Methodology

Performance Data

• Recommended Care (Core Measures)
• Composite Measures of Recommended Care
• Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
• Emergency Care
• Immunization
• Timely and Effective Stroke Care
• Blood Clot Prevention and Treatment
• Readmission Rates
• Value-Based Purchasing – Readmissions Program
• Mortality Rates
• Early Elective Delivery Rates
• Spending per Medicare Beneficiary
• Health Care Costs
• Health Care–Associated Infections
• Health Information Technology
• Population Health / Utilization and Costs
• County Health Rankings

Data Not Available

Compare Performance by Groups and Regions

Top Performers

Benchmarks

Interactive Map

Differences from CMS Hospital Compare

This site includes data on the performance of most U.S. hospitals. It does not include data on the following types of hospitals: Rehabilitation, Children's or Psychiatric. Unregistered users can compare up to 70 hospitals (or hospital groups or regions) in a single report. To add more hospitals to a single report, please register for the site and log in.

Recommended Care (Core Measures)

(Heart Attack Care, Heart Failure Care, Pneumonia Care, Surgical Care)
Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): Hospital Quality Alliance (CMS, Joint Commission)
Technical Specifications: http://www.jointcommission.org/specifications_manual_for_national_hospital_inpatient_quality_measures.aspx
Data Collection: Medical record, all-patients 18 years and older, all-payer.

These measures report how often hospitals delivered recommended care processes in the following four areas: heart attack, heart failure, pneumonia, and surgical care improvement.  

Read More: http://www.qualitymeasures.ahrq.gov/browse/by-organization-indiv.aspx?objid=25813

Composite Measures of Recommended Care

(Heart Attack Care, Heart Failure Care, Pneumonia Care, Surgical Care)
Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): IPRO, Commonwealth Fund
Technical Specifications: https://sites.google.com/a/ipro.us/pelliki/home/qualitymine/category-measures-catalogue/composite-measures
Data Collection: Medical record, all-patient 18 years and older, all-payer.
WhyNotTheBest.org presents composite performance scores for each hospital for each of the following four conditions:

• Overall Heart Attack Summary Rate (composite of four process-of-care measures for this condition)
• Overall Heart Failure Summary Rate (composite of three process-of-care measures for this condition)
• Overall Pneumonia Summary Rate (one process-of-care measure for this condition)
• Overall Surgical Care Improvement Summary Rate (composite of nine care processes used to improve surgical care/prevent surgical infections)

To create composite scores for each condition, the site uses a methodology prescribed by the Joint Commission. This approach suggests that the composite score be the number of times a hospital performed the appropriate action across all measures for that condition, divided by the number of opportunities the hospital had to provide appropriate care for that condition. Composite scores will not be displayed if all measures in that condition were less than 30 cases.

Scores are not weighted, except that measures with larger denominators do contribute more weight to the calculation of the mean for that measure. None of the measures is risk adjusted.

We also create an overall quality composite (Overall Recommended Care) that takes into account 31 Hospital Quality Alliance process-of-care measures, including stroke care and blood clot measures. 

It is possible for a hospital to submit “0” on a particular measure, indicating that it had no patients whose treatment was relevant to that measure. For example, a hospital reporting seven measures of heart attack care could submit denominators of 0, 6, 2, 12, 30, 29, and 14 and still have a composite score calculated.

In all instances we calculate a weighted average, wherein we add all the numerators and divide by the total of the denominators.

We also rank hospitals on these composite measures, but to be ranked hospitals must satisfy the following additional criteria:

• Measures must contain all available quarters worth of data.
• Must report all indicators within the topics (i.e. be fully reported). For example, HF composite score will be ranked only if all 4 HF indicators were reported.
• At least one indicator in the topic had denominator >= 30.

Some hospitals report enough data to be considered eligible for inclusion in the WhyNotTheBest.org top performers listing. These criteria are detailed below.

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Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS, Joint Commission
Technical Specifications: http://www.hcahpsonline.org/techspecs.aspx
Data Collection: Patient survey, all-patient 18 years and older, all-payer.

