bypass surgery. Heart failure will account for about 900,000, the respiratory condition called chronic obstructive pulmonary disease another 700,000 and surgery to remove all or part of the colon will account for some 250,000.

Any hospital should be able to treat such relatively common ailments successfully, and many do — but some treat them better than others. The Best Hospitals procedures and conditions ratings show consumers how well their local hospitals stand up to close scrutiny in those six procedures and conditions and the 11 others U.S. News rates. How U.S. News evaluated hospitals for the ratings is addressed in this FAQ. A comprehensive methodology report is available as a downloadable PDF.

What are the Best Hospitals for procedures and conditions ratings?

The Best Hospitals procedures and conditions ratings — originally called Best Hospitals for Common Care — evaluate almost every hospital in the U.S. that admits patients in any of 17 common procedures and conditions: abdominal aortic aneurysm repair; aortic valve surgery; back surgery (spinal fusion); chronic obstructive pulmonary disease; colon cancer surgery; congestive heart failure; diabetes; heart attack; heart bypass surgery; hip fracture; hip replacement; kidney failure; knee replacement; lung cancer surgery; pneumonia; stroke; and transcatheter aortic valve replacement. This list of procedures and conditions will expand over time.

In December 2021, U.S. News published the Best Hospitals for Maternity. This evaluation of uncomplicated labor and delivery differs from the other procedures and conditions in a few important ways:

— Due to the lower age of the patients seeking Maternity Care, much of the data used in the methodology were collected directly from hospitals rather than from Medicare data.

— In part due to this, only hospitals deemed High Performing received an actual rating. Other hospitals that participated in the survey have a scorecard describing their performance on individual metrics, but do not have an overall rating.

— Included alongside the quality assessment are factors that many new parents look for when choosing where to have a baby.

A comprehensive methodology report is available as a downloadable PDF.

In 2021, U.S. News evaluated more than 4,300 hospitals to generate the procedure and condition ratings. While more than 2,000 hospitals were rated high performing in at least one procedure or condition, only 11 were rated high performing in all 17 procedures and conditions.

How were the ratings for each hospital determined?

We defined 17 groups of patients, each corresponding to one of the common procedures or conditions being rated. For each group — called cohorts — we assessed hospital’s risk-adjusted outcomes, such as 30-day mortality, 30-day readmission and length of stay. These measure how well the hospital performed the procedure at the time of care and also was able to prevent an unplanned re-visit to the hospital due to the same condition. A shorter length of stay is indicative of a lower complication rate.

We also factored in variables that have been linked to higher quality of care, including volume, nurse staffing and whether the hospital employed a specially trained physician known as an intensive care unit specialist. In addition, patient satisfaction scores were factored into the ratings in most procedures.

A hospital’s stance on data transparency was also a factor. In our heart bypass surgery and aortic valve surgery ratings, we weighed whether the hospital had voluntarily released ratings it received from the Society of Thoracic Surgeons. For hospitals that had done so, we factored in their STS ratings as of February 1, 2021.

What data sources were used?

We analyzed objective data from multiple sources, including a federal data set known as the Standard Analytical File, which contains details of every hospital admission paid for by traditional Medicare. We used SAF data on inpatients aged 65 and older who were treated from 2015-2019 to assess each hospital’s risk-adjusted rates of mortality, readmission and other outcomes. We also used a limited amount of data from late 2014.

How well older patients are treated is generally considered a good test of a hospital’s capabilities. Such patients have a greater chance of being admitted with one or more conditions that put them in a higher-risk category, such as diabetes or high blood pressure. Some data from the outpatient SAF files were also incorporated into the analysis of the knee replacement procedure and the stroke condition.

In addition, our analysis incorporated publicly available data from the Centers for Medicare & Medicaid Services, the agency that oversees Medicare. These included information on each hospital’s efforts to prevent dangerous blood clots and the results from federally mandated patient-satisfaction surveys. Claims data from the Medicare database are the most comprehensive source data available. We are open to exploring alternatives for future editions of the ratings. Risk-adjusted data from clinical registries are one promising area.

