Best Hospitals 2012-13 (via U.S. News)

Almost everyone needs a hospital sooner or later. When you do—whether for an aging parent, a sick child, your spouse, or yourself—you’ll face a crucial decision: which medical center to turn to.

Which hospital is the right one depends, of course, on the patient’s needs and location. Whether he faces a tricky joint surgery or a complex heart problem, whether she lives in a big city or a rural expanse, the U.S. News Best Hospitals rankings offer grounded guidance to supplement what patients learn from their healthcare providers. The rankings—now in their 23rd year—feature data on nearly 5,000 hospitals across the country. They span 16 medical specialties, from cancer to urology, and identify top hospitals in several hundred regions, including all major metropolitan areas. No matter where you live or what kind of care you’re seeking, you can find essential data on how medical centers near and far stack up.

[See the Rankings: Best Hospitals 2012-13]

U.S. News this year recognizes more than 700 hospitals as Best Regional Hospitals, indicating they are highly proficient in serving the needs of the majority of patients in at least one specialty. Some parts of the country are thick with solid choices: The New York metro area, for instance, packs in 56 Best Regional Hospitals. Elsewhere, there’s a dearth of such medical centers. Wyoming, for example, has none. In most states and many large metro areas, U.S. News has published a ranking of the Best Regional Hospitals to help healthcare consumers assess their nearest options.

[Which Cities Have the Best Hospitals?]

Some medical conditions are so serious and so complex that they require rare expertise beyond what most top regional hospitals can offer. Hospitals ranked nationally in a specialty have the skill and experience to treat cases that other hospitals cannot. Up to 50 medical centers are ranked per specialty, and a total of 148 earned a national ranking in at least one specialty. The best of these are called out on the Honor Roll, which recognizes 17 hospitals that are each near the top of the rankings in at least half a dozen specialties.

This year, the Honor Roll is led for the first time by Massachusetts General Hospital in Boston. Mass General displaces Johns Hopkins Hospital in Baltimore, which held the list’s No. 1 spot for 21 consecutive years. Three other hospitals joined the Honor Roll this year: NYU Langone Medical Center in New York, Northwestern Memorial Hospital in Chicago, and Indiana University Health in Indianapolis.

[See the Honor Roll in Pictures]

The rankings are based largely on objective measures of hospital performance, such as patient survival rates, and structural resources, such as nurse staffing levels. Each hospital’s reputation, as determined by a survey of physician specialists, is also a factor in the ranking methodology.

Hospitals’ adoptions of electronic medical records (EMRs) isn’t a factor in the Best Hospitals 2012-13 rankings. That’s because EMR usage, while booming, hasn’t been proven to consistently advance patient care. But given the scope of the digital shift afoot in medicine, and its potential to affect patients and their healthcare providers, U.S. News has taken a close look at which hospitals are leading the way in EMRs. The U.S. News Most Connected Hospitals list highlights 156 members of this vanguard.

For the youngest patients and their caregivers, U.S. News in June published a separate Best Children’s Hospitals Honor Roll and rankings in 10 pediatric specialties.

Best Hospitals 2012-13: How They Were Ranked

Here’s your situation: You are about to be hospitalized and your condition, or the procedure you need, is especially challenging. Should you simply trust the hospital that your doctor recommends? The Best Hospitals rankings give you a tool that might help you find a better one.

Now in its 23rd year, Best Hospitals’ central mission remains unchanged: to help those who need an unusual degree of skilled inpatient care decide where to get it, especially when there’s time to make a choice. Other ratings and rankings typically examine how well hospitals perform fairly routine procedures, such as hernia repair and uncomplicated heart bypass surgery, and how successfully they manage relatively unthreatening conditions such as mild heart failure. That’s fine for most hospital patients—in any given year, hardly anyone who visits a hospital spends a single night there. (There are about 20 outpatient visits for every hospital admission.) But for patients whose surgery or other care poses a technical challenge, or whose age, physical condition, or infirmities multiply the risk, good may not be good enough.

To be nationally ranked, a hospital must excel across a range of tough cases within a given specialty. For example, a hospital nationally ranked in cardiology and heart surgery—one of 16 specialties in which U.S. News evaluates medical centers—can be expected to have doctors with the talent and experience to replace a faulty heart valve in a patient well into his or her 90s. Most hospitals would decline to perform major surgery on such elderly patients, as they should if they aren’t up to speed on the special techniques and precautions involved and don’t see many such patients. A hospital ranked in gastroenterology can offer the most appropriate care to a patient whose severe inflammatory bowel disease flares up. At hospitals ranked in neurology and neurosurgery, surgeons face more spinal tumors in a couple of weeks than most community hospitals see in a year.

This year, only 148 of the 4,793 hospitals evaluated met such criteria and performed well enough to rank in even one specialty. And of the 148, just 17 qualified for a spot on the Honor Roll by ranking at or near the top in six or more specialties.

In 12 of the 16 specialties, a hospital’s ranking depends largely on objective data, much of which comes from the federal government. Many categories of data go into the rankings. The importance of some data points are self-evident, such as a hospital’s death rates. Others, such as the number of patients and the balance of nurses and patients, are important for less obvious reasons, but are backed by solid medical research. A survey of physicians, who are asked to name hospitals they consider tops in their specialty, produces a reputation score that is also factored in.

Hospitals in the four remaining specialties—ophthalmology, psychiatry, rehabilitation, and rheumatology—are ranked solely on their reputation among specialists. Most of the care in these specialties is delivered on an outpatient basis, and such a small number of patients die that mortality data, which are weighted heavily in the 12 other specialties, mean little.

To be eligible for ranking in any of the 12 data-dependent specialties, a hospital first has to satisfy at least one of four criteria: It has 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 of eight specific medical technologies, such as a PET/CT scanner and certain precise radiation therapies. This year a total of 2,227 hospitals, or 46 percent of the initial universe, made it through this first door.

The hospitals next have to meet a volume requirement to be eligible in a particular specialty. The threshold is a certain number of Medicare inpatients who were discharged from 2008 to 2010 after having had certain procedures or specific conditions related to the specialty. The number differs for each specialty. For 2012-13 the minimum number of heart patients, for example, was set at 1,308, of whom at least 500 had to have had a surgical procedure; in orthopedics the required number was 303 total, 275 of them surgical. A hospital that fell short still could make it through the gate if nominated by at least 1 percent of the physicians in a specialty who responded to the 2010, 2011, and 2012 reputational surveys. That left 1,868 hospitals eligible to be ranked. Fewer than 1 in 12 of them performed well enough to be ranked in any specialty.

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About thebenefitblog

Eric is a Producer at Lockton Insurance Brokers, Inc., the world’s largest privately held commercial broker. Eric has over 23 years of experience in the insurance industry and has spent the last 11 years with Lockton. Eric specializes in Health & Welfare Benefits, Retirement Planning, and Executive Benefits. Eric's clients utilize his expertise in the areas of Plan Due Diligence, Transaction Structure, Fiduciary Oversight, Investment Design, Compliance and Vendor negotiation to improve the operational & financial outcome for each client. The Benefit Blog is a place to share that expertise and industry news.
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