Latest / Becker’s Healthcare Podcast / How U.S. News Is Redefining Best Hospitals Rankings with Ben Harder

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How U.S. News Is Redefining Best Hospitals Rankings with Ben Harder · Becker’s Healthcare Podcast

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  - There's a small circle of people who truly
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  - understand what it takes to lead a health
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  - The variables are constantly shifting, and the stakes
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  - of getting a call wrong don't stay contained.
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  - That's not a complaint. It's a structural reality.
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  - And it's why the most effective c suite
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  - leaders are deliberate about where they go to
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  - pressure test their thinking.
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  - Becker's fourteenth annual CEO and CFO roundtable
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  - brings together more than 1,500
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  - executive level attendees
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  - and nearly 400 speakers for four days built
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  - around growth, financial sustainability,
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  - workforce strategy, and the leadership questions that don't
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  - have easy answers.
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  - Join us November second through the fifth in
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  - Chicago.
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  - For the agenda and event details,
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  - visit beckershospitalreview.com
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  - and click on the events tab in the
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  - upper right.
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  - Welcome to the Becker's Healthcare podcast. My name
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  - is Paige Twinter, and I'm an editor here
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  - at Becker's Healthcare.
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  - On today's podcast, I am thrilled to interview
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  - Ben Harder,
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  - managing editor and chief of health analysis at
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  - US News and World Report.
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  - Ben, thank you so much for joining me.
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  - Before we dive in, I'd love, you know,
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  - for you to briefly introduce yourself and tell
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  - us a bit about your background.
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  - Sure. Thank you so much for having me
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  - here, Paige. It was really a pleasure, and
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  - and and a privilege to be able to
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  - speak to Becker's, Becker's audience.
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  - So I'm, I am Ben Harder, as you
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  - said. I am a health care journalist by
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  - background.
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  - I began my career, actually at US News
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  - and then at other publications,
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  - including, you know, writing for the Washington Post
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  - and and USA Today and others,
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  - around,
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  - health care,
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  - both medical care and epidemiology,
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  - which gave me a heavy dose of research
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  - methods, which has been very helpful as I've
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  - actually come into, you know, leading a team
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  - at US News that is comprised of people
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  - with health services research backgrounds, epidemiology
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  - training, and so on. I'm the least educated
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  - member of my team. The rest of them
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  - have PhDs or at least masters in public
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  - health or some similar field, some quantitative
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  - area, and, it's a real privilege to be
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  - able to work with them every day. Just
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  - a a really smart group of people who
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  - are, good at identifying how to measure health
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  - care quality.
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  - One one today marks The US News And
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  - World Report's
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  - thirty seventh annual
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  - best hospitals
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  - ranking, and then you led this for about
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  - past fifteen years.
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  - This
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  - time around, what would you say is the
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  - single
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  - biggest change in what the report measures and
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  - what what drove that change?
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  - Yeah. If I if I can, I may
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  - cheat and and and mention two, changes? I
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  - think the the biggest change we're making this
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  - year is really leaning in on the regional,
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  - information that we provide to consumers.
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  - So we've introduced regional rankings in four,
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  - you know, major specialty areas,
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  - which complement and expand on regional rankings we've
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  - been publishing for over a decade. So we've
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  - been publishing,
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  - you know, the best regional hospitals rankings for
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  - every state, every major metropolitan area, for quite
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  - a while. This year, we expanded that to,
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  - look at,
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  - cardiovascular
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  - services,
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  - at orthopedics,
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  - at cancer, and at, physical rehabilitation.
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  - So those four areas now have their own
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  - regional rankings, which means that each state,
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  - if it has a hospital or at least
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  - one hospital that meets the criteria,
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  - it has a, you know, has a number
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  - one hospital in cancer and a number one
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  - hospital in orthopedics and and so on. I
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  - mean, that's really designed to help patients understand
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  - which
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  - hospitals may be appropriate for them based on
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  - their particular clinical needs.
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  - The second thing I would mention is we've
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  - continued,
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  - a long running evolution of our methodology
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  - toward, outcomes driven
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  - methodology. And so we've really leaned in on
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  - that this year, and a number of the
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  - changes we made, reduced the, role of or
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  - moved entirely
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  - the role of other factors, and really doubled
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  - down on, risk adjusted outcomes. And risk adjustment
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  - is really important to us because, obviously, every
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  - hospital treats a different mix of patients.