The site includes 11 measures from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). This survey asks a random sample of recently discharged patients about important aspects of their hospital experience.  HCAHPS is a relatively new survey, and hospitals across the U.S. are not yet achieving very high scores across all of the questions. Nevertheless, some hospitals are scoring significantly better than others, and a 2011 Press Ganey study [http://www.healthleadersmedia.com/content/QUA-276127/Hospital-HCAHPS-Scores-Beat-Expectations.html] found that some hospitals are achieving rapid improvement on these measures. Patients rate certain questions on a scale of 0 to 10, where 0 is the worst and 10 is the best. Responses to other questions consist of the following possible answers: Always, Usually, Sometimes, or Never.  For example, one survey question asks how often their nurses communicated well, and respondents reported their nurses ("Always," "Usually," "Sometimes," or "Never") communicated well.  Hospital rankings are displayed on the measure detail page when applicable.

Read More: http://www.qualitymeasures.ahrq.gov/browse/by-organization-indiv.aspx?objid=25772

www.hcahpsonline.org.

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Emergency Care

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS, Joint Commission
Technical Specifications: https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1141662756099
Data Collection: Electronic medical record, paper medical records, all emergency department patients, all-payer.

These four measures assess how quickly hospitals treat patients who come to the hospital emergency department. Reducing the time patients remain in the emergency department can improve access to treatment and increase quality of care. The measures are:

• Median time from ED arrival to ED departure for admitted ED patients,
• Median admit decision time to ED departure time for admitted patients,
• Percentage of patients who left the emergency department before being seen, and    
• Percentage of patients who came to the emergency department with stroke symptoms who received brain scan results within 45 minutes of arrival (Note: only 345 hospitals reported data for this measure as of April 2013.) 

Read more: http://www.qualitymeasures.ahrq.gov/browse/by-organization-indiv.aspx?orgid=22&objid=26099

Immunization

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS, Joint Commission
Technical Specifications: https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1141662756099
Data Collection: Administrative claims, paper medical records, all-payer.

These measures assess whether hospitals screen their patients for influenza vaccine status (age 6 months and older) and pneumococcal vaccine status (age 65 and older and high risk patients age 6-64) and provide vaccine to patients prior to discharge if indicated. Influenza vaccination is the most effective method for preventing influenza virus infection and its potentially severe complications. A sizable proportion of pneumococcal infections and deaths are potentially preventable through pneumococcal vaccination. The highest mortality from pneumococcal disease occurs among the elderly and patients who have underlying medical conditions.

Read more: http://www.qualitymeasures.ahrq.gov/browse/by-organization-indiv.aspx?orgid=11&objid=35559

Timely and Effective Stroke Care

• Thrombolytic Therapy –This measure shows the percentage of ischemic stroke patients who arrived at the emergency department within 2 hours of the onset of their symptoms and who got medicine to break up a blood clot within 3 hours after symptoms started.  This medicine, called tissue plasminogen activator, a type of thrombolytic therapy, can limit the damage and disability caused by an ischemic stroke when given within 3 hours after a stroke begins.
• Antithrombotic Therapy By End of Hospital Day 2 – This measure shows the percentage of ischemic stroke patients who started antithrombotic therapy within 2 days of arriving at the hospital.  This medicine prevents and treats clots and reduces death, disability, and the risk of another stroke.
• Venous Thromboembolism (VTE) Prophylaxis – Stroke patients are at increased risk of developing new blood clots in their veins that break off and travel to other parts of the body, like the brain or lung, a condition called venous thromboembolism or VTE.  Treatment to prevent new blood clots from forming includes medicine, medical devices, and tightly fitting stockings.  This measure shows the percentage of ischemic or hemorrhagic stroke patients who either received treatment to prevent blood clots on the day of or day after arrival at the hospital or had paperwork in their chart to explain why they had not received this treatment.
• Discharged on Antithrombotic Therapy – Ischemic stroke patients are at risk for developing complications like another stroke even after discharge from the hospital.  This measure shows the proportion of ischemic stroke patients prescribed antithrombotic therapy (medicine that prevents the formation of blood clots in the blood vessels) at hospital discharge.
• Anticoagulation Therapy for Atrial Fibrillation/Flutter - This measure shows the percentage of ischemic stroke patients with an irregular heartbeat (also called atrial fibrillation/atrial flutter) who were prescribed an anticoagulant before they were discharged from the hospital.  Anticoagulants are medicines that thin the blood and this reduces the chance of another stroke in these patients.
• Discharged on Statin Medication - This measure shows the percentage of ischemic stroke patients who received a prescription for a statin before they were discharged from the hospital.  Statins are medicines that lower LDL cholesterol and this helps lower the chance of another stroke in these patients.  Patients who shouldn’t take statins are excluded from this measure.
• Stroke Education - This measure shows the percentage of ischemic or hemorrhagic stroke patients or their caregivers who received written information about all of the five following topics during their hospital stay: 1) how to activate the hospital emergency system, 2) the importance of doing follow-up after discharge from the hospital, 3) medicines prescribed at discharge, 4) risk factors for stroke, and 5) warning signs and symptoms of stroke.

