FAQ: How and Why We Rank and Rate Hospitals

The Best Hospitals rankings are broken into two subcomponents — specialty rankings and procedure and condition ratings. Understanding which is more relevant to you depends on the medical condition for which you’re seeking hospital quality information.

The Best Hospitals specialty rankings are meant for patients with life-threatening or rare conditions who need a hospital that excels in treating complex, high-risk cases. These rankings are helpful if you’re looking for information about a rare condition or difficult diagnosis that isn’t treated at many facilities.

Hospitals are ranked from 1 to 50 in each specialty, with hospitals not in the top 50 but still in the top 10% of all rated hospitals receiving a designation of “high performing.”

The Best Hospitals procedure and condition ratings focus on specific and more commonly required individual procedures and conditions, such as hip replacement and heart failure, rather than on broader specialties like orthopedics and cardiology. The goal is to evaluate how well hospitals perform in each procedure or condition – not just with the most challenging cases, as with the specialty rankings, but with the full range of patients.

Because the procedures and conditions evaluated are performed at many more hospitals than the specialties, the evaluations produce ratings rather than numerical rankings. Hospitals that treat enough patients to be evaluated are rated one of three ways for each procedure or condition: high performing, average or below average.

Based on your health situation, it might make more sense to go to an average hospital closer to you or within your insurance network than a high-performing hospital that is far and out-of-network.

As always, these ratings should be taken as a starting point. All care decisions should be made in conjunction with medical professionals.

Say your doctor has informed you that you’re about to take your place among the more than 30 million patients a year admitted to U.S. hospitals for a procedure or other care. You may want to start researching your care options.

Checking the U.S. News Best Hospitals specialty rankings in whichever of the 15 specialties applies to you is in order if your care calls for special expertise or if age, physical ailments or a chronic condition could add a layer of risk.

This FAQ explains how the Best Hospitals specialty rankings are produced and addresses questions of interest to media and health care professionals. A formal methodology report, available as a downloadable PDF, provides much more detail.

U.S. News evaluates 15 specialty areas of care. In 12 of the specialty areas, rankings are derived from data sources, such as Medicare. These specialties include:

In the remaining three specialties – ophthalmology, psychiatry and rheumatology – ranking is determined entirely by expert opinion, based on responses from three years of surveys of physician specialists who were asked to name the hospitals to which they would be inclined to refer their sickest patients.

The rankings name the top 50 hospitals for complex care in each of the 12 data-driven specialties and roughly a dozen in the three expert opinion-based specialties.

U.S. News estimates that nearly 2 million hospital inpatients a year face the prospect of surgery or special care that poses either unusual technical challenges or significantly heightened risk of death or harm because of age, physical condition or existing conditions. The rankings are a tool that can help these patients and their families find sources of skilled inpatient care.

The 15 Best Hospitals’ national specialty rankings are updated annually. As noted, rankings in 12 of the 15 rely largely on objective data. Each specialty showcases the 50 top-scoring hospitals, based primarily on survival rates for particularly challenging patients, patient experience and other measures of performance that can be assessed using hard data. All evaluated hospitals and their results, including overall scores, are displayed online, but rankings are only displayed for the top 50.

In these 12 specialties, results from the three most recent years of an annual expert-opinion survey of specialized physicians are also factored in. Surveyed physicians are asked to name up to five hospitals they consider the best for complex cases in their specialty.

Except in rehabilitation; ear, nose and throat; and obstetrics and gynecology, hospitals not nationally ranked but that scored high enough in a specialty to put them in the top 10% of the analyzed centers are recognized as high performing. Hospitals nationally ranked in at least one data-determined specialty, or that earned at least seven ratings of high-performing and few or no low-performing ratings across the 21 Best Hospitals procedures and conditions, are further designated as Best Regional Hospitals within their state, metro area or region.

In the three Best Hospitals expert opinion-based specialties, national ranking is based on the latest three annual physician surveys referenced above. Those receiving nominations from a weighted average of at least 5% of the respondents are nationally ranked Best Hospitals. Those nominated by at least 3% but below 5% of physicians are high performing. Each physician’s response is assigned a weight that ensures the weighted averages represent the overall opinion of all specialists nationally, not simply those who responded.

The 22 hospitals with the most and highest rankings and the greatest number of high-performing procedure and condition ratings are recognized in the Honor Roll.

