Few newbies among U.S. News & World Report's top hospitals

For 22 years, U.S. News & World Report has issued a report card grading the nation’s hospitals for patient care and acknowledging 50 hospitals as the best. This year, as in years past, Johns Hopkins Hospital, Massachusetts General Hospital and the Mayo Clinic have been chosen as top performers for demonstrating superior care in at least six of the 16 specialties. Cleveland Clinic reclaims its position as number one for heart care for the 17th year in a row.

Hospitals had to meet any of the following four criteria: be a teaching hospital, be affiliated with a medical school, have at least 200 beds or have at least 100 beds plus four or more of eight key medical technologies (PET/CT scanner or radiation therapies, among others). This year, 2,196 hospitals were in the running. The report ranked hospitals in 16 specialties, from cardiology and heart care to urology.

Only 140 of the 4,825 hospitals evaluated ranked in one specialty and only 17 hospitals landed on this year’s Honor Roll where hospitals are ranked at or near the top in six or more specialties.

For each applicable specialty, hospitals received a score from 0 to 100 that was based on four elements: reputation, patient survival, patient safety and care-related factors (nursing and patient services, for example).

The 17 hospitals that made U.S. News & World Report’s honor roll for demonstrating top-quality in six or more specialties were:

1. Johns Hopkins Hospital, Baltimore
2. Massachusetts General Hospital, Boston
3. Mayo Clinic, Rochester, Minn.
4. Cleveland Clinic, Cleveland
5. Ronald Reagan UCLA Medical Center, Los Angeles
6. New York-Presbyterian University Hospital of Columbia and Cornell, New York City
7. University of California San Francisco Medical Center, San Francisco
8. Brigham and Women’s Hospital, Boston
9. Duke University Medical Center, Durham, N.C.
10. Hospital of the University of Pennsylvania, Philadelphia
11. Barnes-Jewish Hospital/Washington University, St. Louis
12. UPMC-University of Pittsburgh Medical Center, Pittsburgh, Penn.
13. University of Washington Medical Center, Seattle
14. University of Michigan Hospitals and Health Centers, Ann Arbor
15. Vanderbilt University Medical Center, Nashville, Tenn.
16. Mount Sinai Medical Center, New York City
17. Stanford Hospital and Clinics, Stanford, Calif.

The top 10 hospitals ranked for best in cardiology and heart surgery were:

1. Cleveland Clinic
2. Mayo Clinic
3. Johns Hopkins Hospital
4. Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston
5. Massachusetts General Hospital
6. New York-Presbyterian University Hospital of Columbia and Cornell
7. Duke University Medical Center
8. Brigham and Women’s Hospital
9. Ronald Reagan UCLA Medical Center
10. Hospital of the University of Pennsylvania

The entire list of the top 50 best hospitals for cardiac care can be found here.

Recently, U.S. News & World Report rankings and others, have received increased scrutiny for being too loosely based on subjective interpretations, rather than quality. In fact, a study published in the Annals of Internal Medicine last April noted that these rankings are based on the subjective view of 250 board certified physicians selected at random to evaluate five hospitals in their specialty they feel provided the best care to patients.

In the study, Sehgam and colleagues wrote, “The current rankings fall short of being an evidence-based system that data-conscious consumers, value-based purchasers and reform-minded policymakers can rely on for healthcare decisions.”

Additionally, a study published in Circulation: Cardiovascular Quality and Outcomes urged that the hospital rankings may need quick overhaul after the researchers found that while top 50 hospitals named the best for heart and heart surgery care had significantly lower 30-day mortality rates, there was an overlap in performance. In fact, Harlan M. Krumholz, MD, professor of medicine and outcomes researcher at Yale University School of Medicine in New Haven, Conn., said, “With this list, you’re identifying a group that on average does better, but some that are not better than average."

While the researchers found that the hospitals ranked had low 30-day mortality rates, the best hospitals did not fare as well on readmission rates.

Likewise, a study published in the January issue of the Journal of the American College of Surgeons found that U.S. News & World Report and HealthGrades surveys that rank “Best Hospitals” according to their high-quality cardiovascular care may not create the most comprehensive list and often exclude hospitals that may provide the same quality of care.

Nicholas H. Osborne, MS, the study’s lead author, told Cardiovascular Business that while these quality rankings do identify some of the nation's top hospitals, they may create a “disservice” to patients by discouraging them from receiving care at equivalent hospitals closer to home.

Questions remain as to whether these rankings, along with HealthGrades' best hospitals surveys, need an overhaul.