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Blood Clot Prevention and Treatment

• Venous thromboembolism prophylaxis – This measure shows the percentage of hospital patients who either got treatment to prevent blood clots on the day of or day after hospital admission or surgery or had paperwork in their chart to explain why they had not received this treatment. Treatment to prevent new blood clots includes tightly fitting stockings, blood thinners, and/or other medicines. 
• ICU venous thromboembolism prophylaxis - This measure shows the percentage of ICU patients who either got treatment to prevent blood clots on the day of or day after hospital admission or surgery or transfer to the ICU, or had paperwork in their chart to explain why they had not received this treatment.  Treatment to prevent new blood clots includes tightly fitting stockings, blood thinners, and/or other medicines. 
• Incidence of potentially preventable VTE – This measure shows the percentage of hospital patients who developed a blood clot while in the hospital who did not get preventive treatment beforehand, such as tightly fitting stockings, blood thinners, and/or other medicines. 
• Anticoagulation overlap therapy – Hospital patients who develop blood clots in their veins (also called venous thromboembolism, or VTE) need treatment to break up the clots quickly and prevent others from forming.  The recommended treatment is to first give a blood thinner that can get into the bloodstream quickly through an intravenous (IV) method or injection (heparin), then give a slower-acting oral blood thinner medicine (warfarin), and continue giving both blood thinners for 5 days or until it is safe for the patient to transition off of the IV blood thinner and use only the oral blood thinner medicine. This measure shows the percentage of hospital patients who had a confirmed diagnosis of blood clot when admitted to the hospital or during their hospital stay, and received both medicines for at least 5 days, or were discharged from the hospital on both kinds of medicine, unless they no longer needed it.
• Unfractionated heparin with dosages/platelet count monitoring – Patients who have a blood clot (also called venous thromboembolism, or VTE) are usually treated with a blood thinner.  One type of intravenous blood thinner, called unfractionated heparin, increases the risk of bleeding more than a different type, called low molecular weight heparin.   Patients getting unfractionated heparin should be given regular blood tests to check if they are at an increased risk of bleeding from getting the medication. This measure shows the percentage of hospital patients with a blood clot treated with unfractionated IV heparin who had their blood checked using recommended procedures.
• Warfarin therapy discharge instructions – Hospital patients with blood clots in their veins (also called venous thromboembolism or VTE) are usually given blood thinner medicines when they leave the hospital.  This measure shows the percentage of hospital patients with a blood clot (either present at admission or developed during their hospital stay) discharged from the hospital on blood thinners (anticoagulants or anticoagulant therapy or warfarin therapy) who received written discharge instructions or other educational materials at hospital discharge on all of the following topics: 1) compliance issues, 2) dietary advice, 3) follow-up monitoring, and 4) potential for adverse drug reactions and interactions.

Readmission Rates

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS, Joint Commission
Technical Specifications: http://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1141662756099
Data Collection: Administrative clinical data, Medicare fee-for-service patients 65 years and older.