In our Best Hospitals for Maternity, much of the data used in the methodology was collected directly from hospitals rather than from Medicare data.

Hospital reputation was not a factor in the ratings.

Our methodology also drew on several measures from the 2019 American Hospital Association’s annual survey and two from the Society of Thoracic Surgeons, a professional organization for heart and chest surgeons. None of these organizations have endorsed or been asked to endorse the U.S. News ratings.

What do the ratings mean?

An overall rating of high performing indicates a hospital was significantly better than the national average in a given procedure or condition. Hospitals rated below average scored significantly below the national average. Hospitals rated average do not all have equal performance, but they were not distinctly different from average in our methodology. In each procedure and condition, 10% to 20% of the evaluated hospitals in a condition or procedure typically fell into the high performing tier and another 10% to 20% were rated below average.

Relatively few hospitals performed consistently across all measures for a given condition or procedure. Strengths and weaknesses in particular measures often varied considerably between hospitals with similar overall ratings. Such differences give patients flexibility by allowing them to decide, in consultation with their doctor, which qualities are most important to them. One hospital might have a lower readmission rate but have worse patient experience scores. Another might have a better balance of nurses to patients but relatively low numbers of patients.

Should I worry about going to a hospital rated average or below average or that is unrated?

About 50% to 70% of the hospitals in each procedure or condition were rated average, so they could be considered typical. Some hospitals were rated below average in part because of low patient volume, not necessarily because of a high number of deaths or other adverse events. No firm conclusion can be reached about any unrated hospital; these hospitals did not treat enough patients to be evaluated fully. The ratings are just a starting point for patient decision-making, which certainly should include consulting a doctor.

Pending such consultation, patients who have access to a high performing or average hospital might elect to choose that hospital over one that is below average or unrated in the type of care they need.

How did U.S. News build in risk adjustment?

We took a number of risk factors into account:

Age at admission.

Sex.

Transfer status. A patient transfer from the initial receiving hospital may indicate a complex procedure or condition. Patients were classified as inbound transfers if they were treated at another acute-care hospital on the day of admission, if claims data indicated they were transferred or if a previous claim indicated an outbound transfer.

Year of hospital admission. Quality of care tends to improve over time. This means the risk of adverse outcomes is less year to year. For that reason, and given that the ratings use five years of data, year of admission is included as a risk factor.

Comorbidities. A wide range of comorbidities such as diabetes is associated with higher death rates. This means a patient has multiple diagnoses, with the primary diagnosis being treated, which typically means more challenging care. We used an inventory known as the Elixhauser comorbidities in risk adjustment.

Medicare eligibility status. The reason or reasons why the patient is eligible for Medicare: age, disability or end-stage renal failure. This is a proxy for comorbidities.

Socioeconomic status. Patients with lower incomes and education are typically sicker when they arrive at the hospital and may face more challenges in obtaining or managing their care after they are discharged. This can affect their risk of death, readmission and complications. When hospitals differ by the socioeconomic status of their patients, this can create bias in comparing outcomes. We used “dual eligibility” — patients who are eligible for both Medicare and Medicaid — as a socioeconomic factor.

Why did U.S. News adjust for socioeconomic status?

In 2014, the National Quality Forum, an influential standard-setting body, recommended considering socioeconomic status in certain evaluations of hospital performance. Since our objective is to enable a patient who is consulting our ratings to make apples-to-apples comparisons among hospitals, it follows that we should adjust for patient attributes such as age, sex and socioeconomic status.

Did U.S. News consider patient satisfaction?

The methodology uses one measure, how discharged patients rated a hospital overall, from the federal government’s quarterly survey called Hospital Consumer Assessment of Health Providers and Systems, or HCAHPS.

What changes were made from last year?

