A Hospital Ranking That Makes Sense.

• Author: Glastris, Paul

Ten years ago this fall, two dear friends of mine, the journalists Shannon Brownlee and Phillip Longman, joined me at the Washington Monthly offices to hash out an idea: creating a ranking of the nation's hospitals to compete with U.S. News & World Report's "Best Hospitals" list, just as the Monthly had done with its alternative college guide.

The three of us had worked at U.S. News in the 1990s, and Shannon and Phil had recently published seminal books about health care quality and cost that had been road-tested as articles in the Monthly. So we had an inside sense that U.S. News's hospital rankings suffered from the same basic design flaws as its college rankings. Both elevated (and still do) prestigious institutions that primarily cater to the elite at the expense of those that serve the rest of us, using metrics that are as dubious as they are destructive. Their hospital rankings focus almost exclusively on expensive specialized treatments and surgeries, like organ transplants. Meanwhile, they ignore the bulk of what most hospitals do, which is treating patients for more routine ailments, like broken bones and pneumonia. And they rely heavily on a survey of medical specialists, effectively boosting the ratings of hospitals with high national brand-name recognition, while downgrading or ignoring others that score better on measures of cost and value. The latter failing is especially damaging, given that health care costs for most privately insured Americans have been rising for years at twice the rate of wages.

Taking on U.S. News made sense to us because its rankings have real power. Hospital administrators all over the country devote considerable energy to climbing them--and then bragging about it on expensive billboard ads--because doing so helps bring in more well-insured patients. Yet such behavior also fuels the profligate and inegalitarian tendencies of our health care system.

We spent weeks back in 2010 looking into the specifics of building a robust alternative hospital ranking and quickly realized that it would take considerable funds, especially for computational expertise we lacked. When we couldn't find a funder, we shelved the project. But whenever we'd get together after that--often over dinner at each other's homes--we'd wind up excitedly talking about reviving the idea. It was our data journalism white whale.

Then, a couple of years ago, we had a breakthrough. Shannon was by then working at the Lown Institute, a health...