What It Takes To Be The Best

Three months after his knee replacement surgery, patient Paul Kreindler has physical therapy at the Hospital for Special Surgery in New York City.
Jim Lo Scalzo For USN&WR
For most people most of the time, the hospital their doctor recommends is fine — the majority of hospital care is fairly routine.

That's not a word normally associated with hospitalization, but consider this: In 2005, the latest year for which figures are available, fewer than 6 percent of hospital visits—including those for surgery—necessitated even an overnight stay.

Compare that with 7 percent in 1995 and 13 percent in 1985. Besides, many community hospitals are perfectly capable of performing operations formerly reserved for elite medical centers. Going to a hometown hospital means being close to family and friends, whose watchfulness might keep things from going wrong. And patients draw strength from their comforting presence.

A local hospital shouldn't always be the default choice, however. Many community hospitals cannot legitimately claim to be highly competent, to name just a few tough challenges, in replacing an elderly woman's heart valve, diagnosing and treating a cancer of the neck, shoring up a weak spot in the aorta that threatens to rupture, or saving a leg with circulatory blockages from amputation.

From admission to discharge, Dr. Bernadine Healy preps patients and their families for major surgery
What this means is that when confronted with a difficult or complex condition, selecting a hospital with a solid track record could be nothing less than lifesaving. That is why U.S. News has annually ranked America's medical centers for 18 years: to help patients find the best hospital when the need is great.

Centers of excellence. This year's "America's Best Hospitals" rankings cover 16 specialties, from cancer and heart disease to respiratory disorders and urology. (After a year's absence, geriatrics is back; pediatrics is not included, but only temporarily. It will return in the near future, revamped and expanded.) Hospitals are ranked by specialty and not by specific procedures because the goal is to identify facilities that excel at treating a variety of demanding illnesses and procedures within a specialty, not just a few.

Out of 5,462 hospitals evaluated, only 173 met that standard in one or more specialties. Most that did are referral centers, places accustomed to seeing the toughest patients and conducting bench-to-bedside research that advances the state of the art. We don't consider military and veterans hospitals, not by choice but because the federal government won't part with the necessary data. Of the 173 ranked hospitals, just 18 made the super elite Honor Roll. These are medical centers that scored at or near the top (at least 2 standard deviations above the mean) in a minimum of six specialties.

In 12 of the 16 specialties, a hospital's prowess is largely measured by hard data. In four others, ranking is determined solely by annual surveys of physician specialists, as explained in the "reputation" section below. Initial eligibility in the 12 data-driven specialties is based on meeting any of three standards: membership in the Council of Teaching Hospitals, affiliation with a medical school, or availability of at least six out of 13 advanced services such as image-guided radiation therapy and robotic surgery. This year, three quarters of all hospitals failed this first test.