San Francisco questions legality of US News hospital rankings

San Francisco's top attorney is requesting information from U.S. News & World Report on its rankings of hospitals, including details on payments the media outlet receives from hospitals. 

David Chiu, San Francisco's city attorney, sent a letter to U.S. News & World Report June 20 demanding that the media outlet explain its methodology, how it intends to address apparent biases, and immediately publicly disclose the revenue it receives from hospitals.

"Consumers use these rankings to make consequential healthcare decisions, and yet there is little understanding that the rankings are fraught and that U.S. News has financial relationships with the hospitals it ranks," Mr. Chiu said in a news release issued from his office. 

"The hospital rankings appear to be biased towards providing treatment for wealthy, white patients, to the detriment of poorer, sicker, or more diverse populations. Perverse incentives in the rankings risk warping our healthcare system," Mr. Chiu said. "Hospitals are treating to the test by investing in specialties that rack up the most points rather than in primary care or other worthy specialties."

Mr. Chiu is requesting that U.S. News provide evidence that substantiates its advertising claims that its hospital rankings are "authoritative," based on "world-class data and technology" and help patients and families "find the best healthcare," "make data-informed decisions," and "find sources of skilled inpatient care." 

Mr. Chiu is also zeroing in on the exchange of payments between hospitals and the ranking outlet, requesting a list of the hospitals that have paid U.S. News or its agents as well as the number of website impressions for the hospital rankings in the last four years. In his letter, Mr. Chiu notes that the outlet appears to violate FTC regulations by not disclosing payments it receives from the hospitals it ranks, including fees to license Best Hospitals badges, subscriptions to Hospital Data Insights, and payments for online and print advertisements on the U.S. News website and its Best Hospitals Guidebook.

A U.S. News spokesperson shared the following comment with Becker's in response to the inquiry filed by the San Francisco city attorney: 

"U.S. News categorically disagrees with the assumptions and conclusions in the City Attorney's letter.

U.S. News' hospital rankings provide an important public service to individuals and families making critical decisions about medical care for themselves or their loved ones. We have consistently stated that our rankings should be one factor in that decision-making process, and any medical decisions should be made in consultation with a physician. Families facing a serious or complex medical problem deserve to have a place where they can easily identify the factors that are important to them and help determine which hospital is the best suited for their individual needs. 

U.S. News is the leading trusted source for quality hospital rankings precisely because we do not in any way accept or engage in compensation for rankings placement. Our rankings and ratings are based wholly on the data we analyze and detail in our transparent methodology, which is fully disclosed on 

Our esteemed journalists and data analysts who participate in creating the rankings take their responsibility to produce quality journalism very seriously, which has earned the trust of consumers for more than 30 years."

The city's scrutiny of U.S. News' ranking methodology and mission follows that exercised by law schools, medical schools and even some health systems in the past year. More than a dozen medical schools withdrew their cooperation from the premier ranking, beginning with Harvard Medical School on Jan. 17. 

The medical and law school tumult raised questions about whether hospitals would follow suit and begin to question or downplay their rankings, which are released in the summer. Unlike medical schools, however, the hospitals are ranked by publicly available data from CMS as well as the American Hospital Association, medical associations and physician surveys. Children's hospitals are invited to participate in their evaluation. 

In early June, St. Luke's University Health Network — a nonprofit 14-hospital system based in Bethlehem, Pa. — announced it would pull back from the rankings, alleging they run on "misguided methodology."

Ben Harder, managing editor and chief of health analysis for U.S. News, told Becker's earlier this spring that no sudden movement from hospital stakeholders had been detected since the law school and medical school shakeups. Mr. Harder also emphasized the cooperation U.S. News exercises in working with hospitals and health systems to collect, analyze and act on stakeholder feedback, including adjustments to its methodology to better account for health equity and changes in care delivery. 

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