Best Hospitals Award Methodology
The Women’s Choice Award has identified America’s Best Hospitals across our nation to help women make smart healthcare choices. Our goal is to simplify your choice of hospitals as we understand how this critically important decision can impact you and your family. Being treated with the proper level of care impacts your health, well-being and healing so our goal is to identify those hospitals that have demonstrated the highest level of quality care to their patients, with a special focus on the female experience.
Being named and recognized as a hospital of choice among women is an honorable achievement as it represents the strongest and most important consumer message in today’s healthcare marketplace. Considering that women account for 90% of all healthcare decisions for her and her family, being a hospital of choice women trust is commendable.
Our methodology is unique in that it is the only national list that simplifies a woman’s choice when selecting a hospital. Our understanding of what matters most to women when selecting a hospital is based on surveys of tens of thousands of women, as well as research conducted in partnership with the Wharton School of Business on what drives the consumer experience for women vs. men. This research led us to understand that we cannot separate clinical performance from patient experience. Furthermore, all of the methodologies below take into consideration the female recommendation rating based on patient feedback.
In arriving at our award determinations, we use the most recent publicly available information from The Centers for Medicare and Medicaid Services (CMS), as well as accreditation information from appropriate sources. In some cases we have surveyed thousands of women to determine which measures are most important to them. Our methodology is objective, replicable and uniform. There are no subjective considerations for any of our awards.
America’s Best Hospitals for Bariatric Surgery
Hospitals earning the 2017 America’s Best Hospitals for Bariatric Surgery Award have met the Comprehensive Center standards of The American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS) through the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). A study in the Journal of the American College of Surgeons has shown that patients who have undergone weight-loss operations at Comprehensive Centers have had fewer postoperative complications, and lower costs are reported at accredited bariatric surgical centers compared with non-accredited centers.
Additionally, those awarded hospitals have received a patient recommendation rating above the national average on the HCAHPS survey by the Centers for Medicare and Medicaid Services (CMS).
America’s Best Breast Centers
America’s Best Breast Centers award recipients have all met the National Accreditation Program for Breast Centers (NAPBC) standards from the American College of Surgeons. Alternatively, they may also be designated as a Certified Quality Breast Center of Excellence (Comprehensive) by the National Consortium of Breast Centers.
To receive our award the center must also carry the seal of the American College of Radiologists as a Breast Imaging Center of Excellence (BICOE).
Those breast centers associated with a hospital must receive a rating in the top 75% for the Centers for Medicare and Medicaid Services’ (CMS) patient recommendation measures, or their equivalent in the case of breast centers without hospital affiliation.
America’s Best Hospitals for Cancer Care
The America’s Best Hospitals for Cancer Care must have received accreditation from the American College of Surgeons Commission on Cancer as any of the following: a National Cancer Institute (NCI) Designated Comprehensive Cancer Program; a Comprehensive Community Cancer Program; an Integrated Network Cancer Program (with over 200 beds); or an Academic Comprehensive Cancer Program. These accreditations require that the hospital have treated over 500 cancer cases in the most recent year.
These selected hospitals were then given a numerical score based on their patient recommendation rating from the Centers for Medicare and Medicaid Services’ (CMS) Hospital Consumer Assessment for Healthcare Providers and Systems (HCAHPS) survey. Additional criteria considered if a hospital offered on-site chemotherapy, radiation or hospice, and cancer research activities. Hospitals were penalized for having certain high infection rates (CLABSI and CAUTI).
America’s Best Hospitals for Emergency Care
The America’s Best Hospitals for Emergency Care are hospitals that consistently rank among the best of the 3,500 hospitals reporting on the performance of their respective Emergency Departments. They are judged on the following Emergency Department performance measures reported by the Centers for Medicare and Medicaid Services (CMS):
- Average number of minutes before outpatients with chest pain or possible heart attack got an ECG,
- Average time patients spent in the Emergency Department, before they were admitted to the hospital as an inpatient,
- Average time patients spent in the Emergency Department before they were seen by a healthcare professional,
- Average time patients spent waiting in the Emergency Department, after the doctor decided to admit them as an inpatient, but before leaving the Emergency Department for their inpatient room,
- Average time patients spent in the Emergency Department before being sent home,
- Average time patients who came to the Emergency Department with broken bones had to wait before receiving pain medication,
- Percentage of patients who came to the Emergency Department with stroke symptoms who received brain scan results within 45 minutes of arrival,
- Percentage of patients who left the Emergency Department before being seen.
Each of the measures indicated above were weighted according to a survey of over 1,000 women on their relative priority, and listed above in order of importance. In addition, hospitals that fell within the bottom 25th percentile for patient recommendation scores were eliminated from consideration for the award.
