Metro

Brigham and Women’s falls out of top 20 in US News hospital rankings

Jonathan Wiggs\Globe Staff

Like many institutions, Brigham and Women’s takes great pride in its top-20 status in the US News & World Report annual hospital rankings. The national accolade has been featured on its website and on huge banners strung across its front entrance.

But when the publisher releases its new honor roll on Tuesday, the Brigham won’t make the cut for the first time in 24 years. In the past, the Brigham has ranked as high as No. 6 on the list, which US News has published for 28 years.

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Dr. Allen Kachalia, the hospital’s chief quality officer, blamed the results, in large part, on one factor: US News made changes in how the rankings are determined that increase the importance of a specific measure of nursing care. Over the past several years, hospitals have gotten extra points for achieving something called “magnet designation’’ — a recognition given by a national nursing organization for superior nursing practices.

The Brigham applied for this designation in 2014 but does not expect to earn it until next year.

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Ben Harder, chief of health analysis at US News, said the role of magnet recognition in the rankings “didn’t dramatically change this year’’ but “remains an important differentiator.’’

He said the Brigham was affected by improvements in how US News measures patient safety. US News dropped two safety measures — how often patients suffer a specific type of lung injury and surgical wound complication — that it considers unreliable.

“Many hospitals that historically did very well on our patient safety measures — and Brigham and Women’s Hospital is among those — received scores that were closer to average this year,’’ he wrote in an e-mail. “It’s important to emphasize that this change is related to how we measure care, not a change in the quality of the care that any hospital delivered.’’

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The Brigham said it will pull back on its marketing around the US News list. “While it is wonderful to receive awards and accolades, they do not define us as an institution,’’ according to an e-mail the hospital planned to send to staff on Tuesday.

“It’s not like we’ve changed anything,’’ Kachalia said. “Our care here is still the best care possible.’’

A growing number of organizations evaluate hospitals on a wide range of measures, including the federal Centers for Medicare and Medicaid Services, Consumer Reports, and Leapfrog Group. They all use different measures and methodologies, which can be confusing for patients.

The US News honor roll is awarded to 20 hospitals the publisher believes deliver exceptional treatment in multiple areas of care.

Dr. Ashish Jha, a Harvard School of Public Health professor, said no ranking system is perfect, but that US News publishes some of the most reliable results. He said the organization has significantly improved its methods by relying less on hospitals’ reputations and more on patient safety and quality-of-care data.

Jha said he is surprised the Brigham would fall out of the top 20 and is not sure why magnet designation would carry such weight. “At the end of the day, so much of this is based on weighting. Because no hospital does great on everything. It’s a judgment call.’’

In a statement, US News highlighted several changes it made this year. They include adjusting for low-income patients and complicated patients transferred from other institutions, so hospitals aren’t penalized for treating patients who may have worse outcomes due to factors outside a hospital’s control.

‘No hospital does great on everything. It’s a judgment call.’

Ashish Jha, Harvard School of Public Health 
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Kachalia said the Brigham, part of the Partners HealthCare network, did not protest or appeal its drop off the honor roll.

“We commend them for continually adjusting what is the right way to judge hospitals,’’ he said.

This year, Massachusetts General Hospital, also owned by Partners, is the only hospital in the state that made the top 20. It ranked 4, following the Mayo Clinic, the Cleveland Clinic, and Johns Hopkins Hospital.

US News also ranks hospitals by specialty, and the Brigham is listed in the top 10 this year for gynecology and rheumatology, and in cancer as the Dana-Farber/Brigham and Women’s Cancer Center.

Liz Kowalczyk can be reached at kowalczyk@globe.com. Follow her on Twitter @GlobeLizK.
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