These rates include patients readmitted to a hospital within 30 days of discharge from a previous hospital stay for heart attack, heart failure, or pneumonia. Readmissions rates reflect three years' worth of data. Regional rates are derived by calculating a simple average of all risk-adjusted averages for hospitals reporting within the region. Regional rates should not be directly compared to a hospital's risk-adjusted rate. The site also includes a composite measure as calculated by IPRO: average Medicare hospital 30-day readmission rates for heart failure, heart attack, and pneumonia.  

Read More: http://www.qualitymeasures.ahrq.gov/browse/by-organization-indiv.aspx?objid=26098

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Value-Based Purchasing – Readmissions Program

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS
Technical Specifications: http://cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html/
Data Collection: Medicare Provider Analysis and Review (MEDPAR) File (claims data)

Hospitals participating in the Acute Care Hospital Inpatient Prospective Payment System (IPPS) contract with Medicare to furnish acute hospital inpatient care and agree to accept predetermined acute IPPS rates as payment in full. The Hospital Readmissions Reduction Program requires CMS to reduce payments to IPPS hospitals with excess readmissions. A readmission is defined as an admission to a general, acute-care, short-term hospital within 30 days of a discharge from the same or another acute-care hospital. Planned readmissions are excluded. Currently, CMS calculates the excess readmission rate for three conditions: acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN). Excess readmissions are determined by comparing a hospitals’ readmission rates for the three conditions (AMI, HF, & PN) with what would be expected in that hospital based on national averages and adjusted for factors that are clinically relevant including patient demographic characteristics, comorbidities, and patient frailty. A minimum of 25 cases is needed for a condition (AMI, HF, or PN) to be included in the excess readmissions calculations for a given hospital.

For fiscal year 2014, CMS calculated an excess readmission rate for discharges occurring from July 1, 2009, through June 30, 2012. The penalty for excess readmissions is expressed as an "adjustment factor" that is applied to Medicare reimbursements for care for patients admitted for any reason (not just for the 3 conditions used to calculate the penalty). For fiscal year 2014, the lowest adjustment factor, 0.9800, is the maximum penalty and means that a hospital would receive only 98 percent of the amount Medicare usually pays. The highest adjustment factor is 1.0000, meaning that a hospital would receive its full Medicare reimbursement, or 100 percent. Maryland hospitals are exempt from the Hospital Readmissions Reduction Program.

Readmissions Payment Adjustment Factor – This measure shows the degree to which an IPPS hospital is penalized in fiscal year 2014 for excess readmissions that occurred from July 1, 2009, through June 30, 2012. An adjustment factor of 1.000 (best possible) means no penalty and the hospital receives its full Medicare reimbursement. The lowest adjustment factor possible, 0.9800, means that the hospital receives a 2% penalty and receives only 98% of the usual Medicare reimbursement.

Mortality Rates

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS, Joint Commission
Technical Specifications: http://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1141662756099
Data Collection: Administrative clinical data, Medicare fee-for-service patients 65 years and older.

These rates take into account deaths within 30 days from all causes after an initial hospitalization with a principal diagnosis of heart attack, heart failure, or pneumonia. Mortality rates displayed on this site reflect three years' worth of data. Regional rates are derived by calculating a simple average of all risk-adjusted averages for hospitals reporting within the region. Regional rates should not be directly compared to a hospital's risk-adjusted rate. The site also includes a composite measure as calculated by IPRO: average Medicare hospital 30-day mortality rates for heart failure, heart attack, and pneumonia.

Read More: http://www.qualitymeasures.ahrq.gov/browse/by-organization-indiv.aspx?orgid=22&objid=26095 

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Early Elective Delivery Rates

Spending per Medicare Beneficiary

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS
Technical Specifications: https://www.cms.gov/HospitalQualityInits/32_MedicarePaymentAndVolume.asp
Data Collection: Claims/payment data, Medicare patients, acute care hospitals only.