For each Emergency Department measure, the top 25th percentile and the top 50th percentile are determined for all hospitals reporting the measure. Hospitals that ranked in the top 25% nationwide for a measure received points according to the measure’s relative importance. Hospitals that ranked between 25% and 50% received half points. Points were then totaled for all measures, per hospital. Those hospitals with total scores that placed them in the top 10% nationally, earned the Women’s Choice Award.
America’s Best for Extended Care
The Extended Care award was given to those facilities that have 25 or more beds, and have received at least 18 combined stars in the four categories in the Centers for Medicare and Medicaid Services (CMS) five-star rating system. No three star ratings are accepted – only four and five stars. The CMS rating categories are:
- General Staffing
- Registered Nurse staffing
- Quality rating
- Inspection survey rating
Recipients must also have:
- Medicare certification
- Full sprinkler systems
- No recent history of penalties or fines.
Approximately 900 facilities were awarded out of over 15,000 across the nation.
America’s Best Hospitals for Heart Care
The America’s Best Hospitals for Heart Care list is determined by first identifying hospitals across the nation that offer a minimum of six of the following cardiac and/or vascular services:
- Cardiac Catheter Lab
- Cardiac Rehabilitation
- Cardiac Surgery
- Carotid Stenting
- Coronary Interventions
- Vascular Intervention
- Vascular Surgery
- Coronary Intensive Care (CCU)
Only qualified hospitals that performed well clinically with regard to heart care measures of mortality and readmission as reported to Medicare, and also have a high Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) recommendation score, are selected. Data provided is totally objective and uniform. No subjective considerations are used to determine the award recipients.
America’s Best Hospitals for Obstetrics
The America’s Best Hospitals for Obstetrics scoring process is unique in that it is the only national list that is evidence-based and focuses on female patient satisfaction. Awarded hospitals ranked above the national average for patient recommendations, as indicated by the data reported by the U.S. Department of Health and Human Services in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Additional considerations included: having a NICU on-site, low rates of early elective deliveries (between 0-1%) as well as ranking above the national average for patient safety.
America’s Best Hospitals for Orthopedics
The America’s Best Hospitals for Orthopedics are hospitals that provide comprehensive orthopedics services, indicating a minimal number of arthroscopy, joint replacements and spine surgery services, as well as offering onsite MRI and physical therapy. These full service hospitals are then judged based on their results through the Hospital Consumer Assessment for Healthcare Providers and Systems (HCAHPS) survey for patient recommendations and post-operative recovery instructions, measures that are very important to women when choosing a hospital.
Hospitals could be disqualified for abnormally high rates of surgical complications and infections. Data made available by CMS is utilized in a method that is totally objective and uniform. No subjective considerations were used to determine the award winners.
America’s Best Hospitals for Patient Safety
The America’s Best Hospitals for Patient Safety are hospitals that had a low incidence of problems arising from surgical errors and infections. The hospitals that report the frequency of these adverse surgical events to The Centers for Medicare and Medicaid Services (CMS) are ranked for each of the following eleven measures:
- Deaths among patients with serious treatable complications after surgery,
- Collapsed lung due to medical treatment,
- Serious blood clots after surgery,
- A wound that splits open after surgery on the abdomen or pelvis,
- Accidental cuts and tears from medical treatment,
- Serious complications,
- Central line-associated blood stream infections (CLABSI),
- Catheter-Associated Urinary Tract Infections (CAUTI),
- Surgical Site Infection from colon surgery (SSI: Colon),
- Methicillin-resistant Staphylococcus Aureus (MRSA) blood laboratory-identified events (bloodstream infections), and
- Clostridium difficile (C.diff.) laboratory-identified events (intestinal infections).
Hospitals can be eliminated from consideration for the following reasons:
- Not reporting on at least 4 of the surgical complication measures (1-6) or 4 of the infection measures (7-11),
- Having a patient recommendation rating in the bottom 25% nationally,
- Receiving a CMS rating of “Worse than the U.S. National Rate” for any of the above measures
- Not implementing Safe Surgery Checklists.
For the remaining hospitals, the Women’s Choice Award (WCA) averaged their rankings for all the measures (weighted slightly toward surgical errors as a result of a WCA women’s survey) and cut off the award list only including those that averaged in the top half nationally.
America’s Best Stroke Centers
The America’s Best Stroke Centers are hospitals that hold an Advanced or Comprehensive Stroke Center Certification, recognizing centers that meet high standards for stroke care as determined by the Joint Commission. To receive Advanced Primary certification, Stroke Centers must meet disease-specific requirements, clinically specific requirements, and expectations which include:
- Use of a standardized method of delivering care,
- Support for patient self-management activities,
- Tailoring of treatment and intervention to individual needs,
- Promotion of the flow of patient information across settings and providers, while protecting patient rights, security and privacy,
- Analysis and use of standardized performance measure data to continually improve treatment plans, and
- Demonstration of their application of and compliance with clinical practice guidelines published by the AHA/ASA or equivalent evidence-based guidelines.
In order to be certified as a Comprehensive Advanced Stroke Center, the center must meet additional requirements.