We made several methodology changes, including but not limited to:

New ratings. We introduced seven new ratings that evaluate hospitals in back surgery (spinal fusion), diabetes, heart attack, hip fracture, kidney failure, pneumonia and stroke. The new ratings have also been factored into the calculation of the Best Regional Hospitals and Honor Roll rankings.

New covariates. We introduced additional covariates in the risk model in order to properly risk-adjust patient outcomes. For example, for our heart bypass surgery cohort, we employed covariates indicating whether a patient had a principal diagnosis of congestive heart failure or heart attack, identified from claims data.

Cohort-specific readmission outcome measures. For certain of our cohorts, we switched to cohort-specific unplanned readmission outcome measures defined by CMS rather than utilizing their hospital-wide unplanned readmission measure.

How do the U.S. News ratings compare with other public reporting on hospital quality?

In judging the validity and usefulness of any public reporting effort to evaluate health facilities, patients should ask: What is its intention? What information does it claim to deliver? Does it meet the stated intent?

Our national Best Hospitals and Best Children’s Hospitals rankings, for example, are meant to be used as guidance when life is in the balance or an uncommon condition or procedure is involved. Most patients, thankfully, will not need to consult them.

Best Hospitals for procedures and conditions, on the other hand, rates overall quality of inpatient care in the kinds of procedures and conditions that many hospitals commonly encounter. Clinical outcomes (such as mortality, readmissions and length of stay) are stressed, but among the other measures included are patient volume, patient satisfaction and hospital staffing data. Patients can choose to factor some or all of these individual quality indicators into their decisions about where to get care.

For comparison, other public reporting approaches measure different aspects of hospital quality and/or use different approaches to assess quality:

— The federal government’s Hospital Compare website publishes an array of quality data as well as hospital star ratings.

— The Joint Commission measures how frequently each hospital follows specific guidelines. It doesn’t use any outcome measures.

— The Leapfrog Group grades hospitals from A to F on patient safety.

— Healthgrades rates hospitals in a variety of clinical areas, using mortality, complication rates and patient experience ratings.

2021-22 Best Regional Hospitals, Published July 2021

U.S. News first published Best Regional Hospitals in 2011. These state and metro area rankings offer information on community hospitals that are highly rated but may not be nationally ranked. Regional rankings are displayed for nearly every state and for the nation’s largest metro areas, provided there is at least one Best Regional Hospital located there.

In 2021-22, 531 hospitals in 49 states and 93 metro areas were recognized as Best Regional Hospitals. There is no separate methodology report for the regional rankings, but additional information is contained at the end of the 2021-22 U.S. News Best Hospitals Procedures & Conditions Methodology Report.

What defined a 2021-22 Best Regional Hospital?

A Best Regional Hospital is a hospital that:

— Offers a full range of general medical and surgical services (as opposed to a specialty hospital).

— Either was nationally ranked in one of the 11 data-driven Best Hospitals specialties (excluding rehabilitation) or had six or more ratings of high performing in the Best Hospitals procedures and conditions (note that for Best Regional Hospitals eligibility and scoring purposes, the TAVR and AVR cohorts were combined).

— In addition to the aforementioned eligibility criteria, this year a hospital must have had at least three more high performing procedures/conditions than below average procedures/conditions in order to be a Best Regional Hospital.

Nationwide, 531 hospitals were identified as Best Regional Hospitals, compared with 563 last year. The Best Hospitals for Maternity was not included in the Best Regional Hospitals calculation.

How was each Best Regional Hospital assigned its numerical ranking?

In a given region (state or major metro area), a hospital on the Best Hospitals Honor Roll outranked all other hospitals that were not on the Honor Roll regardless of point totals. Other hospitals located in each region were ranked according to the number of points they earned: Hospitals earned two points for each of the 11 data-driven Best Hospitals specialties in which they were nationally ranked and one point for each of the 11 specialties (excluding rehabilitation) and 16 procedures and conditions in which they were rated high performing (AVR and TAVR are combined in this calculation).

