Healthgrades names America’s best hospitals. Here’s how the rankings are done.

It's not a popularity contest. The focus is on patient outcomes, and top honorees must show consistency over time, the company says.

Healthgrades has published its annual compilation of America’s best hospitals, and Brad Bowman stresses the rankings aren’t based on reputation.

Bowman is the chief medical officer and head of data science at Healthgrades, the company which allows consumers to search for information about doctors and hospitals. Healthgrades released its annual rankings Tuesday recognizing what the company considers the nation’s best hospitals: America’s 50, 100 and 250 Best Hospitals Awards. The company says each designation represents the top 1%, 2% and 5% of hospitals in the country.

The Healthgrades analysis reflects patient outcomes, and Bowman said that differentiates it from other rankings.

“We have no popularity component to our scores,” Bowman said in a phone interview Tuesday afternoon. “The only thing we measure is deaths and complications.”

In coming up with its rankings, Healthgrades examined about 4,500 hospitals and analyzed their performance in more than 30 common procedures and conditions, such as heart procedures and strokes. Healthgrades examined three years of Medicare patient data (2018 through 2020).

While focusing on patient outcomes, Bowman said the analysis involves poring through Medicare claims but also making adjustments as needed, such as age or severity of illness. Then Healthgrades creates a national set of averages to evaluate hospitals.

“We try to create this fair and equitable playing field based on the case mix of the patients going into the hospital,” Bowman said.

The top hospital rankings also reflect consistency, Bowman said.

To get into the top 250, hospitals must be among the top 5% of hospitals in at least 20 cohorts. To reach the top 100, hospitals must have reached the top 250 for at least 5 consecutive years. Those in the top 50 must have been ranked among the top 250 for 9 years in a row.

If all hospitals performed as those in the top 250, Healthgrades estimated 160,256 lives could have been saved.

While the rankings cover a wide array of conditions, Healthgrades did not weigh COVID-19 cases, even though the grading period includes 2020, the year the pandemic began. Bowman said incorporating COVID-19 cases introduces many variables, and some larger hospitals became magnets for coronavirus cases.

Bowman said the rankings offer consumers more tools to make the best choices to receive the best care, although most patients don’t do much homework when it comes to hospitals. Only 22% of consumers considered hospital quality the last time they selected a specialist, a recent Healthcare survey found.

“Consumers think hospitals are all the same,” Bowman said. “Nothing could be further from the truth.”

While it’s good to do research on surgeons for a specific procedure, Bowman said it makes sense to look at the hospital as well. “He may be the best surgeon, but you’ll only spend a couple hours with him,” Bowman said. If a procedure requires days in the hospital, it makes sense to do a little homework, he said.

Bowman said he hopes the rankings offer consumers more credible information when making choices about where they should get treatment.

“The whole reason for doing this is to steer consumers toward higher-quality care,” Bowman said. “It's about helping consumers find better care.”

The company also works with hospitals to help improve their care, including identifying areas where they can improve. “Many top-performing hospitals that you wouldn’t think need our help, are the ones that use our help the most,” he said.

Sometimes, hospitals don’t renew contracts if they fall off the list, prompting Bowman to joke that the business model isn’t quite perfect.

Hospitals do offer feedback, particularly if they fall off one of the top rankings, Bowman said.

“There’s winners and losers every cycle,” Bowman said. “When people roll off the list, they’re unhappy.”

And he said sometimes leaders are surprised when a community hospital outperforms a hospital with wider recognition. “We just have to agree to disagree,” he said.

While Bowman hopes consumers use the rankings to get better informed about hospitals, he said there’s value in using the Healthgrades website to gain more information about doctors, including how many procedures surgeons perform and patient evaluations.

“You should put at least as much effort in searching for a surgeon for your procedures as buying your next refrigerator,” he said.

Visit Healthgrades for the full rankings of the top hospitals.