'Misguided methodology': Pennsylvania health system withdraws from US News rankings

Universities have been speaking out against U.S. News & World Report's ranking systems for months, alleging they unfairly prioritize prestige and subjective opinion. But as medical schools chose to withdraw participation from the ranking system, the same institutions' health systems remained in the running for a chance on the "Best Hospitals" list. 

Now, St. Luke's University Health Network — a nonprofit 14-hospital system based in Bethlehem, Pa. — is also pulling back, alleging the rankings run on "misguided methodology." 

On May 24, Richard Anderson, president and CEO of the health system, and Donna Sabol, its senior vice president and chief quality officer, penned a letter expressing their concerns with the rankings. They wrote to Ben Harder, managing editor and chief of health analysis at U.S. News, stating they would no longer submit data to the publication. 

St. Luke's is the only hospital in the region to be named to the Fortune/Merative 100 Top Hospitals list, which it has made for eight consecutive years, the executives wrote. It also consistently receives quality awards from other organizations, including an "A" grade for hospitals through The Leapfrog Group and the highest possible scores in CMS' Hospital Compare Analysis. 

However, St. Luke's did not fare as well in U.S. News' list; its executives attribute this to flaws in the rankings' methodology. 

"The above results [of other rating systems] are based on OBJECTIVE METRICS, data gathered by CMS and other independent parties with indisputable outcomes," the executives wrote. "Despite these accomplishments, St. Luke's is ranked as the eighth best hospital in Pennsylvania by US News & World Report. We respectfully disagree with your rankings, and consider them as being seriously flawed for the following reasons." 

The health system executives allege that U.S. News does not include a balanced performance scorecard for the cost of care; ranks availability of services without assessing whether they improve clinical outcomes; places 'undue" emphasis on mortality; and does not appropriately weight patients treated for chronic illnesses, which account for a significant percentage of hospitalizations. 

Additionally, the rankings rely heavily on "subjective opinions of physicians across the country, despite any evidence that this 'popularity contest' approach is a valid barometer of quality," the executives wrote. 

They attached a copy of a Feb. 6 article published by Mr. Harder, which states that the 2023 to 2024 best hospitals and best children's hospitals rankings will give more weight to clinical outcomes and other objective measures of quality and less weight to the opinion survey of physicians. It also noted that health equity measures, still a work in progress, would not factor into this year's adult rankings. 

These "expert opinion" scores have also been criticized by law and medical schools. The publication reduced the weight of these scores from 50 percent to 30 percent in some areas and 27.5 percent to 15 percent in others, but St. Luke's executives believe the system still gives objective opinion too much weight. 

"Your ongoing reliance on subjective criteria, influenced in part by hospitals investing time and resources to solicit support from physicians, is ill advised," the executives wrote. "The results are misleading to the public and unfortunate knowing patients unduly rely on these rankings and may choose hospitals demonstrating problematic quality based on objective criteria." 

The rankings serve to generate marketing revenue, the executives alleged, explaining that they will no longer dedicate time to them. 

"Given these concerns, this is to advise you St. Luke's will no longer respond to requests for data to US News & World Report," the executives wrote. "Rather, we will continue to focus on meeting the requirements of those organizations that compile accurate quality information and produce reports that serve as true measures of quality." 

It is unclear if this withdrawal will have much impact — the publication can still rank the health system using publicly available data, as it did for schools that withdrew from its best medical schools ranking. Maternity care is the only adult-care service line where hospitals are invited to complete an annual survey and one area that might be affected by St. Luke's decision.

"We will continue to evaluate hospitals in all services covered by the U.S. News rankings and ratings," the publication told Becker's

Read more about the ongoing exodus from U.S. News rankings here.

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