Not necessarily. Hospitals are evaluated across a wide range of conditions and procedures. Within that range, hospitals can and do perform differently. In pulmonology and lung surgery, for example, a hospital might rank below another one but do better at treating patients with chronic obstructive pulmonary disease.

That’s right. Patients still have to do their research and talk with their doctors. We also understand that families have to consider such factors as the stress and expense of travel and lodging in another city and their insurer’s willingness to pay for care if a hospital is out of network.

For consideration in the 12 data-driven rankings, the rankings started with about 4,500 hospitals, which represent virtually all U.S. community inpatient facilities.

No. That misconception persists, even in medical journals that make the assertion. In fact, teaching status or medical-school affiliation are only two of the four ways a hospital can be a rankings candidate.

Many hospitals become part of the eligible pool through two other pathways. A hospital qualified for consideration in the 12 data-driven specialties if it satisfied any of four criteria:

More than 2,000 hospitals met one of the four standards. Eligibility standards for the rehabilitation rankings were slightly different.
In the three specialties in which ranking was determined only through the last three physician surveys, any hospital with enough nominations was ranked.

No. Claims data for VA and military hospitals are unavailable in Medicare claims data and are largely unavailable. If these data become publicly available, we will consider evaluating them.

Hospitals had to show that they treated a given number of patients with explicitly defined conditions or procedures. The threshold number for each specialty was based on traditional fee-for-service Medicare inpatients discharged during the three years from 2019 to 2021 (2021 is the most recent year of available data). Volume-based eligibility rules used in the ear, nose and throat, as well as obstetrics and gynecology rankings, now include relevant outpatient procedural cases.

Because the rankings focus on challenging care, only patients who had particular procedures or conditions at a defined level of severity and complexity were included.

A hospital that fell short was still evaluated if it was nominated by at least 1% of the physicians in a specialty who responded to 2021, 2022 and 2023 physician surveys.

A total of 2,320 hospitals met these standards and qualified for further consideration in at least one specialty.

For a schematic overview of the eligibility process for the rankings, complete with this year’s hospital population data, you can refer to page 12 of the 2023-2024 U.S. News Best Hospitals Specialty Rankings methods report.

Across all 15 specialties, only 164 U.S. hospitals performed well enough to be nationally ranked in one or more specialties.

We evaluated each hospital’s performance using a variety of measures. Some data came from the federal Centers for Medicare and Medicaid Services’ Standard Analytical File database. Other information came from the American Hospital Association and professional organizations.

We put the heaviest reliance on outcomes because of the self-evident connection between a patient’s outcomes, including survival and the quality of their care. Other data, such as the number of patients and the ratio of nurses and patients, are less obviously related to quality, but ample research supports the connection. The physician survey also played a role, though it accounted for only slightly more than one-fourth of each hospital’s score (see below).

In the three expert opinion-based specialties, most care is delivered on an outpatient basis. The number of outpatients who die in these specialties is so low that risk-adjusted mortality rates, heavily weighted in 11 of the 12 other specialties, are not significantly tied to the quality of care. Hospitals in these specialties are therefore ranked solely on expert opinion.

Each hospital analyzed in 11 of the 12 data-driven rankings received an overall score from 0 to 100 based on four elements:

The hospitals with the 50 highest scores in each specialty were ranked. Scores and data for all eligible hospitals in each specialty are also posted. The four elements and their weightings are, in brief:

A hospital’s success at keeping patients alive accounted for 36% of its score. U.S. News compared the number of Medicare inpatients with certain conditions who died within 30 days of admission in 2019, 2020 and 2021 with the number who would be expected to die given the severity of illness. “Prevention of outpatient procedural complications” outcome measures were added in this year’s orthopedics and urology rankings, and similar outcome measures may be added in other specialties in future editions of Best Hospitals. The new measures are important to patients because outpatient surgeries account for a growing share of surgical procedures in orthopedics and urology, as well as for a majority of all surgeries performed in the U.S.

Hospitals were scored from 1 to 5, with 5 indicating the highest statistical likelihood that the survival rate was better than expected and 1 indicating that survival rates were worse than expected. U.S. News’s calculation of each hospital’s expected deaths factored in:

This score reflects the percentage of patients who responded positively to the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS, a survey about the overall quality of their hospital stay. Most hospitals are required to assess patients’ satisfaction using the HCAHPS survey.

Other Care-Related Indicators (35%)

These include nurse staffing, patient volume, certain clinically proven technologies and professional and specialty-specific recognition. The 2021 American Hospital Association Annual Survey was the primary source.

