Since U.S. News & World Report started its Best Hospitals rankings in 1990, the classification has become the industry’s gold standard. If hospitals were to shun the orders like law and medical schools, big questions loom for what it means to be the “best.”
The law schools started it. In November, top-ranked Yale Law was the first to say it would no longer cooperate with the U.S. News Scale of law schools and would stop sharing data with the publication. Within three months, more than 40 law schools — about 20 per cent of the programs that U.S. News ranked — did the same, including 12 of the top 14.
The medical schools followed. No. 1 Harvard Medical School took the plunge in January. Within a month, a dozen medical schools followed, including Stanford (Calif.) School of Medicine, Columbia University, University of Pennsylvania Perelman School of Medicine, University of Chicago Pritzker School of Medicine and Johns Hopkins University School of Medicine. All said they would end their cooperation and no longer share data with the publication.
The medical and law school tumult raised questions about whether hospitals would follow suit and begin to question or downplay their rankings, released in the summer. Unlike medical schools, however, the hospitals are ranked by publicly available data from CMS and the American Hospital Association, medical associations and physician surveys. Children’s hospitals are invited to participate in their evaluation.
A Trusted Source for Quality Healthcare
“At this point, I can definitively say neither top-ranked hospitals nor other hospitals will opt out of our survey this year,” Ben Harder of U.S. News told Becker’s May 2. “We’ve completed our data collection survey of children’s hospitals, and hospital participation was as high as last year. Every hospital ranked last year submitted data again this year.”
Mr Harder joined U.S. News in 2007 and oversees its portfolio of health rankings, including the Best Hospitals and Best Children’s Hospitals, as managing editor and chief of health analysis. He is in talks with hospitals and health system executives, clinicians, researchers and speciality societies on an ongoing basis. No sudden movement from hospital stakeholders has been detected since the law and medical school shakeups.
“Those conversations have continued for the last six months, for sure, but I wouldn’t say the tenor has changed in any way,” he said. “I can’t recall a single conversation or change in which anyone has turned away from the rankings or not given us data.”
The Importance of U.S. News Rankings
While no hospitals have signalled a chilling effect, the attention paid to top-ranked institutions’ involvement in the prestigious ranking system raises important questions about what the status of “best” means today about hospitals.
Unlike the rankings of law and medical schools, U.S. News & World Report intends for its hospital rankings to be used by patients, and ranked hospitals heavily cite their U.S. News ratings in direct-to-patient advertising. But as visible as hospitals’ rank and standing may be, hospital leaders are oddly reluctant to talk about it openly and instead prefer to leave the matter for quiet hallway conversations — or such was the case at one recent industry event.
One hospital insider who did speak to Becker’s on the record about U.S. News is Steve Klasko, MD. Dr Klasko was the CEO of Philadelphia-based Jefferson Health for nearly a decade before joining venture capital firm General Catalyst as its executive-in-residence. In his time with Jefferson, the system’s flagship hospital clinched a spot in the U.S. News Honor Roll, landing at No. 16 in 2017.
He has many thoughts on hospital rankings.
“Let me start with something positive,” Dr. Klasko said. “Transparency is great. Having some form of transparency is good — an objective model that says, ‘Here’s quality, here’s access, here’s cost, here’s experience.’ Interestingly, those measures are already out there through CMS Hospital Compare, Leapfrog, and people can already get that.”
The critical from Dr Klasko: “We, in 2023, don’t understand how to measure quality when it comes to value and equity. There is no validated outcome composite measure for hospital performance and value.”
Earlier this year, U.S. News announced it would assign more weight to clinical outcomes and other objective quality measures in its hospital rankings, reducing the weight of physician opinion. Hospital leaders and medical experts informed the change, it said.
A Symbiotic Relationship
In the upcoming hospital rankings methodology, outcome measures derived from federal data will account for 45 per cent of the method in 11 speciality rankings, up from 37.5 per cent the year prior. Structural indicators of quality will account for 35 per cent of the methodology. The weight of physician opinion fell from 25 per cent to 12 per cent for four specialities, from 27.5 per cent to 15 per cent for another seven things, and from 50 ratios to 30 per cent for the speciality of rehabilitation.
“Sometimes present in the C-suite is the impression that physician opinion drives the results,” said Mr Harder. “We’ve looked at this extensively, with maybe one exception I’ll mention, but it’s not what drives which hospitals are best. We can remove that factor from the methodology and re-run the results, and the top 50 in every speciality is virtually unchanged.”
