US News Best Hospitals 25th anniversary

As Americans become health care shoppers, learning to spend “their” money to meet high deductibles and manage expenses in health savings accounts, they seek information — made transparent through trusted, sometimes branded, sources. One of these is U.S. News & World Reports, which has published the U.S. News & World Reports Best Hospitals list since 1990, and as such, has become a popular go-to source for engaged patients looking for information on hospitals before receiving surgery, seeking second opinions for a medical condition, or moving to a new town looking to affiliate with a health system.

But in February 2014, a health policy journal published a story challenging the report’s methodology, and a news story emerged about hospitals’ use of the “Best Hospitals” logo — a familiar health care marketing brand frequently seen on outdoor billboards, on hospital websites, and in print media advertising giving hospital designees valuable “bragging rights” in their local markets.

This logo also appears to be a valuable asset for U.S. News as a company.

In a story titled Some hospitals won’t reveal how much they pay U.S. News for use of “Best Hospitals” logo, Fox 4 News in Kansas City, Kansas, reported that Children’s Mercy Hospital, a local pediatric facility ranked nationally in 9 pediatric specialties, and subsequently paid $42,000 to use the logo for one year in advertising. According to Fox 4, “The spokesperson said it’s a small price to pay to be able to tell the world about the hospital’s excellence.” 

U.S. News & World Report’s Best Hospitals for 2014-15 ranks a total of 144 hospitals in 16 specialties. An Honor Roll identifies 17 Best Hospitals with top scores in at least six specialties; the top 5 Honor Roll institutions include Mayo Clinic, Mass General, Johns Hopkins, Cleveland Clinic, and UCLA Medical Center.

U.S. News explains the project’s methodology here in an FAQ, and here in a detailed PDF that’s 129 pages long.

A Health Affairs article published in February 2014 criticized U.S. News’ methodology. Understanding Differences Between High- And Low-Price Hospitals: Implications For Efforts To Rein In Costs” by Chapin White and colleagues asserted that, “Quality indicators for high-price hospitals were mixed: High-price hospitals fared much better than low-price hospitals did in U.S. News & World Report rankings, which are largely based on reputation, while generally scoring worse on objective measures of quality, such as postsurgical mortality rates. Thus, insurers may face resistance if they attempt to steer patients away from high-price hospitals because these facilities have good reputations and offer specialized services that may be unique in their markets.”

Health Populi’s Hot Points: The “Best Hospital” designation has become a powerful and popular marketing component for those hospitals who have earned it over the years. In just the past two weeks since the list was published, news stories abound in local healthcare markets talking of the top-ranked hospitals in their towns. This is not trivial for local economies: hospitals are major employers in their communities, and they spin out local jobs for other businesses that serve hospital employees — think flower shops, card and gift stores, restaurants, parking lots, uniform outlets, and so on. Hospitals are local economic engines in their communities.

Thus, this designation is a coveted award. In return, to use the designation in advertising, those organizations awarded the designation pay a price to use the well-recognized logo, which yields potential economic benefits to the institutions in the form of the ability to attract new patients, skilled clinicians, staff, and, of course, bragging rights at the local country club and Rotary meetings. Some examples of these local stories include:

From the patient’s point of view, the Best Hospitals designation is but one piece in the complicated job that is health care shopping in the U.S. at this immature stage of health care transparency. (For more on transparency in health care, see my series here on Health Populi featuring a full week of stories on the topic). As U.S. News FAQ spells out on its second page, “The rankings are just a starting point….Patients have to do their own research.”

And patient and caregiver experience is the true, ultimate report card in health care. A personal story: my own father, dealing with chronic heart failure at the end of his long and fruitful life of 86 years, was a frequent flyer in and out of one of the nation’s consistently top cardiology hospitals in 2007. One night about midnight, I received a call from a hospital resident letting me know that he had just resuscitated Dad following a fall. I asked why the heck the young doctor would resuscitate Dad when there were Orders Not To Resuscitate he had signed earlier that day placed in the (paper-based) medical file. Suffice it to say, this was not the patient-centered response I would like to have seen at a Best Hospital. [As an aside, this experience motivated me to become involved in promoting Digital Directives and well-planned (and executed) end-of-life care. See my column Digital Directives Could Aid End-of-Life Care from iHealthBeat, published June 12, 2007.]

For more on health care shopping – with a nod to Smokey Robinson – check out You’d better shop around in HealthcareDIY.