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  - But looking at how good the outcomes are
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  - that, that an organization achieves for its patients
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  - is now central to all of our rankings
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  - and ratings.
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  - I definitely wanna ask about
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  - the risk adjusted
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  - outcomes and kind of how case mix
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  - is involved in that. But first, for the,
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  - regional
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  - rankings and the,
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  - kind of localized rankings or service line specific
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  - ones,
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  - How should
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  - consumers
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  - and hospital leaders
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  - read,
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  - like, a strong regional results versus a national
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  - one?
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  - So they are really measured on the same
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  - yardstick.
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  - We use one methodology
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  - to assess, all hospitals in, for example, heart
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  - and vascular care,
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  - and then, you know, similar but but very
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  - distinct,
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  - measures, to measure them and say oncology care.
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  - The national ranking,
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  - is, is an indicator of a hospital being
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  - in the top 50 in the nation.
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  - So they really have to be a major
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  - quaternary care center in that specialty,
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  - to to to qualify.
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  - And those hospitals are are are, you know,
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  - national or at least sort
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  - of uber regional
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  - magnets for
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  - some of the most complicated and challenging cases
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  - that are often, research centers that are doing
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  - clinical trials and other advanced therapeutic,
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  - you know, clinical innovation,
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  - translational research, and so on. So that's really
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  - the the kind of archetype of the nationally
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  - ranked hospital.
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  - In each of those specialties that I mentioned,
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  - we also have regional rankings, and
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  - those
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  - include the nationally ranked hospitals, but also, another
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  - echelon of of hospitals that excel,
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  - but may not treat the same,
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  - complicated case mix. They may have,
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  - you know, outcomes that aren't quite as stellar
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  - as the nationally ranked institutions.
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  - But, nevertheless,
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  - they're incredible resources,
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  - for for people in the in the, you
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  - know, metro area or the region or the
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  - the state in which they're located and sometimes
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  - well beyond that state.
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  - And for patient outcomes, they're weighted differently
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  - this year, I believe. So what's the thinking
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  - behind
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  - that, and what what is it, like, emphasize
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  - or deemphasize compared to last, you know, previous
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  - rankings?
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  - Yeah. I mean, I'll I'll use,
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  - cardiovascular
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  - care as an example here. So our cardiology
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  - heart and vascular surgery,
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  - ranking,
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  - I I recently had a chance to speak
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  - about the methodological evolution at the US News
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  - Healthcare of Tomorrow conference, and that gave me
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  - an opportunity to look back at methodologies that
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  - we used in the past. And I've been,
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  - as you mentioned, at US News for quite
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  - a while, so I've, had the chance to
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  - shepherd the evolution of this methodology over more
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  - than a decade.
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  - Looking back about ten years,
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  - our methodology for evaluating top cardiology
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  - hospitals was about one third, risk adjusted outcomes,
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  - about one third survey of physicians, and about
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  - one third, sort of structural measures, you know,
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  - characteristics, services available at the hospital, and so
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  - on.
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  - This year with, with a, you know,
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  - con continued and and and and and pretty
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  - punctuated,
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  - change to that methodology,
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  - we are now 80%
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  - based on, risk adjust outcomes,
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  - and don't have any,
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  - role for, expert opinion. The survey of you
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  - know, we we we do continue to survey
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  - cardiologists about hospitals, but but we're we do
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  - not use that data in the methodology. So,
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  - you know, repute hospital's reputation has no role
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  - whatsoever.
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  - Again, 80% of the hospital score is determined
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  - by its performance on a panel of, over
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  - 40 different risk adjusted outcome measures looking at
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  - different subpopulations
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  - of the sort of, heart and vascular services.
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  - And, and the rest of it is, comprised
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  - of measures that are good proxies for, for
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  - being able to achieve good outcomes. For example,
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  - offering certain advanced services like, LVAD or a
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  - heart transplant
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  - or having considerable experience,
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  - performing,
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  - complex surgeries and so on.
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  - The 30% to 80%
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  - change in how the pie is, I I
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  - think that's crazy. That's a crazy
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  - difference
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  - from previous
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  - It's it's it's a big evolution. You know?
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  - One of the one of the sort of
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  - surprising things we found, though, is that the,
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  - the results actually haven't changed that much. Even
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  - as we've made these major shifts in in
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  - the methodology,
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  - that determine the rankings.
