A Guide to the Rankings

How we identified 164 outstanding hospitals in 15 specialties

by Ben Harder 

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OR MORE THAN three decades, the mission of the Best Hospitals rankings has been to help guide patients, in consultation with their doctors, to the right place when they need a high level of specialty care. These are patients whose surgery or condition is complex. Or whose advanced age, physical infirmity or existing medical condition limits their options.

Such people account for a small fraction of hospital patients, but they add up to millions of individuals, and many hospitals may not be able to meet their needs. A hospital ranked by U.S. News in cancer, say, is likely to have the expertise and capability to enroll an elderly patient with a metastatic tumor into a clinical trial for an unproven but innovative treatment. Some community hospitals also can provide access to such experimental therapies. But not all.

The following pages offer hospital rankings in 15 specialties, from cancer to urology. Of more than 4,500 hospitals evaluated by U.S. News this year, only 164 performed well enough to be ranked in any specialty. In 12 of 15 specialties, analysis of objective data from the federal government and other sources generated the main factors determining whether a hospital was ranked. Some kinds of data, such as death rates, are intimately related to quality. Numbers of patients and the balance of nurses to patients are examples of data that are also important, although the quality connection may seem less evident. To capture medical experts’ opinions, we also factored in results from annual surveys of specialist physi-

No hospital is best for every patient.

cians who were asked to name hospitals they consider best in their specialty at handling difficult cases. Hospitals in the other three specialties (ophthalmology, psychiatry and rheumatology) were ranked solely on the basis of the annual physician surveys. That’s because reliable objective data aren’t available for those areas of care.

Based on input from experts and medical studies, we have revised the ranking methodologies over time to make the rankings even more useful to consumers. This year, for example, the obstetrics and gynecology ranking factored in whether each hospital had completed a U.S. News survey designed to provide the public with more transparent information about its maternity care.

Beyond the specialty rankings, we expanded a set of hospital ratings that give patients information about which hospitals excel in specific procedures or in caring for patients with certain conditions. New this year are ratings in ovarian cancer surgery, prostate cancer surgery and uterine cancer surgery. Hospital performance in these areas can be found in the Best Regional Hospitals rankings (Page 190), which combine data from the specialty rankings and the procedures and conditions ratings to help consumers identify hospitals with expertise in numerous areas of care. More detail is available at usnews.com/best-hospitals.

To be considered for ranking in 11 of the data-driven specialties, a hospital had to meet any of four criteria: It had to be a teaching hospital, or be affiliated with a medical school, or have at least 200 beds, or have at least 100 beds and offer at least four out of eight advanced medical technologies.

The hospitals next had to meet a volume requirement in each specialty – a minimum number of Medicare inpatients from 2018 to 2020 who received certain procedures and treatment for specific conditions. A hospital that fell short was still eligible if nominated in the specialty by at least 1% of physicians responding to the expert opinion survey. At the end of the process, 2,203 hospitals remained candidates for ranking in at least one specialty. Each received a U.S. News score of 0 to 100 based on four elements, described below. The top 50 hospitals in each specialty were ranked. Scores and data for the rest are at usnews.com. The four elements and their weights in most specialties are:

Patient outcomes (37.5%). Success at keeping patients alive and getting them home was judged by the proportion of Medicare inpatients with certain conditions in 2018, 2019 and 2020 who died within 30 days of admission or were discharged to another health care facility. Both rates were adjusted to account for the severity of patients’ illnesses, the complexity of their care, and risk-elevating factors such as advanced age, obesity, high

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Visit usnews.com regularly while researching your health care choices, as U.S. News often adds content aimed at helping patients and families make decisions about their medical care. We also update the Best Hospitals content and data on the website when new information becomes available.

blood pressure and poverty (as reflected by whether they received Medicaid).

A widely used approach to so-called risk adjustment was employed to adjust each patient’s risk in calculating odds of a good outcome. To avoid penalizing institutions receiving the sickest patients, we excluded from our analysis patients transferred in from another hospital. A score of 5 indicates the best chance of survival or discharge to home (and 1 the worst) relative to other hospitals.

Patient experience (5%). Most hospitals are required to assess patients’ satisfaction with their experience using a survey known as the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS. The score reflects how many patients had a positive overall experience during hospitalization.

Other care-related indicators (30%).

The balance of patients per nurse and the hospital’s number of patients – an indicator of its degree of experience in a specialty – are examples of these factors.

