Visiting Professor Does Deep Dive into Rankings

By Denise Bray Hensley

Gene Liu, MD, MMM, FACS, visiting professor from Cedars-Sinai Medical Center in Los Angeles, told Houston Methodist physicians in a recent Grand Rounds, “Do the right thing and rankings will come.” In other words, physicians who are doing their best for their patients will be getting good ratings, he said. “There are two camps: Rankings either matter a lot or rankings don’t matter at all. Very few of us fall in the middle,” said Dr. Liu, Director of Academic Otolaryngology and Program Chair of the Otolaryngology Residency Training Program at Cedars-Sinai Medical Center.

Dr. Liu is an accidental expert in data analysis of hospital rankings and the physician honor roll after he became interested as part of the Cedars-Sinai Medical Center and health system leadership. He is a longtime contemporary and friend of Mas Takashima, MD, FACS, professor and chairman of Houston Methodist Otolaryngology-Head and Neck Surgery. They met at the University of Colorado when Dr. Takashima was an attending physician and Dr. Liu was in his last year of residency. Dr. Takashima invited Dr. Liu as a visiting professor to speak at Grand Rounds in Houston and take out some of the mystery of rankings. He also presented the case for the staff members to do their part with due diligence to ensure rankings are considered in proper perspective.

"Do the right thing

and the rankings will come."

-Gene Liu, MD, MMM, FACS

"Do the right thing

and the rankings will come."

Gene Liu, MD, MMM, FACS

Dr. Liu started his solo private practice 18 years ago, then joined the Los Angeles health system as the first employed Otolaryngologist. Subsequently, the group at Cedars-Sinai has grown to 18 full-time physicians with a full academic shop, publishing approximately 50 papers a year, as well as participating on 50 national panels and lectures. Under his leadership, Cedars-Sinai started an Otolaryngology-Head and Neck Surgery residency program in 2020. Dr. Liu says U.S. News and World Report considers rolling data from three years. Surprisingly, the data concerns only Medicare patients – so mostly patients who are 65 years old and older. Ultimately, the rankings, as a measure of quality and brand equity, can impact negotiations with insurance companies and other payors. However, rank position among hospitals within the US News "honor roll” is not necessarily correlated with differences in patient outcomes following surgical intervention, according to recent otolaryngology literature, he said.

Bottom line is the data is not perfect. Whether we like it or not, people look at it. So, we have to focus on the things we can control and ignore the things we can’t. The gist of it for me is that I’m not going to ‘game’ the system. Just keep doing the right thing.

Gene Liu, MD, MMM, FACS

Visiting Professor from Cedars-Sinai Medical Center in Los Angeles

“Whether we like it or not, at least a third of our patients are looking at U.S. News and World Report rankings,” he said. “Many physicians look at rankings and assume it’s just a popularity contest for brand recognition only. Some is but a lot of it isn’t.” In 2023, U.S. News and World Report stopped ranking hospitals. Instead, they combine the top 22 hospitals in the same “honor roll.” Houston Methodist and Dr. Liu’s home base Cedars-Sinai are both among the top tier in hospitals. Specific numbers are still given to specialty and regional lists.

Methodology used for rankings:

Medicare claims data

Three-year rolling analysis

Inpatient cases/volume only

Patient experience: HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems

Reputation: Doximity survey

Factors that patients most frequently identified as important drivers included:

Hospital reputation or ranking

Hospital appearance and cleanliness

Hospital location

Referrals by primary care physicians, friends or family

Methodology used for rankings:

Medicare claims data

Three-year rolling analysis

Inpatient cases/ volume only

Patient experience: HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems)

Reputation: Doximity survey

Factors that patients most frequently identified as important drivers included:

Hospital reputation or ranking

Hospital appearance and cleanliness

Hospital location

Referrals by primary care physicians, friends or family

The methodology for the rankings is constantly assessed and changed to small and large degrees. A big change in methodology for otolaryngology-head and neck surgery will be the inclusion of outpatient surgeries as well as inpatient care. In recent years, the survey only considered patients who were admitted to the hospital. The methodology will also include the Area Deprivation Index, which measures risk-adjustment of the outcome measures used in the Health Equity analysis. This work will be accompanied by a sustained push to measure and report on social and economic disparities in healthcare to ensure that risk adjustment does not mask inequities. “Bottom line is the data is not perfect. Whether we like it or not, people look at it. So, we have to focus on the things we can control and ignore the things we can’t. The gist of it for me is that I’m not going to ‘game’ the system. Just keep doing the right thing. “Keep the patients alive; keep them happy. Provide quality care. Find a way to send them home.”