Each year, board-certified physicians in the relevant specialties are invited to list up to five hospitals, ignoring location and cost, that they consider to be the best in their area of expertise for complex or challenging cases.

The figures displayed in the rankings represent the average percentage of responding specialists in 2021, 2022 and 2023 who rated the hospitals. More than 30,000 physicians responded in 2023.

In four specialties – cardiology, heart and vascular surgery; obstetrics and gynecology; neurology and neurosurgery; and pulmonology and lung surgery – expert opinion received a reduced weight of 12% to accommodate public transparency metrics, which is determined by the extent to which a hospital is publicly transparent about specific care-related performance metrics. Expert opinion is weighted 30% in rehabilitation and 15% in most other data-driven specialties.

No. Many ranked hospitals have very low, even zero, reputational scores but are strong clinical performers.

In the three expert opinion-determined specialties, ranked hospitals had to be cited by an average of at least 5% of the physicians who responded to the latest three years of U.S. News surveys of specialists. That resulted in lists of 10 hospitals in ophthalmology, seven in psychiatry and 11 in rheumatology.

Several targeted methodological revisions were implemented this year based on input from patients, clinicians, researchers and hospital leaders. These and other modifications to the methodology are described in this blog post.

Each year RTI International and U.S. News revisit the methodology based on the medical literature and input from hospitals and health care experts. U.S. News approves all methodology changes.

The Best Hospitals Honor Roll recognizes 22 hospitals with unusual competence taking into account the full range of adult inpatient care – both performance in the Best Hospitals specialty rankings and the Best Hospitals procedures and conditions. The honor roll is not an ordinal list.

Hospitals were awarded points by being nationally ranked in the 12 Best Hospitals specialty rankings, driven primarily by hard data or in the three expert opinion-based specialty rankings, or by being rated as high performing in 21 procedures and conditions.

All 50 hospitals received points in each of the 11 data-driven specialties (excluding rehabilitation). The No. 1-ranked hospital received 25 Honor Roll points, No. 2 received 24 points and so on. All hospitals ranked 21 through 50 received five points. The maximum number of points across these 11 specialties is 275, but no hospital has ever been No. 1 in all 12 specialties.

In rehabilitation and the three Best Hospitals specialty rankings based entirely on expert opinion (ranked hospitals were recommended by at least 5% of respondents to annual U.S. News physician surveys), the number of ranked hospitals varies year by year and specialty by specialty. The No. 1-ranked hospital received 10 Honor Roll points, No. 2 received nine points and so on; all hospitals ranked from 10 to the final ranked hospital received one point. If a hospital had ranked at the top in all four specialties (none was), it would have received 40 points.

In 16 of the 21 Best Hospitals procedures and conditions ratings, hospitals received 12 Honor Roll points for each “high-performing” rating. “High-performing” status in AVR and TAVR resulted in six points each because these procedures are alternative treatment approaches to the same underlying cardiac condition; similarly, high-performing status in ovarian cancer surgery and uterine cancer surgery resulted in six points each because tumors in these organs are treated with similar procedures.

Hospitals that achieved a rating of high performing in all 21 procedures and conditions would have received 228 points. In some circumstances, where a health system with multiple hospitals had consolidated a certain service at a regional center of excellence, we reassigned Honor Roll points for that service from the system’s center of excellence to the system’s so-called flagship hospital.

The 22 hospitals that earned the most points out of the 543 possible comprise the Honor Roll. In 2023-2024, hospitals that earned 273 points or more were recognized.

In a typical year, U.S. hospitals admit more than 30 million patients. More than 1 million will have a knee or hip replaced, and about 400,000 will undergo heart bypass surgery. Heart failure will account for about 900,000, while chronic obstructive pulmonary disease another 700,000 and surgery to remove all or part of the colon will account for some 250,000.

Any hospital should be able to successfully treat such relatively common ailments, and many do – but some treat them better than others. The Best Hospitals procedures and conditions ratings show consumers how well their local hospitals stand up to scrutiny in those six procedures and conditions and the 14 others U.S. News rates. How U.S. News evaluated hospitals for the ratings is addressed in this FAQ. A comprehensive methodology report is available as a downloadable PDF.

The Best Hospitals procedures and conditions ratings evaluate almost every hospital in the U.S. that admits patients in any of 21 common procedures and conditions:

In 2023, U.S. News evaluated more than 4,300 hospitals to generate procedure and condition ratings. While more than 1,900 hospitals were rated high performing in at least one procedure or condition, none were rated high performing in all 21 procedures and conditions.