Expert opinion (27.5%). Specialists were asked to name up to five hospitals that they consider best in their area of expertise for patients with the most difficult medical problems. In the 2022 survey alone, responses were tallied from more than 32,000 physicians. The figures shown under “% of specialists recommending hospital” in the tables are the average percentages of specialists in 2020, 2021 and 2022 who recommended a hospital. In rehabilitation, expert opinion carried a weight of 50%. In the three specialties based entirely on expert opinion, a hospital had to be cited by at least 5% of responding physicians in the latest three years of U.S. News surveys to be ranked. That created lists of 12 hospitals in ophthalmology, 11 in psychiatry and 11 in rheumatology.

If you’ve consulted past editions of Best Hospitals, you may notice that a hospital you’re considering has risen or fallen in the rankings. A decline shouldn’t automatically be interpreted as a decline in performance; rather, it may be because of changes to the methodology or because other hospitals improved.

No hospital, no matter how excellent, is best for every patient. You’ll want to add your own fact-gathering to ours and consult with your doctor or other health professional as you weigh your options. l

A Glossary of Terms

CARF: accredited by the Commission on Accreditation of Rehabilitation Facilities International as of April 30, 2022. Completion of care rate: how often a hospital avoids needing to transfer patients to an acute-care hospital during their rehabilitation. Discharge to home score: reflects proportion of patients who, at discharge, went home rather than to a nursing home or other facility. FACT accreditation level: hospital meets Foundation for the Accreditation of Cellular Therapy standards as of March 1, 2022, for harvesting and transplanting stem cells from a patient’s own bone marrow and tissue (level 1) and from a donor (level 2) to treat cancer. Flu vaccination rate: percentage of hospital’s staff who received a seasonal flu vaccine. NAEC epilepsy center: designated by the National Association of Epilepsy Centers as of March 1, 2022, as a regional or national referral facility (level 4) for staffing, technology and training in epilepsy care. NCI cancer center: designated by the National Cancer Institute as of March 29, 2022, as a clinical or comprehensive cancer hospital. NIA Alzheimer’s center: designated by the National Institute on Aging as of Feb. 7, 2022, as an Alzheimer’s Disease Center, indicating high quality of research and clinical care. Number of patients: except in rehabilitation, estimated number of Medicare inpatients in 2018, 2019 and 2020 who received certain high-level care as defined by U.S. News. (In some cases, data from 2017 were used to adjust for the pandemic’s impact on 2020 data.) Based on an adjustment to the number of such patients with traditional Medicare insurance. In geriatrics, only patients ages 75 and older are included. In rehabilitation, only patients treated in 2020 are included. A Nurse Magnet hospital: recognized by the American Nurses Credentialing Center as of Jan. 4, 2022, for nursing excellence. Nurse staffing score: relative balance of nonsupervisory registered nurses (inpatient and outpatient) to average daily number of all patients. Inpatient staffing receives greater weight. Agency and temporary nurses are not counted. Patient experience: percentage of patients who responded positively to a survey about the overall quality of their stay. Patient services score: number of services offered out of the number considered important to quality (such as genetic testing in cancer and an Alzheimer’s center in geriatrics).

% of specialists recommending hospital:

percentage of physicians responding to U.S. News surveys in 2020, 2021 and 2022 who named the hospital as among the best in their specialty for especially challenging cases and procedures, setting aside location and cost. Public transparency: indicates whether hospital publicly reports its performance through the American College of Cardiology, the American Heart Association and the Society of Thoracic Surgeons (in cardiology & heart surgery) or the American Heart Association (in neurology & neurosurgery), and whether hospital completed a U.S. News survey about maternity care (in obstetrics & gynecology). Rank: based on U.S. News score except in ophthalmology, psychiatry and rheumatology, where specialist recommendations determined rank. Readmission prevention rate: how often hospital keeps patients from being readmitted to an acute-care hospital within the 30 days following discharge. Successful discharge rate: how often patients go directly home from this hospital and remain at home, rather than requiring further institutional care. Survival score: reflects patient survival rate in the specialty within 30 days of admission. Technology score: reflects availability of technologies considered important to a high quality of care, such as PET/CT scanner in pulmonology and diagnostic radioisotope services in urology. Trauma center: indicates Level 1 or 2 trauma center certification. Such a center can care properly for the most severe injuries. U.S. News score: summary of quality of hospital inpatient care. In most specialties, survival is worth 30%, discharge to home 7.5%, operational quality data such as nurse staffing and patient volume 30%, specialists’ recommendations 27.5%, and patient experience 5%.