This year, the U.S. News hospital rankings place more weight on outcomes

U.S. News & World Report made some noteworthy changes in its methodology of selecting its “Best Hospitals for 2025-26.”

This year, U.S. News placed a greater weight on hospital outcomes in selecting its best regional hospitals. The analysis of hospitals includes a bigger emphasis on survival rates, discharging patients to homes and readmissions, says Chelsey Wen, a senior health data analyst at U.S. News.

“The common theme of this year is increasing that weight on outcomes,” Wen says.

• Read more: U.S. News reveals top hospitals for 2025-26

In ranking hospitals in their performance of procedures and conditions, up to 75% of the composite score is now based on outcomes, she says.

“We want to make our ratings and rankings useful for patients,” Wen says. “And I think what matters most to patients is those outcomes, like survival, like readmission, discharge to home. So over the years, we've been making these steps, small steps, but they're all towards an ultimate goal of making more of those objective patient outcomes of focus in the actual results.” (See part of our conversation in this video. The story continues below.)

The new methodology in assessing the top regional hospitals favors mortality outcomes, Wen says. And that’s reflected in the hospitals ranking among the best in their regions.

“Honestly, the overall trend for these high performing hospitals is that they have better survival rates,” Wen says.

The shift is also being seen in another aspect of the best regional hospitals, with specialty rankings no longer being utilized. “With Best Regional Hospitals this year, we've revised it slightly so that it more so depends on performance, on the procedures and conditions, instead of the specialties,” Wen says.

“We are shifting to a very outcome-based methodology,” she says. “For example, this year, because we're not using the specialty ranking to decide which hospitals are (Best Regional Hospitals), that means that expert opinion is not going to be a factor in that subset of hospitals.”

U.S. News also tries to account for the complexity of certain cases in assessing outcomes, including mortality, and if certain hospitals see more patients with certain conditions because they have more experience or proficiency in those areas.“We do try to account for the complexity of the cases served to the best of our ability,” Wen says. “So we are able to capture comorbidities in the inpatient data, and that allows us to have some sort of benchmark to risk adjust the outcomes based on that.”

In the future, Wen says U.S. News may also offer more consideration to the risk profile of inpatient populations and outpatient populations in evaluating hospitals.

U.S. News first began publishing its annual hospital rankings in 1990, and has refined its methodology repeatedly over the years.

When the rankings were first compiled, they were rooted in expert opinion, Wen notes. Now, U.S. News is utilizing objective data for the bulk of its rankings.

For the rankings in 12 of the 15 specialties examined, U.S. News compiles those rankings largely on objective data, including Medicare claims and other publicly available data. U.S. News ranked the top 50 hospitals in each of those 12 specialties, based primarily on survival rates, if patients are discharged to their homes rather than another facility, and avoiding complications.

There are three specialties - ophthalmology, psychiatry and rheumatology – where the U.S. News rankings are based entirely on expert opinion. In those areas, U.S. News says it developed the rankings based on three years of surveys of about 30,000 specialists asking where they would send their sickest patients.

This year’s rankings also include additional data on complications in knee replacement and hip replacement ratings for the first time this year. Other outpatient ratings have included measures of complications in the past.

Reflecting patient trends, the U.S. News rankings weigh outcomes on patients who use Medicare Advantage, including survival rates in procedures and conditions. U.S. News says the analysis of Medicare Advantage patients doesn’t include discharge destinations, because certain insurers’ policies can affect how long patients stay in the hospital.

Wen says the incorporation of more Medicare Advantage data has been discussed for a while, given the growing popularity of those plans. More than 30 million Americans are participating in Medicare Advantage plans.

“We have noticed that trend, and I think it contributed to the validity of our results and the relevance of it to most Americans, because of that large population share that is moving towards Medicare Advantage,” Wen says.

The U.S. News rankings include two new additions to the ratings on procedures and conditions: arrhythmia and pacemaker. Hospitals were evaluated in their treatment of atrial fibrillation and other cardiac arrhythmias. And the ratings include how hospitals fared in treating patients who require a pacemaker and didn’t need one previously.

“It's a combination of us listening to the healthcare industry and what clinicians are saying is more necessary and becoming more relevant,” Wen says. “And if the data is there, we're going to want to measure it.”

As U.S. News publishes other rankings in the coming years, Wen says she expects to see the evaluations relying more on data on patient outcomes.

“I think as we move into the future, we'll see more and more of that focus on those objective outcomes,” she says.