Oct 23, 2023



How Healthgrades Determines the Nation’s Top Performers in Specialty Care

Since 1998, Healthgrades has been helping consumers evaluate and compare hospital performance for care provided during a hospital stay for specific conditions or procedures.

When searching for high-quality specialty care, patients can look beyond overall performance ratings and find a hospital that excels in their specific condition or procedure. Hospital quality is not one-size-fits-all: the same hospital with exceptional outcomes in joint replacement might have a cardiac care program with higher-than-average mortality rates, which is why data-driven tools like Healthgrades quality awards and ratings are crucial to helping consumers make informed choices about where to seek care.  

But what goes into achieving a Healthgrades Specialty Excellence Award™?

If you’re a scientific type and want to read all the details of why our methodology is the most rigorous (and impartial), you can read the full methodology. Otherwise, keep reading for an overview on how the process works.

By The Numbers

To get a quick overview of how we rate hospitals, let’s start by looking at the numbers:

  • Our analysis is based on 45+ million Medicare medical claims for the most recent three-year period available.
  • We get our data from approximately 4,500 hospitals nationwide.
  • Hospitals can neither opt-in nor opt-out, nor can they submit their own data.
  • Healthgrades has comprehensive healthcare expertise and rates hospitals across 31 conditions and procedures — that’s a lot of specialties!

Hospital quality is not a popularity contest

We don’t consider the reputation of the institution or any financial information. Our scientific and transparent methodology focuses on what matters most to patients: clinical outcomes.

Methodology Simplified

Our methodology* works like this:

  1. Patient groups are identified by ICD-10-CM (this stands for International Classification of Diseases, Tenth Revision, Clinical Modification) codes. It’s the system used by healthcare providers to classify and code all diagnoses, symptoms, and procedures, everything from headaches to hypertension.
  2. Identify the mortality and complications outcomes for 31 different conditions or procedures.
  3. Develop a list of potential risk factors. These include comorbid conditions (existing conditions like heart disease), demographics (such as age and gender), procedural risk factors (for example, single vs. bilateral knee replacement), and admission sources (such as patient transfers).
  4. Use a Logistic Regression (Wald Backward Stepwise if you’re keeping score) to identify risk factors that are statistically significant in predicting outcomes.
  5. Apply the logistic regression model to the data set to derive the predicted outcome by hospital.
  6. Compare the actual outcome to the predicted outcome to calculate a z-score.
  7. Create a weighted average score by combining the outcome z-scores of at least 21 of the 31 conditions or procedures rated for a facility.
  8. Rate hospital performance based on overall combined scores in each procedure or condition: better than expected (five stars), as expected (three stars), or worse-than-expected (one star).

    • To be eligible for an award, hospitals must receive a rating in the cohort(s) included in the determination of the award. Some awards, like the Cranial Neurosurgery Excellence Award™, are based on a single cohort–cranial neurosurgery–while others, such as the Orthopedic Surgery Excellence Award™, require the combination of a grouping of three cohorts: hip fracture treatment, total knee replacement, and total hip replacement. For awards that evaluate multiple cohorts, an average of volume-weighted z-scores is used to determine hospital performance.

  9. The top 10% of hospitals within each specialty are recognized as Specialty Excellence Award™ recipients based on having the highest risk-adjusted mortality and complication z-scores.
  10. The list of Specialty Excellence Award recipients is then used to determine the top 100 hospitals for 11 specialty areas and the top 50 hospitals for three specialty areas. These hospitals are recognized as America’s 50/100 Best Hospitals for Specialty Care™ in their respective areas.

Why Hospital Quality Matters

When it comes to choosing healthcare, quality saves lives, which is why Healthgrades is committed to delivering the most scientifically accurate and comprehensive information about doctors and hospitals — with data insights not available anywhere else. By offering easy access to data-driven hospital ratings, Healthgrades connects consumers with the doctors and hospitals who are right for their specialty care needs.

This year’s award recipients consistently deliver superior clinical outcomes for some of the most common conditions and procedures. In fact, if all hospitals as a group performed similarly to those with a five-star rating, on average: 

  • 215,667 lives could potentially have been saved.*
  • 149,521 potential complications could have been avoided.*

Hospital quality definitely makes a difference!

For more information about how Healthgrades rates hospitals, contact us at full methodology. Healthgrades also offers a patient-friendly “How Healthgrades Rates Hospitals and Why It Matters” infographic to help consumers understand how we pick award recipients and the impact of choosing the right hospital has on your likelihood of a positive outcome.

* Statistics are based on Healthgrades analysis of MedPAR data for the years 2020 through 2022 and represent three-year estimates for Medicare patients only.