Changes in the Hospital Ranking System

U.S. News has been a sound resource for many seniors and their families when looking for the best hospitals for specialty treatment. The news agency’s hospital ranking system is a key factor for many people who are determining which hospital to go to for specialty care.Changes in the Hospital Ranking System

Learn more about recent changes in the hospital ranking system, and what that means for you and your family.

Changes in the Hospital Ranking System

According to U.S. News, their rankings are meant to provide a tool for patients with complicated issues. They use an example of an elderly woman with pancreatic cancer to exemplify the benefits of their ranking system:

“Most hospitals would decline to operate on her — as they should if their surgeons lack the expertise to remove the cancer without harming the rest of the fragile pancreas. But others would go ahead, possibly at considerable risk to her. She would be better served by one of the hospitals in the Best Hospitals cancer rankings, which see a steady stream of patients like her.”

So when U.S. News announced this past summer that they were making changes to their hospital ranking system, the industry took notice.

Less Emphasis on Patient Safety Indicators

U.S. News’s new ranking system will focus less on the Agency for Healthcare Research and Quality’s Patient Safety Indicators (AHRQ PSIs) when assessing hospitals for quality.

Brian Zimmerman of Becker’s Infection Control & Clinical Quality reports that the 2015-2016:

 “U.S. News hospital rankings equally weigh seven AHRQ PSIs to generate a hospital’s patient safety score, and that score accounts for 10% of the overall score that determines a hospital’s ranking across 12 specialties. After conducting a review of medical literature, an internal data analysis and considering input from clinicians, researchers and healthcare administrators, U.S. News decided to make changes to the role PSIs play in their assessment of hospital quality.”

In August, U.S. News published information about the revised 2016-2017 ranking system, which rates the top 50 hospitals for complex care in 16 specialty areas. Rankings for the following 12 specialty areas are based on data. These areas include:

  • Cancer
  • Cardiology & heart surgery
  • Diabetes & endocrinology
  • Ear, nose & throat
  • Gastroenterology & GI surgery
  • Geriatrics
  • Gynecology
  • Nephrology, neurology & neurosurgery
  • Orthopedics
  • Pulmonology
  • Urology

The types of data used to score hospitals that specialize in these areas include quantifiable factors like “death rates for patients who represent especially challenging cases, patient safety and other measures of performance that can be assessed using hard data,” U.S. News explains. They also take into account the “three most recent years of an annual reputational survey of physicians…Surveyed physicians are asked to name up to five hospitals they consider the best in their specialty for difficult cases.”

According to U.S. News, “each hospital in the 12 data-driven rankings received an overall score from zero to 100 that was based on four elements: reputation, patient survival, patient safety and care-related factors such as the amount of nurse staffing and the breadth of patient services.”

Rankings for the following four specialty areas are created using reputation — based only on the above mentioned survey of physician specialists. These specialties are:

  • Ophthalmology
  • Psychiatry
  • Rehabilitation
  • Rheumatology

Unlike hospitals in the 12 specialty areas listed above, hospitals that focus on ophthalmology, psychiatry, rehabilitation and rheumatology are not rated based on hard data, but only the reputational physician surveys.

Hospital Ranking Change Consequences

According to Zimmerman, the changes in the role that PSI’s play in U.S. News’ assessment of hospital quality has several consequences:

“1. Due to billing inaccuracies related to the PSI measure for pressure ulcers, said measure will no longer be considered when assessing a hospital for safety.

2. The patient safety score’s weighted influence on overall quality will be reduced from 10% to 5%.

3. The 5% weight reduction from PSIs will be offset with added weight to risk-adjusted survival, increasing this measure’s significance from 32.5% to 37.5%.

4. Data from Centers for Medicare and Medicaid Services (CMS) will no longer be used when calculating PSI scores for Maryland hospitals because CMS reportage regarding these institutions contains incomplete patient admissions data. CMS data will be used to calculate PSIs for all states other than Maryland.

5. U.S. News will now use CMS’s Standard Analytical Files (SAF) instead of Medicare Provider Analysis and Review File when analyzing data on procedures. The SAF contains the date on which procedures are linked to a PSI event. This information will enable U.S. News to conduct a more sophisticated analysis by identifying events not incited by hospital error,” Zimmerman reports.

The question for seniors and their caregivers is whether the changes in the U.S. News rankings should sway them from using the ranking system when making decisions. The answer is that these rankings should be a starting point and not an end-all guide. “Patients still have to do their own research and talk with their doctors,” U.S. News says. “We also understand that families have to consider such factors as the stress and expense of travel and lodging in another city and their insurer’s willingness to pay for care if a hospital is out of network.”

When reading the hospital rankings, keep in mind that “all evaluated hospitals and their results and overall scores are displayed online, but rankings are only displayed for the top 50. Hospitals below the top 50 are ordered alphabetically,” says U.S. News.

Want to view the 2016-2017 hospital rankings? Click here.

What did you learn about these changes in the hospital ranking system, and how will it impact your family? Share your stories with us in the comments below.

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