Read More: https://www.cms.gov/HospitalQualityInits/32_MedicarePaymentAndVolume.asp

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Health Care Costs

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS
Technical Specifications: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient.html
Data Collection: Medicare claims.

WhyNotTheBest.org reports average covered charges per discharge and average total payments per discharge for 13 diagnosis-related groups (DRG) for U.S. hospitals that received Medicare Inpatient Prospective Payment System (IPPS) payments in fiscal year 2011. DRGs make up a classification system that groups similar clinical conditions (diagnoses) and the procedures furnished by the hospital during a patient’s stay. The DRG assignment is determined by the patient’s principal diagnosis, up to 24 secondary diagnoses that may include comorbidities or complications, up to 25 procedures furnished during the hospital stay, and a patient’s gender, age, and discharge status disposition.

• DRG 065 - Intracranial hemorrhage or cerebral infarction with complication or comorbidity
• DRG 194 - Simple pneumonia and pleurisy with complication or comorbidity
• DRG 247 - Percutaneous cardiovascular procedure with drug-eluting stent without major complication or comorbidity
• DRG 249 - Percutaneous cardiovascular procedure with non-drug-eluting stent without major complication or comorbidity
• DRG 291 - Heart failure and shock with major complication or comorbidity
• DRG 313 - Chest pain
• DRG 392 - Esophagitis, gastroenteritis, and miscellaneous digestive disorders without major complication or comorbidity
• DRG 469 - Major joint replacement or reattachment of lower extremity with major complication or comorbidity
• DRG 470 - Major joint replacement or reattachment of lower extremity without major complication or comorbidity
• DRG 480 - Hip and femur procedures, except major joint, with major complication or comorbidity
• DRG 481 - Hip and femur procedures, except major joint, with complication or comorbidity
• DRG 690 - Kidney and urinary tract infections without major complication or comorbidity
• DRG 871 - Septicemia or severe sepsis without mechanical ventilation greater than 96 hours with major complication or comorbidity

Average Covered Charges - The hospital's average charge for services covered by Medicare for all discharges in the DRG. This amount is determined by the hospital and varies from hospital to hospital because of differences in hospital charge structures.

Average Total Payments - The average of Medicare payments to the hospital for all cases for a given DRG. Total costs include the total amount paid by Medicare (for DRG amount, capital, teaching hospital, disproportionate share of low-income patients, and high-cost outlier payments) as well as co-payment and deductible amounts for which the patient is responsible.

Limitations of Maryland Data: The state of Maryland has a unique waiver that exempts it from Medicare’s prospective payment systems for inpatient care. Maryland instead uses an all-payer rate setting commission to determine its payment rates.  Medicare claims for hospitals in other states break out additional payments for indirect medical education (IME) costs and disproportionate share hospital (DSH) adjustments. 

Read More: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient.html

Health Care-Associated Infections

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Health Information Technology (HIT)

Centers for Medicare and Medicaid Services HIT Measures: Outpatient Hospital Department

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS
Technical Specifications: http://www.qualitynet.org/dcs/ContentServer?cid=1196289981244&pagename=QnetPublic%2FPage%2FQnetTier2&c=Page
Data Collection: Self-reported by hospitals

The HIT measures from CMS assess how outpatient hospital departments (such as emergency, imaging, surgery, and clinics) use electronic medical records.

The first measure (Able to receive lab results electronically) assesses whether a facility has the ability to receive electronic laboratory data directly into a certified electronic medical record and whether the facility actually uses this feature.  Facilities answer the following questions:

• Does/did your facility have the ability to receive laboratory data electronically directly into your ONC certified EMR system as discrete searchable data? (Yes/No)
• Did your facility use this feature during the performance period? (Yes/No)

The second measure (Tracking clinical results between visits) assesses whether a facility tracks results of laboratory tests, diagnostic tests (such as screenings), or patient referrals using a certified electronic health record.  This measure applies to all outpatient departments associated with the facility that bill under the Outpatient Prospective Payment System. This may include the emergency department, the outpatient imaging department, the outpatient surgery department, and the facility’s clinics.