If a hospital has met the stroke center certification requirement, it must then meet or exceed the following performance measures from the Centers for Medicare and Medicaid Services (CMS):
- The time from emergency department arrival to head CT scan results (top 80% nationally),
- The time from first symptoms to receiving thrombolytic therapy (top 80% nationally),
- Provision of stoke education for patient and family before discharge (top 80% nationally),
- Patient recommendation scores above the national average,
- Rated Better or No Different than the U.S. National Rate for 30-day mortality measure, and
- Rated Better or No Different than the U.S. National Rate for 30-day readmission measure.
America’s 100 Best Hospitals for Patient Experience
The America’s 100 Best Hospitals scoring process is unique in that it is the only national list that focuses on female patient satisfaction. The process begins with a survey of hundreds of women. Our survey determines which questions in the HCAHPS* survey, completed by patients after discharge, are most important to them in determining their satisfaction with their hospital stay. A weight is given to each of the most important questions. For 2018, the most weight is given to those regarding the patient’s willingness to recommend, doctor and nurse communications, staff help, pain management, cleanliness and explanation of medications, in that order.
The responses to those questions, weighted accordingly, results in a numeric score for each hospital that reported valid HCAHPS data to the Centers for Medicare and Medicaid Services. The scoring is totally objective and uniform. The best 100 scores in each of the four hospital bed size categories (less than 100 beds, 101-250 beds, 251-400 beds, and over 400 beds) determine the recipients of the America’s 100 Best Hospitals for Patient Experience award.
*Hospital Consumer Assessment of Healthcare Providers and Systems.
Region’s Best Hospitals For Patient Experience
Hospitals are selected for this prestigious award based on the Women’s Choice Award proprietary scoring process that assesses the relative performance of hospitals in the region. Consideration is given to their Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction scores as well as their performance on patient safety and emergency care measures. Additionally, a Region’s Best Hospital must provide a full complement of medical services and carry more accreditations than their nearby competitors.
Best Children’s Hospitals
It is our intent to identify children’s hospitals that mothers and fathers can take their children to with the expectation that they will receive excellent and comprehensive care.
The determination of the Best Children’s Hospitals was based on information provided by almost 100 children’s hospitals across the nation. The award criteria looks at 5 different facility areas to determine which hospital is eligible for the Women’s Choice Award. These areas are Pediatric Services, Technology and Family Resources, Board Certified Staff, Nurses and Support Staff and the facility’s Commitment to Quality. We arrive at the top hospitals through a point system as described below.
- Family Centered Care
- Family sleeping/living accommodations
- Dedicated pediatric emergency department
- Pediatric ICU
- Neonatal ICU
- Child Life specialists
- Use of telehealth technologies
- Participation in pediatric health research
- Accreditation by the Joint Commission
- Pediatric Trauma Center accreditation
Each of the above contributes five points to the hospital’s score, with the exception of NICU, which earns five points for a Level IV and two points for a Level III. A maximum of 50 points can be earned for these services.
We also assign points for hospital staffing based on the number of beds per board certified pediatric professional in the following specialties:Anesthesiology
Points of 0 to 5 are assigned based on the relative number of beds per physician, with those having the least average beds scoring the most points. Each of the results was also weighted based on the average beds per physician for all the reporting hospitals, e.g. cardiology staffing was given twice times the weight of radiology staffing because the average number of beds per cardiology staff was 22 versus 52 for radiology. We assigned up to six additional points for high levels of other professional, nursing and support staff.
For those hospitals that did not submit new data for this year’s review, we used data submitted in 2016. We compared the point totals for all the hospitals and awarded those that scored above a point of discontinuity, where points declined rapidly. The Women’s Choice Award for Best Children’s Hospitals was given to 65 children’s hospitals that met our criteria, providing comprehensive services and highly qualified professionals in a wide variety of specialties.
Additionally, if a children’s hospital earned the Best Children’s Hospital award, they can also earn the Best Children’s Emergency Care award if they have all three of the following:
- Dedicated pediatric emergency department
- Pediatric intensive care unit (ICU)
- Pediatric Trauma Center accreditation
America’s Best Hospitals for Outpatient Experience
The America’s Best Hospitals for Outpatient Experience is predominantly determined on patient satisfaction with a hospital visit. The scoring process is unique in that it is the only national list that focuses on the opinion of females. Over 500 women were initially surveyed to determine which questions in the Outpatient and Ambulatory Surgery Survey (OAS-CAHPS) are most important to them in terms of satisfaction. For 2018, the most weight is given to the communication and care provided by the healthcare providers and staff, overall facility’s rating, patients’ recommendation and pre and post-surgical coordination respectfully.
The responses to OAS-CAHPS questions are compared to the nation’s average and a ranking is assigned to each hospital based on its overall numeric score in conjunction to the weights obtained from the survey. In addition, only facilities that are accredited can qualify for the award.