Writer Avery Comarow on the best hospitals

July 12, 2000
Web posted at: 3:23 p.m. EST (1923 GMT)

(CNN) -- For the past 11 years, U.S. News & World Report has published an annual guide which ranks all of the hospitals in the country according to their specialties. The guide does not purport to take the place of asking questions specific to an individual’s needs, but rather acts as a resource. In addition to utilizing criteria such as a hospital’s reputation and mortality rate, 150 board-certified specialists in each of 17 medical fields are polled regarding which hospitals they consider to be the best in a particular specialty.

Avery Comarow, a senior writer with U.S. News & World Report.

Chat Moderator: Welcome to CNN Health Chat, Avery Comarow. We are pleased to have you with us today.

Avery Comarow: I am delighted to be here and to help people figure out which hospital to look for, even though I hope none of them will need one.

Chat Moderator: Can you give us an overview of the U.S. News & World Report report on hospitals?

Avery Comarow: "America's Best Hospitals" is an examination of all 6,247 hospitals in the country, with the idea of picking the hospitals that do the very best in terms of quality of care in 17 different specialties, from cancer to urology.

Chat Moderator: How did U.S. News & World Report qualify hospitals for your rankings?

Avery Comarow: To qualify hospitals for rankings, first all hospitals had to show that they were either a teaching hospital or affiliated with a teaching hospital, or that they had a sizeable amount of medical technology. Once they crossed that hurdle, then they had to show in each of 17 specialties that they had a sufficiently good reputation among board-certified specialists, that they had a sufficiently low death rate, and that their numbers in areas such as the number of nurses compared to the number of beds was adequate.

In 13 of the 17 specialties, we ranked hospitals from 1 to 50. In the remaining four specialties, they were ranked only by reputation because mortality data was not available, or it didn't matter, and the number of hospitals in each of those four specialties ranged from 18 to 22.

Question from Maggie: What's the top hospital?

Avery Comarow: We run a separate list called the "Honor Roll" of hospitals that do a number of things extremely well. They have to show that they rank at or near the very top in at least six of the 17 specialties. And this year, the number one hospital in the Honor Roll, for the 10th year in a row -- the envelope, please -- was Johns Hopkins, in Baltimore.

Question from Candyce-CNN: The number of ranked hospitals rose this year to 188. Does this mean managed care is doing a better job of taking care of patients?

Avery Comarow: Actually, it dropped -- 188 was the number last year. This year, it was 174. What this means to me, because we actually added a specialty this year in kidney disease, is that more hospitals are doing more things very well. Because if you have all of these rankings, yet you have fewer hospitals that appear in them, that means that those hospitals are doing very well across a wider range of specialties.

Chat Moderator: Since this is your 11th year of rankings, have you observed any trends over the years?

Avery Comarow: The funny thing is that, if anything, the trend has been no trend at all. Hospitals that we considered the best five, eight, nine years ago still tend to appear at the top of these rankings. The hospitals that were on our Honor Roll years ago tend to reappear in the Honor Roll. What that means to me is that we have a fairly large group of hospitals that have made a total commitment to extremely high quality.

There is one other change -- I don't know if I would call it a trend. More hospitals that are not academic teaching centers are coming into the rankings. I think that's a very encouraging trend if, indeed, it is a trend, because it means that a hospital doesn't have to be a teaching hospital to provide high quality care.

Question from Haley-CNN: How many hospitals were reviewed, and is there a list of the reviews on those hospitals available to the public?

Avery Comarow: We reviewed all of the hospitals in the country -- all 6,247. We don't release information on hospitals that were not ranked but, later today, on our Web site, www.usnews.com, the rankings will be available in all 17 specialties, complete with the numbers that went into the ranking of each one.

Chat Moderator: Do you find that some of the best hospitals are clustered in any geographical area, e.g. East and West Coast?

Avery Comarow: It depends on the specialty -- not so much by coast, but by region. For some reason, for example, there are many more cancer centers in the Midwest, or what the Census Bureau calls the Midwest, than there are in any other part of the country. And there are certain cities that have huge concentrations of hospitals. The three that immediately come to mind are Boston, Los Angeles and San Francisco, and I should add Chicago to that list.

Question from Candyce-CNN: Is it wiser these days to look for a good hospital first, then a good doctor, based on the comprehensive nature of healthcare today?

Avery Comarow: That's an interesting question. You have to remember that the hospitals we've listed are not hospitals where people should go for routine care. They are places to go when someone is really in trouble. In those cases, it does make sense to determine the expertise of a hospital in dealing with your condition, and that may lead you to a particular physician. But the hospital should be the entry point.

Chat Moderator: Did you take a look at emergency rooms in your report?

Avery Comarow: We did not look at emergency departments because which emergency room to go to is a local question and often emergency rooms are in community hospitals that may or may not be hospitals that would be in this issue. A national magazine has no business advising people where to go locally for emergency care.

Chat Moderator: What should health consumers look for in a good hospital?

Avery Comarow: What they should look for is the right answer to these questions. You should ask a hospital how many of the procedures that you're looking to have been done there in the last year. And what were the results? How many deaths? How many serious complications? What was the outcome for people of approximately your age and medical condition?

And then, ask those very same questions of the doctor you would be working with at that hospital. I can't give you specific numbers to look for, because it depends on the procedure. In this issue of U.S. News, there is a story that I wrote about the whole significance of sufficient numbers, and it gives some recommended numbers for a list of procedures.

Chat Moderator: How do U.S. hospitals compare to those overseas?

Avery Comarow: It's hard to know, because the federal government requires hospitals here to provide a lot of statistical information. That is not true in most other countries and, therefore, it's hard to make a direct comparison of our country's hospitals to those in other nations.

Question from Haley-CNN: How about trauma centers? Were they reviewed?

Avery Comarow: We did not review trauma centers. We used the presence of a very high quality trauma center as one of the pieces of information that went into the rankings.

Chat Moderator: Does this report take you all year to work on?

Avery Comarow: It takes us from roughly October through the end of June, so it takes us roughly nine months to give birth to this project. The number of people who work on this project goes up and down during the year, but the core group consists of two people at U.S. News and three people at our main contractor at the University of Chicago.

Question from Haley-CNN: Will this article be in this week’s U.S. News & World Report?

Avery Comarow: This package, the rankings and a number of associated stories will be in the issue of U.S. News that goes on sale this coming Monday.

Chat Moderator: Do you have any final thoughts for us today?

Avery Comarow: My final thought is not to automatically assume that you always have to go to one of the hospitals on one of these lists. I had coronary bypass surgery in 1998 at a hospital that we didn't even rank in heart care, and I was perfectly comfortable doing so. I had checked out the hospital and the surgeon and was satisfied that my needs would be met, and that I would walk out of the hospital rather than being wheeled out. And here I am!

Chat Moderator: Thank you, Avery Comarow, for joining us today.

Avery Comarow: I would like to say, once again, that I hope no one in this chat room ever has to be an inpatient at any hospital on or off these lists, and that you should all have a healthy and happy life!

Check out the CNN Chat calendar
Post your opinion on our message boards
Post your opinion on our Health Folder

Johns Hopkins Hospital tops U.S. News ranking of nation's best hospitals
July 7, 2000
Medical groups release new safety recommendations, questionnaires
May 19, 2000

American Hospital Association
Mayo Clinic & Foundation for Medical Education and Research

Note: Pages will open in a new browser window

External sites are not endorsed by CNN Interactive.