Healthgrades Americas Best Hospitals for Clinical Excellence Methodology

TABLE OF CONTENTS

• Performance Measurement Data
• America’s 250 Best Hospitals™ Methodology
  
  • America’s 250 Best Hospitals™ Award Determination
• America’s 50 & 100 Best Hospitals™ Methodology
  
  • Identifying America’s 50 Best Hospitals™
  • Identifying America’s 100 Best Hospitals™

To help consumers evaluate and compare hospital performance specific to specialty service lines and specialty focus areas, Healthgrades communicates performance in two ways—through ratings and awards.

To measure performance and evaluate hospitals for overall clinical excellence, Healthgrades used Medicare inpatient data from the Medicare Provider Analysis and Review (MedPAR) file purchased from the Centers for Medicare and Medicaid Services (CMS) for years 2019 through 2021.

Patient outcomes data for 31 conditions or procedures were analyzed (see list below) for virtually every hospital in the country.

Mortality-Based Procedures & Conditions

Bowel Obstruction	Pancreatitis
Chronic Obstructive Pulmonary Disease (COPD)	Pneumonia
Colorectal Surgeries	Pulmonary Embolism
Coronary Artery Bypass Graft (CABG) Surgery	Respiratory Failure
Coronary Interventional Procedures	Sepsis
Cranial Neurosurgery	Stroke
Gastrointestinal Bleed	Upper Gastrointestinal Surgery
Heart Attack	Valve Surgery
Heart Failure

In-Hospital Complications-Based Procedures & Conditions

Abdominal Aortic Aneurysm Repair	Hip Replacement
Back and Neck Surgeries (Without Spinal Fusion)	Pacemaker Procedures
Carotid Procedures	Peripheral Vascular Bypass
Defibrillator Procedures	Prostate Removal Surgery
Diabetic Emergencies	Spinal Fusion
Gallbladder Surgery	Total Knee Replacement
Hip Fracture Treatment	Transurethral Prostate Resection Surgery

Healthgrades America’s 250 Best Hospitals Award recognizes hospitals for superior performance in providing care for conditions and procedures across multiple specialty lines and areas. America’s 250 Best Hospitals Award recognizes the top 5% of hospitals in the country for clinical excellence. While many hospitals have specific areas of expertise and high-quality outcomes in certain areas, these hospitals exhibit comprehensive high-quality care across clinical areas.

To help consumers evaluate and compare hospital performance relative to this award, Healthgrades uses a two-step methodology:

1. Evaluate hospital performance for 31 procedures and conditions using Healthgrades Mortality and Complication Outcomes Methodology. Specifically, Healthgrades evaluates each hospital’s actual performance as compared to the predicted performance for that hospital based on the application of a specific risk-adjustment model. For more details, see Healthgrades Mortality and Complications Outcomes Methodology.
2. Identify the hospitals with superior performance overall for up to 31 of these conditions and procedures using eligibility requirements and the clinical excellence award determination steps below.

To be considered for the Healthgrades America’s 250 Best Hospitals Award, a hospital must have evaluations in at least 21 of the 31 Healthgrades procedures and conditions using Medicare inpatient data from the Medicare Provider Analysis and Review (MedPAR) file purchased from the Centers for Medicare and Medicaid Services (CMS).

After creating a list of hospitals that meet the above eligibility criteria, Healthgrades uses the following steps to determine recipients of the America’s 250 Best Hospitals Award:

1. Determine an overall performance score: The overall performance score for each hospital is calculated using volume-weighted z-scores averaged across all complication and mortality-based cohorts. Volume weights represent the proportion of patients within a given cohort and outcome measure. The proportion is calculated as the ratio of patients in a cohort and outcome measure over total patients across all cohorts and outcome measures. 

Performance is assessed at two time points for mortality cohorts: in-hospital and at 30-days post admission. The patients used for in-hospital mortality and 30-day mortality are treated as independent for the volume weighting calculation.

As each mortality cohort is composed of two outcomes measures (in-hospital mortality and 30-day mortality), and complication cohorts have only one outcome measure, the individual influence of mortality and complication outcomes on the overall performance score is 2 to 1.

Within the mortality cohorts, a higher emphasis is placed on 30-day mortality (0.6) compared to in-hospital mortality (0.4). The 30-day mortality outcome measure is considered a more statistically significant quality indicator and is used for various quality improvement initiatives, including the Hospital Value-Based Purchasing Program by the Center for Medicare and Medicaid Service (CMS).

The final contribution of each cohort to the overall score will vary based on the mix of cohorts at any given hospital.

1. Determine performance in sequential order:  Hospitals are listed in descending order by their overall performance score.
2. Identify top 5% of all facilities: The top performers are selected from the above listing and receive the America’s 250 Best Hospitals Award for 2023.

Healthgrades identifies America’s Best Hospitals and stratifies performance into two categories for consistently delivering clinical excellence year over year: America’s 50 Best Hospitals and America’s 100 Best Hospitals.

Healthgrades America’s 50 Best Hospitals Award recognizes 50 hospitals as the top 1% in the nation for consistent clinical excellence based on an analysis of risk-adjusted mortality and complication rates for common procedures and conditions.

Specifically, these hospitals have received a Healthgrades America’s 250 Best Hospitals Award in consecutive years over an extended period of time.

To identify America’s 50 Best Hospitals, Healthgrades uses the following three-step process:

1. Identify those hospitals that received the America’s 250 Best Hospitals Award in 2023 and count the number of consecutive years of receiving the America’s 250 Best Hospitals Award.
2. Rank order hospitals by number of consecutive years that they received the America’s 250 Best Award, and then secondarily sort by their volume-weighted z-score for the 2023 award year. The volume-weighted average z-score is a statistical measure of hospital quality outcomes. 
3. Identify hospitals that received the America’s 250 Best Hospitals Award for at least eight consecutive years. Since more than 50 hospitals received the America’s 250 Best Hospitals Award for a minimum of eight years, we use the most recent volume-weighted z-score to determine the top 50 and create the America’s 50 Best Hospitals for 2023 list.

Healthgrades America’s 100 Best Hospitals Award recognizes the top 100 hospitals as the top 2% in the nation for consistent clinical excellence based on an analysis of risk-adjusted mortality and complications rates for common procedures and conditions.

Specifically, these hospitals have received the America’s 250 Best Hospitals Award in consecutive years over an extended period of time.

To identify America’s 100 Best Hospitals, Healthgrades uses the following three-step process:

1. Identify hospitals that received the America’s 250 Best Hospitals Award in 2023 and count the number of consecutive years of receiving the America’s 250 Best Hospitals Award. 
2. Rank order hospitals by number of consecutive years that they received the America’s 250 Best Hospitals Award, and then secondarily sort by their volume-weighted z-score for the 2023 award year. The volume-weighted average z-score is a statistical measure of hospital quality outcomes. 
3. Identify hospitals that received the America’s 250 Best Hospitals Award for at least five consecutive years. Since more than 100 hospitals received the America’s 250 Best Hospitals Award for a minimum of five years, we use the most recent volume-weighted z-score to determine the top 100 for the America’s 100 Best Hospitals for 2023 list—which includes America’s 50 Best Hospitals. These hospitals are recognized as the top 2% in the nation for consistent clinical quality.

For a downloadable version of the complete methodology, see the Healthgrades America's Best Hospitals for Clinical Excellence 2023 Methodology PDF.

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