Read more: http://www.qualitynet.org/dcs/ContentServer?cid=1196289981244&pagename=QnetPublic%2FPage%2FQnetTier2&c=Page

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Population Health and Utilization & Costs

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS, Institute of Medicine
Technical Specifications: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Geographic-Variation/Downloads/Geo_Var_PUF_Methods_Paper.pdf
Data Collection: CMS Chronic Condition Data Warehouse (CCW) containing Medicare claims for beneficiaries (all ages) enrolled in the fee-for-service (FFS) program as well as enrollment and eligibility data

The site includes the following measures of population health:

• Average Hierarchical Condition Category (HCC) risk score expressed as a Ratio to the National Average (see definition below);
• Percent of Medicare beneficiaries of all ages with Diabetes; and
• Percent of Medicare beneficiaries of all ages with Heart Failure.

It also includes the following measures of utilization and costs:

• Standardized Risk-Adjusted Per Capita Costs -- total annual Medicare payments per beneficiary standardized to remove geographic differences in payment rates for individual services and adjusted for differences in beneficiaries’ health using the risk-adjusted model that CMS uses to pay Medicare Advantage plans;
• Inpatient Days Per 1000 Beneficiaries of all ages -- annual number of hospital inpatient days covered by Medicare per 1,000 Medicare beneficiaries in the geographic area, including inpatient acute care hospitals paid under the Prospective Payment System (PPS), critical access hospitals, and other inpatient hospitals as inpatient psychiatric facilities and cancer hospitals;
• Imaging (IMG) standardized per user Medicare costs -- total annual Medicare payments for imaging services per Medicare beneficiary in the geographic area who used imaging services during the year, standardized to remove geographic differences in payment rates for imaging services;
• Test events per 1000 Medicare beneficiaries of all ages -- annual number of laboratory and non-laboratory tests per 1,000 Medicare beneficiaries in the geographic area; and
• Emergency Department Visits per 1000 Beneficiaries of all ages -- annual number of hospital emergency department visits (including both visits that result in an admission and visits that do not result in an admission) per 1,000 Medicare beneficiaries in the geographic area.

The Hierarchical Condition Category (HCC) risk score model is used by CMS to adjust capitation payments to private health care plans for the health expenditure risk of their enrollees. The model measures disease burden, taking into account HCC categories, which are correlated to diagnosis codes. The risk scores estimate how beneficiaries’ fee-for-service spending will compare to the overall average for the entire Medicare population. The risk score for the overall average is set at 1.0. Beneficiaries with scores greater than 1 are expected to have above-average spending; beneficiaries with scores less than 1 are expected to have below-average spending. Risk scores are based on a beneficiary’s age and sex; whether the beneficiary is eligible for Medicaid, first qualified for Medicare on the basis of disability, or lives in an institution (usually a nursing home); and the beneficiary’s diagnoses from the previous year.

Read More: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Geographic-Variation/GV_PUF.html.

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County Health Rankings

• Poor or Fair Health - Percent of adults reporting “fair” or “poor” when asked: “In general, would you say that your health is excellent, very good, good, fair, or poor?”   The measure is age-adjusted to the 2000 US population.

• Primary Care Physicians per 100,000 Population – The number of practicing primary care physicians (M.D.s and D.O.s) under age 75, specializing in general practice medicine, family medicine, internal medicine, or pediatrics per 100,000 population.
• Ratio of Population to Primary Care Physicians – The number of people present in a given area as compared to the number of physicians servicing that population. Expressed as the amount of people for each physician.
• Dentists per 100,000 Population – The number of dentists per 100,000 population.
• Preventable Hospital Stays – The hospitalization rate for ambulatory care–sensitive conditions per 1,000 Medicare enrollees.
• Diabetic Screening – Percent of Medicare patients with diabetes who received an A1C test (glycated hemoglobin) in the past year to assess their blood sugar control.
• Mammography Screening – Percent of female Medicare enrollees age 67–69 that had a least one mammogram over a two-year period.
• Percent Inadequate Social Support – Percent of adults answering “never,”, “rarely,” or “sometimes” when asked: “How often do you get the social and emotional support you need?”

