U.S. News made several changes to the Best Hospitals rankings methodology, including adding new data in structural and patient safety components. The most significant change is the 10% weight given to patient safety, doubling from 5% of each hospital’s overall score (in most specialties). The role of hospital reputation, as determined through a national survey of medical specialists, diminished by 5 percentage points.
Reasons for the Shift
- Component Weighting The weight for the process component (reputation) decreased from 32.5% to 27.5%, while patient safety increased from 5% to 10%, recognizing it as a critical component in evaluating and determining the best hospitals. Result: Hospitals with higher relative reputations and patient safety issues could experience a decrease in rank, all else being equal.
- Patient Safety Score Two patient safety indicators were added to the patient safety score due to the availability of POA indicators for bed sores and post-operative hip fractures. Result: Hospitals having a high volume of frail or major surgical patients could experience a lower patient safety score.
- Eligibility for Reputation-only Specialties Thresholds for reputation-only recognition increased to a score of 1% or greater, equating to 1 nomination per year, versus 1 nomination over three years, previously. Result: Eligibility will be restricted to hospitals that are more consistently nominated.
- New Physician Sampling Process for Reputation Half of the 2014-15 survey sampling was conducted through the Doximity online database, along with the AMA database. Result: The new format could increase response rates and improve chances that a wider selection of hospitals are nominated.
- Technology Cardiac ICU was removed from the Cardiology/Heart Surgery score, though still a requirement for eligibility. IMRT was added as a new technology, affecting the Cancer and Urology specialties.
- MS-DRG Deletions MS-DRG 689 (Kidney and Urinary Tract Infections with MCC) was removed from the Urology specialty (a significant medical comorbidity used in other specialties). Result: Hospitals depending on Complex UTI’s for Urology total case eligibility would be eliminated.
Recommendations for Improving Your Scores
Patient Safety Improvements
Hospital should form multi-disciplinary care teams, with clinicians and physicians, focused on the prevention of bed sores and post-operative hip fractures to outline and implement operational changes. Simultaneously, care alerts should be added in the EMR to encourage regular patient rotation and movement. Coders and nurses should be trained in the accurate identification, and recording, of bed sores detected upon admission. To aid in the reduction of hip fractures, door signs should be posted in inpatient units to identify patients who are at increased risk for falls; and a reevaluation of the usage of bed restraints as an overall hospital policy should occur.
Despite the reduction in weighting assigned to reputation, the bar has been raised for eligibility consideration. The result of these two incongruous changes dictates that a comprehensive physician reputation marketing plan be developed promoting overall hospital awareness and recognition of premier programs.
Addition of New Technology
Hospitals should consider conducting a cost-benefit analysis regarding the addition of an IMRT and determine its fit with the overall hospital growth strategy. In order to accomplish this goal, multiple oncology sub-specialists must identify the potential applications of the IMRT and projected usage.