We defined 21 groups of patients, each corresponding to one of the common procedures or conditions being rated. For each group – called cohorts – we assessed the hospital’s risk-adjusted outcomes, such as 30-day mortality, 30-day readmission and length of stay. These measure how well the hospital performed the procedure at the time of care and also was able to prevent an unplanned re-visit to the hospital due to the same condition. A shorter length of stay is indicative of a lower complication rate.

We also factored in variables linked to higher quality of care, including volume, nurse staffing and whether the hospital employed a specially trained physician known as an intensive care unit specialist. In addition, patient satisfaction scores were factored into the ratings for most procedures.

A hospital’s stance on data transparency was also a factor. In our heart bypass surgery and aortic valve surgery ratings, we weighed whether the hospital had voluntarily released ratings it received from the Society of Thoracic Surgeons. We factored in STS data for hospitals that had done so as of late 2022.

We analyzed objective data from multiple sources, including a federal data set known as the Standard Analytical File, which contains details of every hospital admission paid for by traditional Medicare. We used SAF data on inpatients aged 65 and older treated from 2017-2021 to assess each hospital’s risk-adjusted mortality rates, readmissions and other outcomes.

How well older patients are treated is generally considered a good test of a hospital’s capabilities. Such patients have a greater chance of being admitted with one or more conditions, such as diabetes or high blood pressure, that put them in a higher-risk category. We also incorporated some data from the outpatient SAF files into analysis of knee replacement procedure and stroke condition.

In addition, our analysis incorporated publicly available data from the Centers for Medicare and Medicaid Services, the agency that oversees Medicare. These included information on each hospital’s efforts to prevent dangerous blood clots and the results from federally mandated patient-satisfaction surveys. Claims data from the Medicare database are the most comprehensive source data available. We are open to exploring alternatives for future editions of the ratings. Risk-adjusted data from clinical registries are one promising area.

Hospital reputation was not a factor in the ratings.

Our methodology also drew on several measures from the 2021 American Hospital Association’s annual survey and from the Society of Thoracic Surgeons, a professional organization for heart and chest surgeons. None of these organizations have endorsed or been asked to endorse the U.S. News ratings.

An overall rating of high performing indicates a hospital was significantly better than the national average in a given procedure or condition. Hospitals rated below average scored substantially below the national average. Hospitals rated average do not all have equal performance, but they were not distinctly different from the average in our methodology. In each procedure and condition, 10% to 20% of the evaluated hospitals in a condition or procedure typically fell into the high-performing tier, and another 10% to 20% were rated below average.

Relatively few hospitals performed consistently across all measures for a given condition or procedure. Strengths and weaknesses in particular measures often varied considerably between hospitals with similar overall ratings. Such differences give patients flexibility by allowing them to decide, in consultation with their doctor, which qualities are most important to them. One hospital might have a lower readmission rate but have worse patient experience scores. Another might have a better balance of nurses to patients but a relatively low number of patients.

About 50% to 70% of the hospitals in each procedure or condition were rated as average. Some of these hospitals were rated below average partly because of low patient volume, not necessarily because of a high number of deaths or other adverse events. No firm conclusion can be reached about an unrated hospital; these hospitals did not treat enough patients to be evaluated thoroughly. The ratings are just a starting point for patient decision-making, which certainly should include consulting a doctor.

Pending such consultation, patients who have access to a high-performing or average hospital might choose that hospital over one that is below average or unrated in the type of care they need.

We took several risk factors into account:

In 2014, the National Quality Forum, an influential standard-setting body, recommended considering socioeconomic status in certain evaluations of hospital performance. Since our objective is to enable a patient consulting our ratings to make apples-to-apples comparisons among hospitals, it follows that we should adjust for patient attributes such as age, sex and socioeconomic status.

The methodology uses one measure, how discharged patients rated a hospital overall, from the federal government’s quarterly survey called Hospital Consumer Assessment of Health Providers and Systems.

In judging the validity and usefulness of any public reporting effort to evaluate health facilities, patients should ask:

Our national Best Hospitals and Best Children’s Hospitals rankings, for example, are meant to be used as guidance when life is in the balance or an uncommon condition or procedure is involved. Most patients, thankfully, will not need to consult them.

