US News & World Report reveals children's hospital rankings amid legal scrutiny

U.S. News & World Report released its latest rankings for the country’s top children’s hospitals Wednesday, a day after a scathing letter criticized the media company for its annual rating system.

San Francisco City Attorney David Chiu said U.S. News’ rankings system is fraught with bias, questionable methodology and undisclosed financing, according to a letter obtained by USA TODAY on Tuesday. Chiu said the letter is "more than a heads up."

"We are requesting information from them. And depending on the response, we will consider next legal steps," he said.

In Wednesday's rankings, Boston Children’s Hospital was dethroned as the No. 1 children’s hospital in the country. Cincinnati Children’s Hospital Medical Center took its place.

"We are incredibly proud and honored to be recognized as the best pediatric hospital in the nation," said Dr. Steve Davis, president and CEO of Cincinnati Children’s. "Our people are − and have always been − innovators, teachers, collaborators, and compassionate caregivers, and they lead the way in helping kids achieve their full potential."

This would have been Boston Children’s 10th consecutive year occupying the top spot had it not been for changes in the report’s methodology, which deemphasized expert opinion in favor of more objective measures, said Ben Harder, chief of health analysis and managing editor at U.S. News & World Report.

"Boston Children’s is considered an outstanding hospital by medical professionals in all the specialties we evaluated, and it’s a standout in how experts view it," he said. "The change has less to do with what we increased the weight of than what we decreased the weight of."

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Though expert opinion may have accounted for about 30% of the methodology nearly two decades ago when the rankings first started, he said, it now accounts for less than 10%. The report is now placing more weight on measures of hospital quality like commitment to best practices and equity, diversity, and inclusion.

Despite the adjustments, the yearly rankings haven’t changed too much with Boston Children’s securing the second spot in overall rankings.

Top children's hospital rankings

• Cincinnati Children’s Hospital Medical Center.

• Boston Children’s Hospital.

• Texas Children’s Hospital in Houston.

• Children’s Hospital of Philadelphia.

• Children’s National Hospital in Washington, D.C.

• Nationwide Children’s Hospital in Columbus, Ohio.

• Children’s Hospital Los Angeles.

• UPMC Children’s Hospital of Pittsburgh.

• Rady Children’s Hospital in San Diego.

• Johns Hopkins Children’s Center.

"We are honored to be ranked among the nation’s top pediatric hospitals – all working toward making life better for children and families," said Boston Children’s president and CEO Dr. Kevin B. Churchwell. "While our ranking may have shifted, our unwavering commitment to the well-being of children is unchanged."

U.S. News also ranked hospitals by seven different regions – mid-Atlantic, Midwest, New England, Pacific, Rocky Mountain, Southeast, and Southwest – and 10 specialties:

• Cancer.

• Cardiology and heart surgery.

• Diabetes and endocrinology.

• Gastroenterology and GI surgery.

• Neonatology.

• Nephrology.

• Neurology and neurosurgery.

• Orthopedics.

• Pulmonology and lung surgery.

• Urology.

The ability to identify the best hospitals based on location and specialty has become particularly important in recent years as health care systems reduce or eliminate their pediatric services in favor of more lucrative procedures, Harder said.

A research letter published Tuesday in the journal JAMA Pediatrics found hospital systems with pediatric services declined over time from about 2,000 hospitals providing inpatient services in 2011 down to about 1,500 in 2020. Study authors suggested this was largely driven by hospital consolidation when two or more hospitals merge.

"It can be incredibly difficult for families with a sick child to seek care and manage the other obligations that they have beyond the emotional agony of having a very sick child and the uncertainty about their long-term outcome and quality of life," Harder said. "The goal here is to help families identify the right care for their child."

US News controversy

In Tuesday's letter to U.S. News, City Attorney Chiu alleged the outlet's ranking system incentivizes hospitals to focus on certain specialties, including treatments primarily used by white people, to score higher. This ranking system puts less weight on primary care, specialties that reduce health care costs, or treatment for conditions typically experienced by people of color.

Under California state law, Chiu's letter is requesting U.S. News to substantiate advertising claims that the outlet is an "authoritative resource" for hospital rankings and provide more information about its ranking methodology and financing. Depending on the outlet's response, the city attorney said, he would consider "the next legal steps."

The letter comes after U.S. News has received backlash in recent years from dozens of ranked medical and law schools that said they would no longer provide information to the outlet.

Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

This article originally appeared on USA TODAY: Best hospitals for kids: US News releases rankings amid legal scrutiny