Data Not Available

Note that not all hospitals report data for all measures; the site only publishes data when there are at least four quarters' worth of data available for a particular measure.  Not all hospitals report all data for all measures.

There is never data available in certain cases:

• There are no top 1 percent, top 5 percent, top 10 percent or top 25 percent benchmark data for reimbursement rates.
• There are no top 25 percent benchmark data for mortality rates and readmission rates
• There are no benchmark data for HCAHPS ratings of 7 or 8.  There are also no benchmark data for HCAHPS rating 6 or lower (except for state and national averages).
• There are no national benchmark data for the AHRQ Inpatient Quality Indicators and Patient Safety Indicators.

In some cases, data is not reported by a facility or is not calculated for a benchmark.  In other cases, data is reported but does not meet the minimum criteria for inclusion.  In the latter case, N/A will be accompanied by a footnote.

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Compare Performance by Groups and Regions

WhyNotTheBest.org allows users to explore data by hospital characteristics and regions of the U.S.

Compare by Groups

Users can compare hospitals by characteristics such as size, ownership, health system membership, and type—for example, comparing performance of all hospitals in health systems to those not belonging to health systems, or comparing all safety net hospitals to all for-profit hospitals.

Users also can follow the map links from group reports to examine the geographic distribution of U.S. hospitals by various characteristics.

Compare by Regions

Compare by Regions reports enable users to explore aggregated hospital performance by region (i.e., rolled up measurements from all the hospitals within a region) or population health in communities around the nation (i.e., indicators of population health and utilization/costs from the Institute of Medicine). For example, users can select a group of counties or HRRs, and then add in benchmarks from the relevant states as well as the national average.

WhyNotTheBest.org includes regional data for the nation, states, counties, and hospital referral regions (HRRs). Please note: not all measures are available for both county and HRR aggregation.

Users can follow the map links from regional reports to explore regional performance on an interactive map.
 

Top Performers

For each measure included on the site (excluding reimbursement rates, CLABSI data, and AHRQ IQIS and PSIs), the site identifies the top 1 percent of performers—the “top performers.” It also includes other benchmarks: the top 5 percent, top 10 percent and the top 25 percent, as well as top performers by hospital type (e.g., safety net, teaching, etc.).

Top Performers on Process-of-Care Measures

To appear among the top performers on the CMS process-of-care measures, a hospital must have reported data for every available measure and recorded data on 30 or more patients for each of the four conditions (heart failure, heart attack, pneumonia, and surgical care improvement).

No explicit weighting was incorporated, but higher-occurring cases give weight to that measure in the average. Since these are process measures (versus outcome measures), no risk adjustment was applied. 

Top Performers on HCAHPS

To appear among the top performers on the HCAHPS data, hospitals are ranked according to the percentage of survey respondents giving a 9 or 10 rating of overall hospital care. The site uses the results of the following question as a measure of patients' overall experiences:

"Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay?"

Note that the site does not apply exclusion criteria to create these performance rankings. All hospitals are included in the calculation of the percentile scores.

Top Performers on Readmission and Mortality Rates

The site identifies hospitals whose performance is statistically better than the national rate, as reported on Hospital Compare.

To review notes on how scores on this site may vary from scores on public reports, or for more details on how we aggregate scores read about Comparative Reporting.

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Benchmarks

For the purposes of calculating benchmarks, we identified hospitals in the following way:

• Safety Net Hospitals: membership in the National Association of Public Hospitals and Health Systems and/or serving 30 percent or more Medicaid patients
• Rural Hospitals: Hospitals designated by CMS as Critical Access Hospitals
• Teaching Hospitals: membership in the Council of Teaching Hospitals and Health Systems
• Academic Health Centers: membership in the Association of American Medical Colleges
• For-Profit: based on ownership, from the American Hospital Association database
• Not-for-Profit/Private: based on ownership, from the American Hospital Association database
• Government – Non-Federal: based on ownership, from the American Hospital Association database
• Government – Federal: based on ownership, from the American Hospital Association database
• Health Systems: based on system classification from the American Hospital Association database

A system is defined by AHA as either a multihospital or a diversified single hospital system. A multihospital system is two or more hospitals owned, leased, sponsored, or contract managed by a central organization. Single, freestanding hospitals may be categorized as a system by bringing into membership three or more, and at least 25 percent, of their owned or leased non-hospital preacute or postacute health care organizations. System affiliation does not preclude network participation. Read more about health systems.

