How U.S. News weighs risk and outcomes for Best Hospitals

Conceivably, a hospital that is treating patients with the most aggressive cancers may see a slightly higher mortality rate than some other hospitals.

U.S. News & World Report takes such factors into account when it produces its rankings of the nation’s top hospitals. U.S. News released the 2026-27 Best Hospitals list Tuesday morning.

Ben Harder, chief of health analysis and managing editor at U.S. News, says outcomes are always a critical part of the analysis. But he says U.S. News also gives appropriate weight to hospitals that are treating patients with the most serious illnesses.

U.S. News has also refined its methodology to place greater weight on risk-adjust outcomes in this year’s rankings.

“You don't see hospitals that are risk averse performing well in the U.S. news rankings,” Harder says. “To be ranked, you have to get good outcomes, yes, but you have to be treating patients who need high quality care because they are among the most challenging patients.”

Here’s the transcript of our discussion about how U.S. News weighs both risk and outcomes in its Best Hospitals list.

Q: Leading cancer hospitals or leading hospitals for heart care, they often draw patients with the most serious conditions. They might have slightly less robust and impressive survival rates, but they're also getting a lot more complicated cases. Are you able to adjust for that type of factor in the analysis?

A: “Yeah, that's what risk adjustment is, and it's critical. I think clinicians do naturally fret a lot when it comes to looking at quality measurement programs like U.S. News, whether the higher acuity that some of them treat is being appropriately accounted for in the outcome measures. We feel really good about that. We publish a lot of the statistics around how well our risk adjustment models perform, so people can evaluate it for themselves.

“But I would say the simplest way of looking at this is: which hospitals earn a U.S. News Best Hospitals recognition? It's the hospitals that treat the sickest, most challenging patients. You don't see hospitals that are risk-averse performing well in the U.S. News rankings. To be ranked, you have to get good outcomes, yes, but you also have to be treating patients who need high-quality care because they are among the most challenging patients.”

“We see that year after year, and even more so this year with the increased emphasis on risk-adjusted outcomes: hospitals that are taking on those challenging patients and getting good outcomes for them are going to rise to the top. So if anyone questions whether risk adjustment is sufficient to appropriately account for the high risk that some hospitals take, just look at the patient population of the hospitals that are ranked by U.S. News. Most of them are quaternary care — the top-ranked hospitals are quaternary care referral centers. They're taking the sickest of the sick, the most challenging patients in each specialty. I think that really speaks to the power of risk adjustment.”

“When we look at raw outcome rates before risk adjustment, you're right, there are some hospitals that have higher mortality rates or higher readmission rates. And yet they rank higher than hospitals with lower outcome rates, because they are taking on those really challenging patient populations, and so their risk-adjusted outcomes are actually better than their peers.”