US News shares changes to hospital rankings ahead of August release

U.S. News & World Report has made a number of "refinements" to the methodology for its 2023-2024 Best Hospitals rankings and ratings, which are set for release Aug. 1. 

Ben Harder, managing editor and chief of health analysis for U.S. News, and Min Hee Seo, PhD, senior health data scientist for U.S. News, outlined the 18 refinements in the upcoming edition of Best Hospitals and five others under consideration for forthcoming editions in a July 3 article, found here.  

The overview of adjustments to U.S. News' hospital rankings comes after some scrutiny and pushback. U.S. News saw tumult earlier this year with numerous law and medical schools signaling they would no longer cooperate with the rankings, but hospital rankings are unique in that they are ranked by publicly available data from CMS, the American Hospital Association, medical associations and physician surveys. 

Last week, Penn Medicine announced it would no longer participate in the rankings. To be clear, the Philadelphia-based institution is still eligible to be ranked by U.S. News, but it will not submit data to the American Hospital Association's Annual Survey, which U.S. News uses for rankings. The health system will continue to send required data to CMS. Penn Medicine will no longer promote its prior appearances on U.S. News lists and won't purchase any badges to publicize rankings.

"A key aspect of our journalistic approach is our openness to feedback from diverse stakeholders, including patients, healthcare professionals, and the institutions we evaluate," Mr. Harder and Dr. Seo wrote. 

"Our mission is to serve the best interests of patients and to do so, we, like other reputable journalists, are editorially independent of our employer's business operations. To be clear, we give no consideration to whether a correspondent is affiliated with a hospital or health system that advertises in or maintains other commercial agreements with U.S. News."

Below are seven of the refinements made, with all 18 refinements made and five others under consideration for forthcoming editions of Best Hospitals listed and detailed here.

1. Health equity. U.S. News has made three refinements to methodologies under the health equity category with stakeholder feedback, including that from members of a working group U.S. News convened this year. 

First, measures that quantify racial disparities in outcomes will shift focus from readmission to giving patients time at home (i.e., home time). 

Second, the Area Deprivation Index, a marker of neighborhood socioeconomic disadvantage, has been used in lieu of Social Vulnerability Index in risk-adjusting this outcome measure. ADI data for this measure was compiled by CareJourney, a leading healthcare analytics provider, from the CMS Virtual Data Research Center (VRDC). 

Third, measures that quantify the representation of underserved minorities among a hospital's patient population will use data obtained by CareJourney from the VRDC to more precisely benchmark each hospital's patient population against the demographic composition of its community as defined by hospital service area.

2. Greater weight on objective quality measures, less weight on expert opinion. U.S. News increased the weight on outcome measures from 37.5 percent to 45 percent — and from 35 percent to 40 percent for some measures — in each of 11 specialties. The weight on physician opinion was reduced from up to 27.5 percent to either 12 percent or 15 percent, depending on the specialty. The outlet says it anticipates "continued diminution" of expert opinion as it adds and refines other measures, especially those that are outcome-driven.

3. Adjustments for COVID-19 volumes. U.S. News excluded certain visits from outcome measures to account for the disruption and variability of the COVID-19 pandemic. 

A visit was excluded if it occurred in March 2020; occurred in 2020 and the patient was diagnosed with COVID-19; or occurred between April 1, 2020, and December 31, 2020, and the hospital in which the visit occurred experienced a COVID-19 rate higher than the national mean during the month in which the visit occurred. If the patient was diagnosed with COVID-19 in 2021 and onward, the visit is not excluded but is risk adjusted.

4. Debut of leukemia, lymphoma and myeloma rating. A new rating for leukemia, lymphoma and myeloma will debut in the 2023-2024 Best Hospitals rankings, joining 20 existing procedures and conditions ratings. All 21 are determined by objective quality measures. 

5. Inclusion of outpatient outcome measures to two specialties. "Prevention of outpatient procedural complications" outcome measures were added in this year's orthopedics and urology rankings. Similar outpatient outcome measures may be added in other specialties in future editions of Best Hospitals.

6. Metastatic cancer cases excluded from orthopedics. Admissions involving a principal diagnosis of metastatic cancer were excluded from the orthopedics cohort to improve its homogeneity.

7. The specialty formerly known as cardiology and heart surgery has been renamed cardiology, heart and vascular surgery, in recognition that vascular specialists take the lead on some cases that have consistently been included in the specialty's outcome measures.

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