TOP USA HOSPITALS

Johns Hopkins Hospital in Baltimore, Maryland, has regained the top spot in the annual honor roll of best hospitals compiled by US News & World Report after coming in a close second last year behind Massachusetts General Hospital in Boston.

The honor roll, consisting of 18 hospitals, is based on rankings in 16 different medical and surgical specialties. The magazine said it created its rankings "to identify the best medical centers for the most difficult patients."

Except for 2012, Johns Hopkins Hospital has had a lock on first place in the ranking since 1991. This year, the Baltimore hospital made a comeback, amassing 30 "honor-roll points" in the magazine's scoring system compared with 29 points for Massachusetts General Hospital, according to the ranking published online today.

Table 1. US News & World Report Top Hospitals Honor Roll

1. Johns Hopkins Hospital, Baltimore, Maryland

2. Massachusetts General Hospital, Boston

3. Mayo Clinic, Rochester, Minnesota

4. Cleveland Clinic, Ohio

5. Ronald Reagan University of California–Los Angeles Medical Center

6. Northwestern Memorial Hospital, Chicago, Illinois

7. New York–Presbyterian University Hospital of Columbia and Cornell, New York City

8. University of California–San Francisco Medical Center

9. Brigham and Women's Hospital, Boston

10. UMPC-University of Pittsburgh Medical Center, Pennsylvania

11. Hospital of the University of Pennsylvania, Philadelphia

12. Duke University Medical Center, Durham, North Carolina

13. Cedars-Sinai Medical Center, Los Angeles, California

14. New York University Langone Medical Center

15. Barnes–Jewish Hospital/Washington University, St. Louis, Missouri

16. Indiana University Health, Indianapolis

17. Thomas Jefferson University Hospital, Philadelphia

18. University Hospitals Case Medical Center, Cleveland, Ohio

Hospitals amass honor-roll points based on the individual specialty rankings. In 12 of the 16 specialties, measurable performance in terms of quality of care, safety, and mortality accounts for two thirds of a hospital's score. The institution's reputation among specialists, ascertained by a survey, accounts for the remaining one third. In contrast, hospitals are judged solely by their reputation in ophthalmology, psychiatry, rehabilitation, and rheumatology, fields in which most of the care is delivered on an outpatient basis, making mortality rates relatively insignificant, according to US News. Some patient-safety experts, however, do not consider reputation to be a reliable proxy for quality.

To make the honor roll, hospitals must rank at or near the top of at least 6 specialties. For the 12 data-driven specialties, that means placing in the top 20. For the 4 reputation-only specialties, being in the top 10 is good enough. In addition, these hospitals earn up to 2 honor-roll points in each specialty depending on how high they place.

Johns Hopkins earned 30 honor-roll points — and the top spot in the honor roll — by placing first in 5 specialties and in the top 6 in 10 other fields.

Year after year, the top 5 positions in the honor roll have been occupied by the same 5 hospitals, although not always in the same order. Below the top 5 spots, the list is more volatile. Barnes-Jewish Hospital, the adult teaching hospital of Washington University, in St. Louis, fell from sixth place in last year's ranking to 15th in this year's. Meanwhile, the University of California–San Francisco Medical Center rose from 13th place to eighth.

The rearranged list may reflect several changes in the magazine's ranking methodology. In one change, the magazine excluded patients from the patient-safety calculation if they were admitted to the hospital with a condition that put them at greater risk for harm. Accordingly, a hospital would not be marked down if a patient still recovering from pneumonia were admitted for surgery and afterward experienced respiratory problems.

Ranking Began With More Than 4800 Hospitals

The number-one honors by specialty in 2013 repeat those in 2012 for 75% of the 16 fields. The only changes at the top occurred in nephrology, psychiatry, pulmonology, and urology.

Table 2. Top Hospitals by Specialty

Cancer: University of Texas MD Anderson Cancer Center, Houston

Cardiology and Heart Surgery: Cleveland Clinic

Diabetes and Endocrinology: Mayo Clinic

Ear, Nose, and Throat: Johns Hopkins Hospital

Gastroenterology: Mayo Clinic

Geriatrics: Johns Hopkins Hospital

Gynecology: Mayo Clinic

Nephrology: Mayo Clinic

Neurology and Neurosurgery: Johns Hopkins Hospital

Ophthalmology: Bascom Palmer Eye Institute at the University of Miami, Florida

Orthopedics: Hospital for Special Surgery, New York City

Psychiatry: McLean Hospital, Belmont, Massachusetts

Pulmonology: Mayo Clinic

Rehabilitation: Rehabilitation Institute of Chicago, Illinois

Rheumatology: Johns Hopkins Hospital

Urology: Johns Hopkins Hospital

To arrive at its rankings in the 12 specialties graded mostly on the basis of hard data, US News screened 4806 nonfederal community hospitals — the magazine said it could not persuade the federal government to release the necessary data on its hospitals — using 4 eligibility requirements. Hospitals made the first cut if they were affiliated with a medical school, belonged to the Council of Teaching Hospitals, staffed at least 200 beds, or fielded at least 4 of 8 specified medical technologies such as a positron emission tomography–computed tomography scanner. They made the second and final cut if they met thresholds for patient discharges in at least 1 of the 12 data-driven specialties.

All these requirements were waived for hospitals in the 4 specialties judged solely on the basis of reputation. Such hospitals were ranked if they were nominated by at least one physician.

Once the eligible hospitals in all 16 specialties were graded according to performance measures and reputation, only 147 earned a national ranking in one or more specialties.

The full list of top hospitals by specialty is available on the US News & World Report Web site.