In addition, hospitals lost one point for each procedure or condition in which they were rated below average. In some circumstances, where a health system with multiple hospitals had consolidated a certain service at a regional center of excellence, we reassigned Best Regional Hospitals points for that service from the system’s center of excellence to the system’s flagship hospital.

Can a specialty hospital, such as an orthopedic, cancer or children’s hospital, be recognized as a Best Regional Hospital if it is nationally ranked or high performing?

No. The primary intent of the designation is to identify hospitals that perform well across a range of specialties, conditions and procedures. A specialty hospital’s profile and its ratings and rankings pages do show the area or areas of care in which it is ranked or high performing.

In which metropolitan areas and states were hospitals ranked?

U.S. News generally used the U.S. Census Bureau list of Metropolitan Statistical Areas (MSAs) to define metro areas, but we departed from MSAs in cases where we used larger Combined Statistical Areas (CSAs) or combined adjacent MSAs to include nearby smaller cities with nationally ranked hospitals. For example, we used the Detroit CSA instead of the Detroit MSA; and we combined the Durham-Chapel Hill and Raleigh-Cary MSAs to define the Raleigh-Durham metro area.

Some metropolitan areas, such as Cincinnati, Kansas City and New York, cross state lines. Washington, D.C. is included as a metro area but not a state.

What about hospitals in smaller metro areas or outside metro areas?

U.S. News has grouped counties and county equivalents like parishes into approximately 200 regions that reflect geography, local custom and regional health care markets. High performers were recognized but not numerically ranked in regions that are not major metro areas.

Why weren’t children’s hospitals ranked in metro areas?

Very few metro areas have more than one or two Best Children’s Hospitals. That makes decisions about where to go for expert pediatric care simpler than for adult care; ranking small numbers of children’s hospitals within a metro area wouldn’t offer meaningful assistance. A Best Children’s Hospitals FAQ is available below.

2021-22 Best Children’s Hospitals, Published June 2021

What is the purpose of the Best Children’s Hospitals rankings? When should they be consulted? How are they determined? The following FAQ addresses these and other Best Children’s Hospitals questions. A fully detailed methodology report is available as a downloadable PDF.

For the 2021-22 rankings, U.S. News requested medical data and other information from nearly 200 facilities. Of those, 118 turned in enough data to be evaluated in at least one specialty, and 89 were ranked in one or more.

Why does U.S. News rank children’s hospitals?

Relatively few children, compared with the number of adults, face life-threatening or rare conditions or have to go through complicated operations. But for a child who does need a caliber of expertise, a typical hospital, where nearly all inpatients are adults, simply cannot provide. Even a hospital with a busy maternity unit may not be equipped to deal with a newborn who weighs just a few pounds or requires surgery for a defective heart. Similarly, most hospitals don’t see large numbers of children with a range of cancers, respiratory illnesses or kidney conditions.

Even among children’s hospitals and large pediatric services that do, the reality — as true in pediatrics as it is in adult care — is that some hospitals are better than others. That’s why in 2006, U.S. News began collecting data that would allow ranking of pediatric centers on their ability to help children who need it the most.

How are the rankings organized and updated?

The 50 best-performing hospitals are ranked in each of 10 pediatric specialties. Unranked hospitals that provided enough information to be scored in a specialty are listed with their data but without rank or score. The rankings are updated annually in June. The Best Children’s Hospitals Honor Roll recognizes the 10 hospitals that received the highest number of points, based on the number of specialties in which they are ranked and how high they ranked in each one.

What are the 10 specialties?

— Cancer.

— Cardiology and heart surgery.

— Diabetes and endocrinology.

— Gastroenterology and gastrointestinal surgery.

— Neonatology.

— Nephrology.

— Neurology and neurosurgery.

— Orthopedics.

— Pulmonology and lung surgery.

— Urology.

So the rankings should just be a starting point?