Best Hospitals for procedures and conditions, on the other hand, rates the overall quality of inpatient care in the kinds of procedures and conditions that many hospitals commonly encounter. Clinical outcomes (such as mortality, readmissions and length of stay) are stressed, but other measures included are patient volume, patient satisfaction and hospital staffing data. Patients can choose to factor some or all of these individual quality indicators into their decisions about where to get care.

U.S. News first published Best Regional Hospitals in 2011. These state and metro area rankings offer information on community hospitals that are highly rated but may not be nationally ranked. Regional rankings are displayed for nearly every state and for the nation’s largest metro areas, provided there is at least one Best Regional Hospital located there.

This year, 494 hospitals in 49 states and 92 metro areas were recognized as Best Regional Hospitals. There is no separate methodology report for the regional rankings, but additional information is contained at the end of the 2023-2024 U.S. News Best Hospitals Procedures & Conditions Ratings Methodology Report.

A Best Regional Hospital is a hospital that:

Nationwide, 494 hospitals were identified as Best Regional Hospitals, compared with 493 last year. The Best Hospitals for Maternity Care was not included in the Best Regional Hospitals calculation.

In a given region (state or major metro area), a hospital on the Best Hospitals Honor Roll outranked all other hospitals not on the Honor Roll, regardless of point totals. Where multiple Honor Roll hospitals are located in the same region, they are tied for No. 1 in that region. Other hospitals located in each region were ranked according to the number of points they earned: Hospitals earned two points for each of the 11 data-driven Best Hospitals specialties in which they were nationally ranked and one point for each of the 11 specialties (excluding rehabilitation) and 19 procedures and conditions in which they were rated high performing (AVR and TAVR are combined in this calculation, as are ovarian and uterine cancer surgery).

In addition, hospitals lost one point for each procedure or condition in which they were rated below average. In some circumstances, where a health system with multiple hospitals had consolidated a certain service at a regional center of excellence, we reassigned Best Regional Hospitals points for that service from the system’s center of excellence to the system’s flagship hospital.

No. The primary intent of the designation is to identify hospitals that perform well across a range of specialties, conditions and procedures. A specialty hospital’s profile and its ratings and rankings pages show the area or areas of care in which it is ranked or high performing.

U.S. News generally used the U.S. Census Bureau list of Metropolitan Statistical Areas, or MSA, to define metro areas, but we departed from MSAs in cases where we used larger Combined Statistical Areas, or combined adjacent MSAs, to include nearby smaller cities with nationally ranked hospitals. For example, we used the Detroit CSA instead of the Detroit MSA; we combined the Durham-Chapel Hill and Raleigh-Cary MSAs to define the Raleigh-Durham metro area.

Some metropolitan areas, such as Cincinnati, Kansas City and New York, cross state lines. Washington, D.C., is included as a metro area but not a state.

U.S. News has grouped counties and county equivalents like parishes into approximately 200 regions that reflect geography, local custom and regional health care markets. High performers were recognized but not numerically ranked in regions that are not major metro areas.

Very few metro areas have more than one or two Best Children’s Hospitals. That makes decisions about where to go for expert pediatric care simpler than for adult care; ranking small numbers of children’s hospitals within a metro area wouldn’t offer meaningful assistance. A Best Children’s Hospitals FAQ is available below.

Relatively little information is readily available to the public about which facilities across the country are best at caring for expectant parents during labor and delivery following an uncomplicated pregnancy. By evaluating hospitals using core maternity and perinatal care data, including data primarily self-reported by hospitals, and by publishing this information publicly on each hospital’s usnews.com page, we aim to enhance the transparency of the maternity services provided for uncomplicated pregnancies. How U.S. News evaluated hospitals is addressed in this FAQ and a comprehensive methodology report is available as a downloadable PDF.

Following U.S. News’ Best Hospitals rankings and the procedure and condition ratings, Best Hospitals for Maternity Care draws the quality of care from three categories: outcomes, process and structure.

In 2023, U.S. News & World Report began recognizing Maternity Care Access Hospitals, which provide maternity services to communities that might otherwise have inadequate access to maternity care. Hospitals are required to meet both geographic and quality criteria to be eligible. No recognition is displayed for participating hospitals not meeting geographic or quality criteria.

To meet geographic criteria, a hospital must be one of the following:

To meet quality criteria, a hospital can not do either of the following:

In the summer of 2023, U.S. News & World Report invited hospitals that offer maternity care to self-report their maternity data to U.S. News via an online survey, the Maternity Services Survey, hosted on the U.S. News Hospital Dashboard.

