US News & World Report will start disclosing which hospitals pay for rankings in its “Best Hospitals” list after an investigation by SF City Attorney David Chiu’s office. Chiu also published an op-ed in the publication criticizing its ranking methodology.

As KRON4 reports, Chiu didn’t hold back in his August 29 op-ed in US News & World Report. “While U.S. News has represented itself as an expert in hospital rankings, I have had significant concerns about perverse incentives created by its ranking methodology,” Chiu writes.

According to a press release, Chiu’s office began investigating the publication in 2023 and subsequently discovered at least one hospital paid $42,000 for a “Best Hospitals” badge, which was never disclosed — a violation of the Federal Trade Commission Act. The press release states that US News also offers paid options for “Featured Hospital” placement; advertising on the outlet’s website and in its Best Hospitals guidebook; and access to micro-data relating to US News’s rankings.

When US News neglected to respond to a 2023 letter from Chiu (PDF), his office sent two subpoenas in January 2024 (PDF) requesting documents and information from the publication. US News then filed a lawsuit claiming the investigation was in violation of its First Amendment rights, which was later dismissed.

The parties came to an agreement in April of this year, in which US News agreed to include a disclaimer on any webpages that earn revenue from hospital rankings.

“Consumers use these hospital rankings to make consequential health care decisions, but at the outset of our investigation the company did not disclose as required by U.S. law that it received payments from the hospitals it ranked, including licensing fees for permission to display a ‘Best Hospitals’ badge,” Chiu says. “My office is committed to defending consumers’ best interests, so I’m glad we were able to reach a settlement that ensures greater transparency in U.S. News’s financial disclosures.”

In addition to pushing the outlet to disclose its payment structure, Chiu urged the publication in his op-ed to restructure the way it forms its ranking methodology, citing “significant limitations” with the current system. Chiu writes that the data US News utilizes for its “Best Hospitals” rankings is primarily provided by Medicare, making the list mainly applicable to people 65 and older.

“If U.S. News included data from private insurers and Medicaid, as some other hospital ratings do, it would present a fuller and more representative picture of hospital quality,” Chiu writes. “U.S. News also underweights data from outpatient treatment, which is how hospital care is now frequently provided.”

Additionally, Chiu says the outlet relies on physician surveys for ranking medical specialties, which provides skewed information and could potentially motivate hospitals to incentivize higher-ranking specialties. “For example, in its rankings of children’s hospitals, U.S. News allocates at least 19 points for treatment of cystic fibrosis, a rare disease affecting mostly white newborns, and only 1 point for treatment of sickle cell disease, which affects far more babies and disproportionately affects Black or African American newborns,” Chiu writes.

Chiu urges US News to properly measure the quality of care that hospitals provide all of their patients, including those who are historically underserved. “Separate measures prepared by the U.S. News show that many of its very highest ranked hospitals underperform in offering care to their local communities,” he writes. “It is not enough to provide stellar care to a select group of patients and not others.”

He goes on to say that US News’s current ranking methodology helps already prestigious hospitals attract more funding while cash-strapped local hospitals continue to struggle. “These rankings obscure the fact that for many common conditions and procedures – such as a routine knee replacement – your local hospital is likely just as good as the purportedly top-ranked hospitals that may require expensive travel costs,” Chiu writes.

“Many local hospitals providing outstanding care, but not recognized by U.S. News, are facing immense budgetary pressure. If community hospitals go out of business, patient care will suffer,” he continues. “Rather than pitting hospitals nationwide against each other, a better approach would be to provide key quality metrics for each hospital and, if appropriate, flag areas of special expertise or surgical volume.”

Chiu concludes his op-ed by encouraging the public to “keep in mind that the best hospital for you is usually the one in your community.”

Update: Here’s US News Executive Chairman and CEO Eric Gertler’s response to Chui’s op-ed.

Image: David Chiu/Flickr