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  - The results are are are pretty similar to,
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  - you know, the same hospitals tend to excel
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  - across different methodologies, which is some somewhat reassuring
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  - in my mind that there's a consistency to
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  - the signal that we get even from different
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  - datasets and different ways of combining those measures.
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  - But I think it also
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  - really speaks to the importance of risk adjusted
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  - outcomes and how much power they have,
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  - when you're looking across tens of millions of
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  - records of patient encounters with hospitals as we
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  - do, to really identify,
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  - patterns that are
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  - signifiers of, the ability to provide high quality
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  - safe care.
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  - I have two more questions for you, Ben.
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  - So
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  - what would you say is
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  - a popular or or common misconception about how
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  - US News and World Report
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  - best hospitals report
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  - works?
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  - Mhmm. Yeah.
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  - I'll I'll I'll mention two again if if
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  - I can.
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  - One
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  - is a natural misconception, which is just an
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  - outdated,
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  - reference point. So I mentioned that ten years
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  - ago, our methodology is quite different than it
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  - is today. And I think particularly for many
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  - busy frontline clinicians,
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  - they still have some somewhat outdated,
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  - impression of how US News produces the rankings.
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  - In general, we find that hospital leaders,
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  - are more up to speed. Certainly quality teams
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  - are, you know, often very,
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  - well versed in our methodology and ask very
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  - sophisticated questions of my team.
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  - So this is not a a universal characterization,
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  - but I think there are still,
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  - you know, segments of the health care provider
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  - community that that think that, you know, reputation
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  - is a major driver, and it really isn't.
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  - We've made so many changes in the methodology
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  - and leaning in on outcomes, including,
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  - you know, significant upweighting of of risk adjusted
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  - outcomes this this specific year,
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  - that that's not really the the factor that
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  - determines,
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  - which hospitals are are ranked nationally or which
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  - hospitals are ranked regionally. So I think that's
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  - one
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  - misconception we do still encounter sometimes.
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  - The other is I think there's an impression
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  - in some quarters that the, rankings only recognize
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  - or even perhaps only
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  - consider hospitals that are major academic medical centers.
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  - And that might have been true at one
• 10:45
  - time, in the in in in in the
• 10:48
  - past, but
• 10:49
  - right now, you know, first of all, we
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  - evaluate
• 10:51
  - every hospital that treats Medicare patients. So we're
• 10:53
  - looking at over 4,000
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  - acute care hospitals, including critical access hospitals. Our
• 10:58
  - methodologies
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  - apply to all of those. We we look
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  - at every Medicare
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  - and Medicare Advantage encounter that that a hospital
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  - has, in its inpatient setting and increasingly in
• 11:08
  - outpatient settings as well.
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  - Hospitals don't have to do anything to participate.
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  - They don't have to submit any data to
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  - us or respond to any surveys or anything.
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  - It's all done automatically.
• 11:20
  - And, and so and so it's not limited
• 11:23
  - at all to just academic medical centers. And
• 11:25
  - in fact, the methodology
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  - changes that we made this year and the
• 11:28
  - evolution that we've had over a number of
• 11:30
  - years,
• 11:31
  - I think has,
• 11:32
  - in some ways expanded the you know, our
• 11:34
  - ability to detect really high performing hospitals,
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  - that may not be teaching hospitals or, you
• 11:40
  - know, major referral centers. Granted for some of
• 11:43
  - our methodologies, they're really designed to identify hospitals
• 11:46
  - that excel at that quaternary care. And so
• 11:49
  - in general, it's, you know, it's major teaching
• 11:51
  - hospitals that are going to perform well in
• 11:53
  - those rankings. But our procedures and conditions ratings,
• 11:56
  - for example, we now look at about two
• 11:57
  - dozen different,
• 11:59
  - specific services,
• 12:00
  - hip replacement, knee replacement, for example,
• 12:03
  - you know, colon cancer surgery,
• 12:07
  - TAVR,
• 12:08
  - other other services.
• 12:10
  - Those services,
• 12:12
  - we find that there are many hospitals that
• 12:13
  - are community hospitals that aren't large that really
• 12:16
  - can do those things quite well increasingly,
• 12:19
  - even something that's really relatively
• 12:21
  - novel and, still sort of, diffusing through the
• 12:25
  - market like TAVR. And so we're able to
• 12:27
  - identify those and recognize those as among the
• 12:29
  - best hospitals.