Exactly. Families have to weigh many considerations when they seek care for a child, including the stress and expense of traveling to another city with a sick child and staying for days or possibly weeks, as well as an insurer’s willingness to pay for care at a hospital outside its approved network.

Within a specialty, hospital performance is judged across a variety of conditions and procedures. So one hospital might outperform another in some of them, but the second might do better in others. In the pediatric orthopedic rankings, for example, one hospital might have an especially busy spina bifida clinic but doesn’t treat complex fractures as efficiently as another hospital might. Parents and caregivers have to decide for themselves which of all of these factors they want to weigh more or less heavily. Kids and families are all different. There’s no one-size-fits-all.

How is each hospital evaluated?

A third of each hospital’s score, or 33.3%, was tied to outcomes such as survival, infections and surgical complications. (In cardiology & heart surgery, outcomes counted for 38.3% because more and better data are available.) A hospital’s reputation, based on an annual survey of pediatric specialists and subspecialists in each of the 10 specialties, made up another 15% (8.5% in cardiology & heart surgery). The remaining portion of slightly more than 50% evaluated commitment to patient safety (such as the number of specific ways infections are minimized), excellence (such as the number of fellowship programs) and family centeredness (such as the degree to which families are involved in their children’s care).

Why does U.S. News include hospital reputation?

Experts’ opinions are capable of reflecting important information that isn’t evident in objective measurements. That’s particularly the case in a field as full of nuance and complexity as is the medical care of very sick children. We feel the opinions of pediatric specialists add to the objective measures that form the basis for the rankings.

How are the rankings organized?

In each of the 10 specialty areas, the 50 hospitals with the highest scores are ranked numerically based on their overall score. Keep in mind that a lower-ranked hospital may be better in certain areas of a specialty than a hospital with a higher overall ranking in that specialty — and, importantly, hospitals with different rankings may be effectively equivalent on the attributes that matter most to a particular family. You can learn about the nuanced differences by comparing hospitals’ detailed scorecards, which show many of the measures that went into hospital scores. Some measures, such as nurse-to-patient ratios, are common to all specialties. Others, like accreditation for bone marrow transplant, apply to just one or two specialties.

In addition to displaying performance information for the 50 ranked hospitals in each specialty, the same information is shown for unranked hospitals if they provided enough data through the clinical survey to be evaluated. The unranked hospitals are listed alphabetically.

What are the regional Best Children’s Hospital rankings?

Each hospital that’s ranked in at least one pediatric specialty, with two uncommon exclusions described here, is also assigned a ranking in its state and in the multi-state region (there are seven) to which the state belongs. These regional rankings are intended to help families identify excellent pediatric centers near home.

Exclusions: Specialty pediatric hospitals, such as those that exclusively treat cancer, are excluded from the regional rankings. Additionally, a hospital that reports data for a specialty jointly with another hospital does not receive credit from that specialty toward a regional ranking, unless the hospital is deemed by U.S. News to be the lead hospital in that multi-hospital reporting relationship; non-lead hospitals may be ranked regionally only if they are ranked on their own in another specialty or are the lead hospital in a joint reporting relationship in another specialty.

A map accompanying this article shows the seven multi-state regions and which states each region comprises.

What is the significance of the Honor Roll?

The Best Children’s Hospitals Honor Roll recognizes 10 hospitals that are unusually competent not just in one or two specialties but in many.

How is the Honor Roll determined?

Hospitals received points for being ranked in a specialty, and the 10 hospitals with the most points across the 10 specialties make up the Honor Roll. The first-ranked hospital in a specialty received 25 points, the second-ranked hospital received 24 points and so on, until reaching No. 21. All hospitals ranked 21 through 50 received five points. If multiple hospitals had tied for the tenth-most points overall, the Honor Roll would have been extended.

How did U.S. News choose which children’s hospitals to evaluate?

