East Coast reigns supreme in Best Hospitals rankings; what purpose does it really serve?

bykst / Pixabay

The News:

For the second consecutive year, the Mayo Clinic in Rochester, MN, claimed the number one spot in the annual honor roll of best hospitals published by US News and World Report.

The Cleveland Clinic holds the number two spot in the annual honor roll, which highlights hospitals delivering “exceptional treatment across multiple areas of care,” the magazine says, according to Medscape.

Taking the third spot is Johns Hopkins Hospital in Baltimore, up from number four in last year’s honor roll. Massachusetts General Hospital in Boston holds the number four spot, and the UCSF Medical Center, San Francisco, ranks fifth.

Only six hospitals situated in the West made the list.

Here are the hospitals with the highest 2017-2018 rankings:

  1. Mayo Clinic, Rochester, MN
  2. Cleveland Clinic
  3. Johns Hopkins Hospital, Baltimore
  4. Massachusetts General Hospital, Boston
  5. UCSF Medical Center, San Francisco
  6. University of Michigan Hospitals and Health Centers, Ann Arbor
  7. Ronald Reagan UCLA Medical Center, Los Angeles
  8. New York–Presbyterian Hospital, New York
  9. Stanford Health Care–Stanford Hospital, California
  10. Hospitals of the University of Pennsylvania–Penn Presbyterian, Philadelphia
  11. Cedars-Sinai Medical Center, Los Angeles
  12. Barnes-Jewish Hospital, St. Louis
  13. Northwestern Memorial Hospital, Chicago
  14. UPMC Presbyterian Shadyside, Pittsburgh
  15. University of Colorado Hospital, Aurora
  16. Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
  17. Duke University Hospital, Durham, North Carolina
  18. Mount Sinai Hospital, New York City
  19. NYU Langone Medical Center, New York City
  20. Mayo Clinic Phoenix

In their 28th year, the rankings and ratings compare more than 4500 medical centers nationwide in 25 specialties, procedures, and conditions.

In the 2017-2018 Best Hospitals: Specialty Rankings, as was the case last year, the University of Texas MD Anderson Cancer Center holds the number one spot in cancer, the Cleveland Clinic is number one in cardiology and heart surgery, and the Hospital for Special Surgery in NYC is number one in orthopedics.

Top Five for Cardiology and Heart Surgery

  1. Cleveland Clinic
  2. Mayo Clinic, Rochester, MN
  3. New York–Presbyterian Hospital, New York City
  4. Cedars-Sinai Medical Center, Los Angeles
  5. Massachusetts General Hospital, Boston

Top Five for Cancer

  1. University of Texas MD Anderson Cancer Center, Houston
  2. Memorial Sloan Kettering Cancer Center, New York City
  3. Mayo Clinic, Rochester, MN
  4. Dana-Farber/Brigham and Women’s Cancer Center, Boston
  5. Seattle Cancer Care Alliance/University of Washington Medical Center

Top Five for Orthopedics

  1. Hospital for Special Surgery, New York City
  2. Mayo Clinic, Rochester, MN
  3. Cleveland Clinic
  4. Rothman Institute at Thomas Jefferson University Hospitals, Philadelphia
  5. Rush University Medical Center, Chicago

The Best Hospitals report is part of US News’ patient portal, designed to help patients make informed decisions about where to receive care. The rankings are produced by US News with RTI International, a leading research organization based in Research Triangle Park, NC.

Steve’s Take:

Numerous organizations rate hospitals–but doing so is an imperfect science, says Boston Magazine, in an article posted almost exactly one year ago after the 2016-2017 US News rankings were issued.

Gary Young, director of the Northeastern University Center for Health Policy and Healthcare Research, recalls a classic joke at healthcare conferences: A patient in the clutches of a heart attack drags himself across the room, sits at a computer, and frantically starts googling the best cardiology hospitals in the area.

It’s preposterous—-but not a situation that would never happen. Still, Boston Magazine says it begs the question: If hospital rankings won’t help a patient at his or her most vulnerable hour, why do them in the first place?