Note that these multi-hospital systems are often horizontally integrated collections of hospitals—as opposed to integrated delivery systems, which WhyNotTheBest.org defines as a system with two or more facilities, including one non-hospital (e.g., a nursing home). The integrated delivery systems identified on the WhyNotTheBest.org map are drawn from an SDI list of high-performing systems; for more information please see the SDI website.

Top 1 percent, Top 5 percent, Top 10 percent, Top 25 percent: Top n percent  is the lowest score achieved by a hospital in the top n percent (i.e. the minimum threshold to be in the top n percent).

Benchmark calculations are based on hospitals that meet the eligibility criteria for high perfomer status, which is: a hospital must have reported data for every available measure and recorded data on 30 or more patients for each of the four conditions (heart failure, heart attack, pneumonia, and surgical care improvement). 

To review notes on how scores on this site may vary from scores on public reports, or for more details on how we aggregate scores read about Comparative Reporting.

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Interactive Map

The WhyNotTheBest.org interactive map shows performance variation on the national, state, county, and hospital referral region (HRR) levels. It also includes overlays tracking quality improvement activity and displaying health care performance recognitions in various ways, as described below.

The map includes health care performance measures, in the following categories:

• Process-of-care; 
• Patient experience;
• Health Information Technology adoption;
• Population Health
• Utilization and Costs;
• Readmission rates;
• Mortality rates
• Inpatient Quality Indicators;
• Patient Safety Indicators; and
• Prevention Quality Indicators.

For the measures from CMS Hospital Compare, the hospital performance values were adjusted by the denominator so that hospitals with higher reported numbers of observations carried a greater weight toward the regional rate.  Weighting was also used to address hospitals that share identifiers.  CMS Hospital Compare provides data at the level of Medicare Provider Numbers (MPNs).  For the map, hospitals sharing MPNs were weighted so as to not overcount their data.  This also allowed hospitals to contribute to the regional rate, regardless of whether their shared MPNs crossed counties.  The HCAHPS measures of patient experience are an exception.  As denominators are not provided for these data, we instead calculate an unweighted average.  Starting in 2012, HCAHPS values are weighted by the total admissions to the hospitals. Note: for some regions there are no data displayed, since there are no hospitals located in that region.

CMS periodically retires measures, which are referred to on WhyNotTheBest.org as "legacy" measures.  While legacy measures are included in the tabular reports, they do not appear on the map.

Overlays

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Differences from CMS Hospital Compare

WhyNotTheBest.org (WNTB) publishes indicators derived from the publicly available dataset provided by the Hospital Compare website hospitalcompare.hhs.gov

There are certain instances when scores published on WNTB differ from Hospital Compare. Please note the following criteria used by WNTB:

• HHS does not publish numerators. WNTB derives a numerator from the data by multiplying the score by the denominator. i.e. 80% of 100 cases results in a numerator of 80.
• At least 50% of hospitals must report a given measure for that measure to be published to WNTB.
• Aggregate scores (e.g. county, HRR, state averages) for process of care and patient experience are weighted by hospital admissions.
• Comparator benchmarks (e.g. Top 10%, Safety Net Hospitals) only include those hospitals meeting inclusion criteria of reporting all available measures for all available quarters.
• In instances where a minimum denominator is required, WNTB requires 30. Hospital Compare requires 25.
• WNTB calculates some AHRQ Quality Indicators using state-contributed all-payer data. Medicare uses Medicare-only data.

For further information about the methodology, please contact wntb-support@ipro.us.