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  - This year, our best regional hospitals rankings, which
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  - recognize,
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  - the 500 hospitals across the country that really
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  - excel across broadest possible
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  - set of the services that we evaluate,
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  - the number of, of of among those 500
• 12:45
  - that are smaller than 200 beds doubled this
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  - year. And that's a direct result of methodology
• 12:50
  - changes we made that deemphasized,
• 12:52
  - the role of size and volume in the
• 12:55
  - methodology,
• 12:56
  - and really upweighted the role of risk adjusted
• 12:59
  - outcomes.
• 13:01
  - Were hospital leaders trying to make sense of,
• 13:04
  - you know, their the data they're looking at,
• 13:07
  - the release today,
• 13:08
  - what do you feel is the most productive
• 13:10
  - way for them to use this year's rankings
• 13:12
  - or data?
• 13:14
  - So first of all, understanding
• 13:16
  - where their organization's strengths are relative to others
• 13:20
  - is,
• 13:21
  - is one service that we hope to provide.
• 13:23
  - Again, our our
• 13:24
  - core audience is consumers who are looking to
• 13:27
  - make informed decisions about which hospitals excel at
• 13:30
  - the specific service they need, which is why
• 13:32
  - we evaluate hospitals across
• 13:34
  - dozens of different,
• 13:36
  - services, procedures, conditions, and specialties.
• 13:38
  - But that also provides information for health care
• 13:41
  - leaders
• 13:42
  - to understand, you know, to to do gap
• 13:44
  - analysis, to understand why are we not performing
• 13:47
  - as well as other hospitals in our community
• 13:49
  - or other hospitals nationally that we think of
• 13:51
  - as peers.
• 13:53
  - And we do do, you know, try to
• 13:55
  - to facilitate those comparisons to the extent that
• 13:57
  - that hospitals find that valuable.
• 13:59
  - But, but because it's done service by service,
• 14:03
  - they're able to hone in on places where
• 14:05
  - their organization didn't perform as well as they
• 14:08
  - expected or maybe one service line isn't performing
• 14:11
  - as well as others and identify whether there's,
• 14:14
  - an improvement opportunity. And then, obviously, they can
• 14:16
  - also lean in on their strengths. That's,
• 14:19
  - something they wanna, you know, wanna make sure
• 14:21
  - that patients know we want to make sure
• 14:23
  - that patients know which hospitals are good in
• 14:24
  - a particular area.
• 14:26
  - It's why we keep, you know, a robust
• 14:28
  - website, usnews.com.
• 14:30
  - It's freely available. We've added new tools this
• 14:33
  - year to help consumers compare hospitals, in a
• 14:36
  - specific service that they're interested in.
• 14:39
  - We've found, in fact, that the rise of,
• 14:42
  - of, search,
• 14:44
  - you know, of AI
• 14:46
  - driven search results,
• 14:47
  - has seems to have actually increased exposure of
• 14:49
  - The US News rankings. I think because humans
• 14:52
  - trust US News as an authoritative source of
• 14:54
  - data and information,
• 14:56
  - agents,
• 14:57
  - also trust us and, and have really highlighted,
• 15:00
  - the work that we do when answering consumers'
• 15:02
  - questions. So I think it's it's information that's
• 15:06
  - core designed to serve consumers' needs, but we
• 15:09
  - know that that's very helpful for, health care
• 15:11
  - executives both to be aware of and and
• 15:13
  - to meet consumers where they are and also
• 15:15
  - to identify
• 15:16
  - where they're strong, where perhaps their organization can
• 15:18
  - teach others or extend its, you know, its
• 15:20
  - excellence to to others in, you know,
• 15:23
  - hub and spokes model and that sort of
• 15:25
  - thing, but also where there may be,
• 15:27
  - you know, gaps that they can capable work
• 15:30
  - to improve on.
• 15:31
  - Well, thank you so
• 15:33
  - much, Ben, for joining me on the podcast
• 15:35
  - podcast today. I really enjoyed,
• 15:37
  - listening to your insights. I appreciate it.
• 15:40
  - No. Thank you, Paige. It was wonderful to
• 15:42
  - be here, and, thanks so much.