(I have my own ranking system I’ll summarize toward the end of the piece.)

“There’s been this big movement for the last 20, 25 years of improving transparency and developing quality measures and making them available through these rankings,” Young says. “A lot of money, a lot of time has been invested in building this kind of infrastructure.”

Hospital rankings are useful, in exactly the way they seem useful–they give patients information about the institutions they trust with their lives.

Elizabeth Mort, Mass General’s senior vice president of safety and quality, says ratings have value, but she’s dubious of their simplicity.

“Is there really a difference between four and five [stars], three and four, two and three, one and two?” Mort asks. “When you artificially slice a distribution curve of measures into categories, you run the risk of misclassifying people.”

The problem is that the ratings, once they reach a certain level, are somewhat arbitrary. The difference between the first-ranked hospital and the 100th-ranked hospital is fairly significant. But what about the difference between Mass General’s first place finish in 2015 and its third place finish this year?

“That shouldn’t make any difference at all,” says Ben Harder, chief of health analysis at US News. “People like to talk about the Honor Roll [US News’ list of the top 20 hospitals], and it does have its use, but look past the Honor Roll as quickly as possible.”

What Harder means is that the superstar rankings—the exciting, alluring ones that are easy to digest, and the ones that are easy to put in a headline–aren’t really the most useful.

The Honor Roll highlights hospitals that are uniformly excellent, but a patient who needs a hip replacement shouldn’t care that a hospital ranks among the top 20 if it got there because it excels in 10 unrelated specialties.

Measuring the quality of hospital care is an extremely complicated endeavor, both technically and politically. And the stakes are higher than ever for hospitals now that the Centers for Medicare & Medicaid Services has linked payment to quality, HealthLeadersMedia.com reports.

Hospital ranking programs take that data to consumers, who are increasingly shopping around for health services. But when media reports challenge the analysis of the data, the question emerges: Are consumers losing confidence in hospital rankings?

Brian Kelly, the editor and chief content officer at US News, doesn’t think so.

“Our audience has grown,” Kelly says. “We have 100,000 people a day coming to us to look at this information. And we feel very good about it. We think we are providing very comprehensive and very clear information for patients making decisions.”

“I would encourage readers to look at the results that are most relevant to the clinical need they have,” US News’ Harder says. “Look at the most granular set of evaluations that’s relevant.”

Bottom Line:

Back in June I wrote a piece about my own prejudices about local hospitals here in Southern California. The article was based primarily on a sudden encounter I had with a heart-related emergency.

Long story short, I was diagnosed with heart failure due to a damaged aortic valve. About two weeks later, I emerged from the cardiology wing of the University of California, San Diego, Medical Center with a new titanium valve, root and stem, and a 9-inch scar on my chest.

Six months later I was back to full strength, running at the same, pathetically slow pace, but feeling better than I had in years. Today, I’m still at it, just slower than ever.

During my two-week stint at this exceptional teaching hospital, there were legions of care providers. I mean the ones who preceded and followed my brilliant heart surgeon, Michael Madani, and all those in the OR who put me to sleep, opened my chest, stopped my heart, put me on a pump, assisted in removing and replacing the damaged valve and sewed me back together again.

Before and after the OR theater proceedings were the nurses, the residents, the attendings, even daily and nightly check-ins from Thomas Waltman, the cardio department CEO, the therapy dogs, the whole panoply of caregivers who…saved my life.

Steve's Take: UCSD Medical Center made the only Honor Roll that counts--they saved my life! Click To Tweet

Private hospitals here in San Diego are among the region’s best. But the data in a recent study published by the Journal of the American Medical Association are clear. If teaching hospitals save an additional one life versus a private hospital for every documented percentage of medical conditions treated and/or surgeries performed, and your child or another loved one’s life is at stake, which would I recommend: Private or teaching?

I think you can guess my answer. And it doesn’t matter to me that UCSD Medical Center didn’t make the Honor Roll lists at the beginning of this piece. It made the Honor Roll that matters most. I’m back.