Primary data collection from hospitals was necessary because quality data available from other sources, such as the Centers for Medicare and Medicaid Services, were insufficient on their own to evaluate the quality of maternal and neonatal care. Data collection took place over two months and began on June 7, 2023.

What is the purpose of the Best Children’s Hospitals rankings? When should they be consulted? How are they determined? The following FAQ addresses these and other Best Children’s Hospitals questions. A fully detailed methodology report is available as a downloadable PDF.

For the 2023-2024 rankings, U.S. News requested medical data and other information from nearly 200 facilities. Of those, 119 turned in enough data to be evaluated in at least one specialty, and 89 were ranked in one or more.

Relatively few children, compared with the number of adults, face life-threatening or rare conditions or have to go through complicated operations. A typical hospital, where nearly all inpatients are adults, simply cannot provide the caliber of expertise needed by a severely ill child. Even a hospital with a busy maternity unit may not be equipped to deal with a newborn who weighs just a few pounds or requires surgery for a congenital heart defect. Similarly, most hospitals don’t see large numbers of children with cancer, respiratory illnesses or kidney conditions.

Even among children’s hospitals and large pediatric services that do, the reality – as true in pediatrics as in adult care – is that some hospitals are better than others. That’s why in 2006, U.S. News began collecting data that would allow ranking of pediatric centers on their ability to help children who need it the most.

The 50 best-performing hospitals are ranked in each of 10 pediatric specialties. Unranked hospitals that provided enough information to be scored in a specialty are listed with their data but without rank or score. The rankings are updated annually in June. The Best Children’s Hospitals Honor Roll recognizes the 10 hospitals that received the highest number of points, based on the number of specialties in which they are ranked and how high they ranked in each.

Exactly. Families have to weigh many considerations when they seek care for a child, including the stress and expense of traveling to another city with a sick child and staying for days or possibly weeks, as well as an insurer’s willingness to pay for care at a hospital outside its approved network.

Within a specialty, hospital performance is judged across a variety of conditions and procedures. So one hospital might outperform another in some of them, but the second might do better in others. In the pediatric orthopedic rankings, for example, one hospital might have an especially busy spina bifida clinic but doesn’t treat complex fractures as efficiently as another hospital. Parents and caregivers must decide for themselves which factors they want to weigh more or less heavily. Kids and families are all different. There’s no one-size-fits-all.

A third of each hospital’s score, or 33.3%, was tied to outcomes such as survival, infections and surgical complications. (In cardiology and heart surgery, outcomes counted for 38.3% because more and better data are available.) A hospital’s reputation, based on an annual survey of pediatric specialists and subspecialists in each of the 10 specialties, made up another 10% (5% in cardiology and heart surgery).

The remaining portion of slightly more than 50% evaluated commitment to patient safety (such as the number of specific ways infections are minimized), excellence (such as the number of fellowship programs) and family centeredness (such as the degree to which families are involved in their children’s care).

Experts’ opinions can reflect important information that isn’t evident in objective measurements. That’s especially true in a field as full of nuance and complexity like the medical care of very sick children. We feel the opinions of pediatric specialists add to the objective measures that form the basis for the rankings.

In each of the 10 specialty areas, the 50 hospitals with the highest scores are ranked numerically based on their overall score. Keep in mind that a lower-ranked hospital may be better in certain specialties than a hospital with a higher overall ranking in that specialty – and, importantly, hospitals with different rankings may be effectively equivalent on the attributes that matter most to a particular family.

You can learn about the nuanced differences by comparing hospitals’ detailed scorecards, which show many of the measures that went into hospital scores. Some measures, such as nurse-to-patient ratios, are common to all specialties. Others, like accreditation for bone marrow transplant, apply to just one or two specialties.

In addition to displaying performance information for the 50 ranked hospitals in each specialty, the same information is shown for unranked hospitals if they provided enough data through the clinical survey to be evaluated. The unranked hospitals are listed alphabetically.

Each hospital that’s ranked in at least one pediatric specialty, with two uncommon exclusions described here, is also assigned a ranking in its state and the multi-state region (there are seven) to which the state belongs. These regional rankings are intended to help families identify excellent pediatric centers near home.

