Amid criticism, U.S. News releases 2023-2024 Best Hospitals rankings

U.S. News & World Report has released the latest iteration of its Best Hospitals rankings amid industry rumblings over whether the annual list is appropriate for care and education transparency.

The 2023-2024 list lands with several methodology and format updates, such as the increased use of outpatient data, an emphasis on objective quality measures over expert opinions and the decision to list this year’s 22 “Honor Roll” hospitals without ordinal rankings. The publication continues to attribute ordinal rankings to its specialty and regional lists.

This year, U.S. News evaluated more than 4,500 U.S. hospitals across 15 specialties and 21 procedures. The group designated 484 of these as “Best Regional Hospitals,” while 164 were given a “High Performing Hospital” designation within at least one specialty.

The Honor Roll list featured many of the same designees of previous years—Johns Hopkins Hospital, Cleveland Clinic and Massachusetts General Hospital, to name a few—as well as new members North Shore University Hospital at Northwell Health, UC San Diego Health-La Jolla and Hillcrest Hospitals and UT Southwestern Medical Center.

Meanwhile, Mayo Clinic was the only hospital to come out on top for multiple specialties, earning the highest ranking within Diabetes & Endocrinology, Gastroenterology & GI Surgery and Pulmonology & Lung Surgery.

Others awarded a top spot across the other 12 measured specialties included the University of Texas MD Anderson Cancer Center (Cancer), Cleveland Clinic (Cardiology, Heart & Vascular Surgery), Brigham and Women’s Hospital (Obstetrics & Gynecology) and Memorial Sloan Kettering Cancer Center (Urology).

“Consumers want useful resources to help them assess which hospital can best meet their specific care needs,” Ben Harder, chief of health analysis and managing editor at U.S. News, said in a release. “The 2023-2024 Best Hospitals rankings offer patients and the physicians with whom they consult a data-driven source for comparing performance in outcomes, patient satisfaction and other metrics that matter to them.”

In a July 3 blog post, U.S. News analysts in charge of the rankings outlined a slew of methodology changes they said reflect the changing nature of the healthcare industry such as the shift to out-of-hospital services and increased focus on social and economic inequities.

While making the changes, they said the publication works “to ensure that any incentives that might lead to behavioral change among healthcare organizations exert a positive influence that will ultimately benefit patients and their communities”—a frequent point of criticism from individuals and organizations concerned that the rankings do more harm than good.

In late 2022 and early 2023, several of the country’s leading law schools and medical schools announced they would no longer be submitting data to U.S. News for their respective rankings over concerns about the “perverse incentives” and “harmful impact" such lists have on their missions.

Many of the medical schools said they would be seeking alternative approaches to sharing key information such as admissions on their websites and would continue submitting the raw data to industry organizations such as the Association of American Medical Colleges.

“Ultimately, the suitability of any particular medical school for any given student is too complex, nuanced, and individualized to be served by a rigid ranked list, no matter the methodology,” Harvard Medical School Dean George Daley wrote in January when announcing his institution’s decision.

Similar calls have since surfaced regarding U.S. News’ Best Hospital and Best Children’s Hospital rankings.

In a March Health Affairs op-ed, for instance, Seattle Children's pediatricians Madeline Wozniak, M.D., and Chinenyenwa Mpamaugo, M.D., dug into the outlet's published methodology to outline how the current rankings undervalue specialty care delivered to minority patient communities and, subsequently, perpetuate underinvestment in certain conditions.

Specifically, they compared the scoring for cystic fibrosis, which affects about 35,000 primarily white people in the U.S. and reflects nearly half of the points a children’s hospital could earn within the pulmonology subspecialty ranking, and sickle cell disease, which affects 1 in 365 Black newborns but extremely few white newborns.

"Dramatically overvaluing [cystic fibrosis] over [sickle cell disease] in rankings illustrates just how much U.S. News has failed to critically analyze structural racism in medicine, a failure that only perpetuates health inequities rather than addresses them," the authors wrote in the journal.

In June, the San Francisco city attorney sent the publication a letter seeking information on the rankings’ methodology as well as better insight into the payments U.S. News receives from hospitals willing to use its “Best Hospital” badge for marketing purposes.

Still, the publication’s hospital and children’s hospital rankings have yet to see a mass wave of pullouts similar to the law schools or medical schools. The exceptions so far have been St. Luke’s University Health Network and the University of Pennsylvania Health System, both of which said they will stop actively providing data and participating in the Best Hospitals rankings.

The latter organization—which was named as one of U.S. News’ 22 Honor Roll hospitals in the latest rankings and the 16 years prior—criticized the rankings’ focus on inpatient hospital care for those insured by Medicare. The publication said in its announcement that it is still “committed to annual publication of consistent, objective performance metrics” and will be developing a public-facing dashboard of these measures to be updated annually. It also hopes to “work with other health systems nationwide to develop standardized measures for self-reporting on quality and performance.”

“The U.S. News and World Report ‘Best Hospitals’ methodology changes regularly, making it difficult to meaningfully draw conclusions about hospital quality over time, let alone the enormous amount of care provided outside the hospital,” Patrick J. Brennan, M.D., Penn Medicine’s chief medical officer, said in the June announcement. “More importantly, these measures do not help us deliver better care for our patients, and they incentivize health systems to expend resources both to compete for placement in the rankings and promote their position on the list. Now is the time to focus our efforts, resources, and workforce talent on delivering the very best care and measuring the most impactful elements in medicine.”