Selection was originally determined by membership status in the National Association of Children’s Hospitals and Related Institutions, or NACHRI, now called the Children’s Hospital Association, or by nomination from teams of expert advisers. A hospital also can request to be considered. U.S. News makes such decisions not only on a hospital’s willingness to engage in public reporting but also on the size and scope of its pediatric program.

Of approximately 200 hospitals U.S. News invites to participate in the survey each year, about a quarter of the hospitals are freestanding pediatric-focused facilities. Most of the others are pediatric departments within larger full-service hospitals and are so large that the department functions almost like its own hospital within a hospital — with its own staff, operating rooms and support services.

Are there changes from last year?

Year to year, there are always changes — we constantly try to improve our methodology, using feedback we get from knowledgeable parents, doctors and health care leaders. Our approach is conservative, however, since any alterations in our analysis affect not only the new rankings but the ability to compare them with previous results. Some of this year’s changes were highlighted in a U.S. News blog post published shortly before the rankings were released.

How does U.S. News decide what changes to make to the methodology?

RTI International, a large North Carolina-based research and consulting firm that created the Best Children’s Hospitals methodology in 2006 (and is the U.S. News contractor for the Best Hospitals rankings), works every year with experts organized into specialized working groups to review and update the methodology. U.S. News editors review proposed changes and must approve them before they take effect.

Why does U.S. News ask hospitals for data instead of using existing data sources?

We use existing data whenever we can. The lack of banks of critical data that can be tapped in order to evaluate children’s hospitals has been a huge challenge. There is no pediatric equivalent of the Medicare database U.S. News mines to measure hospital performance in the annual Best Hospitals adult rankings and ratings.

In 2006, when U.S. News began looking into the possibility of ranking pediatric centers, children’s hospitals had barely begun to develop standards for care-related quality data or how to best analyze the results. That is still largely the case, despite important progress pediatric researchers have made in certain areas of performance measurement.

So in 2006, U.S. News asked RTI to put together a clinical survey for children’s hospitals. Some questions, such as nursing data and the extent and success of programs that prevent infection, touch on all 10 specialties. Others, such as complication rates of kidney biopsies and five-year survival rates for several types of cancer, are specialty-specific.

What defines the three categories of quality measures — outcomes, process and structure — used in the rankings?

Outcomes. These data reflect a hospital’s ability to keep children alive, keep them safe from harm by protecting them from infections and surgical complications and improving quality of life of children with chronic conditions. For example, we evaluate survival from three types of childhood cancers, bloodstream infections caused by central line catheters and success in managing serious asthma cases.

Process. The intent of the U.S. News process measure is to evaluate how well and efficiently a hospital goes about the day-to-day business of delivering care. That is determined in part by compliance with widely endorsed “best practices,” such as regular morbidity and mortality conferences to explore unanticipated deaths or complications, and commitment to infection control, such as having certified infection preventionists on staff and tracking the correct use of antibiotics prior to surgery.

It is important to have such programs, but they must deliver. So 15% of a hospital’s score (8.5% in the cardiology & heart surgery rankings) relies on the opinions of pediatric specialists and subspecialists via an annual survey that asks them to name up to 10 hospitals in their specialty where they would send the sickest patients without taking location or expense into account. Responses are combined from the three latest surveys, meaning for the 2021-22 rankings, surveys conducted in 2019, 2020 and 2021. More than 17,000 physicians were surveyed in 2020, and more than 4,000 responded.

Structure. This category reflects resources that a hospital makes available to patients, like the number of nurses who care for patients. We collect information about 40 elements, many relevant to every specialty and others specific to just one. A few examples are availability of surgery for congenital heart defects or for liver transplants, specialized clinics for children with diabetes or kidney disease, and services for families that ease the anxiety of a child’s hospital stay.

For PR related questions please contact health-pr@usnews.com.

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FAQ: How and Why We Rank and Rate Hospitals originally appeared on usnews.com

Update 12/06/21: This story was published at an earlier date and has been updated with new information.

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