Exclusions: Specialty pediatric hospitals, such as those that exclusively treat cancer, are excluded from the regional rankings. Additionally, a hospital that reports data for a specialty jointly with another hospital does not receive credit from that specialty toward a regional ranking unless the hospital is deemed by U.S. News to be the lead or co-lead hospital in that multi-hospital reporting relationship. Non-lead hospitals may be regionally ranked only if they are ranked on their own in another specialty or are the lead hospital in a joint reporting relationship in another specialty.

A map accompanying this article shows the seven multi-state regions and which states each region comprises.

Hospitals received points for being ranked in a specialty, and the 10 hospitals with the most points across the 10 specialties make up the Honor Roll. The first-ranked hospital in a specialty received 25 points, the second-ranked hospital received 24 points and so on, until reaching No. 21. All hospitals ranked 21 through 50 received five points. The Honor Roll would have been extended if multiple hospitals had tied for the tenth-most points overall.

Selection was determined initially by membership in the National Association of Children’s Hospitals and Related Institutions, now called the Children’s Hospital Association, or by nomination from teams of expert advisers. A hospital also can request to be considered. U.S. News makes such decisions not only on a hospital’s willingness to engage in public reporting but also on the size and scope of its pediatric program.

Of approximately 200 hospitals U.S. News invites to participate in the survey each year, about a quarter of the hospitals are freestanding pediatric-focused facilities. Most of the others are pediatric departments within larger full-service hospitals, allowing them to function almost like their own hospital within a hospital – with its own staff, operating rooms and support services.

Year to year, there are always changes – we constantly try to improve our methodology, using feedback we get from knowledgeable parents, doctors and health care leaders. Our approach is conservative, however, since any alterations in our analysis affect not only the new rankings but the ability to compare them with previous results. Some of this year’s changes were highlighted in a U.S. News blog post published shortly before the rankings were released.

RTI International, a large North Carolina-based research and consulting firm that created the Best Children’s Hospitals methodology in 2006 (and the U.S. News contractor for the Best Hospitals rankings), works with experts organized into specialized working groups to review and update the methodology each year. U.S. News editors review proposed changes and approve them before they take effect.

We use existing data whenever we can. The lack of critical data that can be tapped to evaluate children’s hospitals has been a huge challenge. There is no pediatric equivalent of the Medicare database U.S. News mines to measure hospital performance in the annual Best Hospitals adult rankings and ratings.

In 2006, when U.S. News began looking into the possibility of ranking pediatric centers, children’s hospitals had barely begun to develop standards for care-related quality data or how to best analyze the results. That is still largely the case, despite the meaningful progress pediatric researchers have made in certain areas of performance measurement.

So, in 2006, U.S. News asked RTI to put together a clinical survey for children’s hospitals. Some questions, such as nursing data and the extent and success of programs that prevent infection, touch on all 10 specialties. Others, such as complication rates of kidney biopsies and five-year survival rates for several types of cancer, are specialty-specific.

These data reflect a hospital’s ability to keep children alive, keep them safe from harm by protecting them from infections and surgical complications and improve the quality of life of children with chronic conditions. For example, we evaluate survival from three types of childhood cancers, bloodstream infections caused by central line catheters and success in managing severe asthma cases.

The intent of the U.S. News process measure is to evaluate how well and efficiently a hospital goes about the day-to-day business of delivering care. That is determined in part by compliance with widely endorsed “best practices,” such as regular morbidity and mortality conferences to explore unanticipated deaths or complications, and commitment to infection control, such as having certified infection preventionists on staff and tracking the correct use of antibiotics prior to surgery. Additionally, hospitals’ efforts to advance equity, diversity and inclusion of patients and staff factor into the rankings.

It’s important to have such programs, but they must deliver. So, 10% of a hospital’s score (5% in the cardiology and heart surgery rankings) relies on the opinions of pediatric specialists and subspecialists via an annual survey that asks them to name up to 10 hospitals in their specialty where they would send the sickest patients without taking location or expense into account. Responses are combined from the three latest surveys, meaning for the 2023-2024 rankings, surveys conducted in 2021, 2022 and 2023. More than 25,000 physicians were surveyed in 2023, and more than 6,000 responded.

This category reflects resources a hospital makes available to patients, like the number of nurses caring for patients. We collect information on about 40 elements, many relevant to every specialty and others specific to just one. A few examples are the availability of surgery for congenital heart defects or for liver transplants, specialized clinics for children with diabetes or kidney disease and services for families that ease the anxiety of a child’s hospital stay.

For PR-related questions, please contact health-pr@usnews.com.