Best Hospitals Award Methodology

2023 Best Hospitals and Health Facilities Award Methodology

The Women’s Choice Award identifies America’s Best Hospitals across our nation to help women make smart healthcare choices. Our goal is to simplify your choice of hospitals as we understand how this critically important decision can impact you and your family. Being treated with the proper level of care impacts your health, well-being and healing, so our goal is to identify those hospitals that have demonstrated the highest level of quality care to their patients, with a special focus on the female experience.

Being named and recognized as a hospital of choice among women is an honorable achievement as it represents the strongest and most important consumer message in today’s healthcare marketplace. Considering that women account for 90% of all healthcare decisions for her and her family, being a hospital of choice women trust is commendable.

Our methodology is unique in that it is the only national list that simplifies a woman’s choice when selecting a hospital. Our understanding of what matters most to women when selecting a hospital is based on surveys of tens of thousands of women, as well as research conducted in partnership with the Wharton School of Business on what drives the consumer experience for women vs. men. This research led us to understand that we cannot separate clinical performance from patient experience. Furthermore, all of the methodologies below take into consideration the recommendation rating based on patient feedback.

In arriving at our award determinations, we use the most recent publicly available information from The Centers for Medicare and Medicaid Services (CMS), as well as accreditation information from appropriate sources. In some cases, we have surveyed thousands of women to determine which measures are most important to them. Our methodology is 100% objective, replicable and uniform. There are no subjective considerations for any of our awards.

Best Hospitals for Bariatric Surgery

The methodology for the bariatric surgery award is unique in that it combines national accreditations, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results and hospital outcome scores with primary research about women’s healthcare preferences. It is the only award recognizing excellence in bariatric surgery based on robust criteria that consider patient satisfaction and clinical excellence.

Hospitals earning the America’s Best Hospitals for Bariatric Surgery Award have met the Comprehensive Center standards of The American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS) through the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).

Additionally, hospitals that have received a Woman’s Choice Award have been assessed for their patient safety ranking and a patient recommendation rating. In addition to the rigorous criteria required for comprehensive accreditation, these awarded centers are above the national average (70%) on the HCAHPS survey by the Centers for Medicare and Medicaid Services (CMS) and exhibit a strong safety culture throughout their organization based on 12 CMS measures of infection and complication rates.

Best Hospitals for Comprehensive Breast Care

The Best Hospitals for Comprehensive Breast Care award recipients have all met the National Accreditation Program for Breast Centers (NAPBC) standards from the American College of Surgeons. As a pioneer to setting criteria for breast diseases, NAPBC-accredited centers offer the highest standard of care providing women with access to board-certified specialists, breast surgeons, breasts radiologists, medical and radiation oncologists, breast pathologists, plastic/reconstructive surgeons as well as support professionals. Alternatively, breast centers can be accredited by the NQMBC (National Quality Measures for Breast Centers) as a Certified Quality Breast Center.

Our awarded hospitals must also carry the seal of the American College of Radiologists as a Breast Imaging Center of Excellence (BICOE) which signifies that the center has achieved breast imaging excellence in mammography, stereotactic breast biopsy, breast ultrasound and breast MRI.

Apart from accreditation, patient experience is also a significant criterion for the Best Hospitals for Comprehensive Breast Care Award. Hospitals must receive a recommendation rating of 64% for the Centers for Medicare and Medicaid Services’ (CMS) patient recommendation measures, or their equivalent in the case of breast centers without hospital affiliation.

Best Hospitals for Cancer Care

The Best Hospitals for Cancer Care must have received accreditation from the American College of Surgeons Commission on Cancer as any of the following: a National Cancer Institute (NCI) Designated Comprehensive Cancer Program; a Comprehensive Community Cancer Program; an Integrated Network Cancer Program (with over 200 beds); or an Academic Comprehensive Cancer Program. These accreditations require that the hospital have treated over 500 cancer cases in the most recent year and supports their commitment to providing high-quality, multidisciplinary, patient centered cancer care.

In addition to their accreditation, these selected hospitals were further segmented based on their patient recommendation rating from the Centers for Medicare and Medicaid Services’ (CMS) Hospital Consumer Assessment for Healthcare Providers and Systems (HCAHPS) survey. All accredited and awarded hospitals must receive a recommendation rating at or above the national average (70%) on the HCAHPS survey. Additional points were given if a hospital offered on-site chemotherapy, radiation or hospice, and cancer research activities. Hospitals were disqualified if infection ratings were worse than the national average with respect to Central Line Associated Bloodstream Infection (CLABSI) and Catheter Associated Urinary Tract Infection (CAUTI).  

Best Hospitals for Emergency Care

The Best Hospitals for Emergency Care are hospitals that consistently rank among the best hospitals reporting on the performance of their respective Emergency Departments. They are judged on the following Emergency Department performance measures reported by the Centers for Medicare and Medicaid Services (CMS):

1. Average time patients spent in the Emergency Department before leaving the hospital
2. Percentage of patients who came to the Emergency Department with stroke symptoms who received brain scan results within 45 minutes of arrival
3. Percentage of patients who left the Emergency Department without being seen
4. Also included were hospitals that performed well in responding to patients showing symptoms of severe sepsis, a very dangerous condition
5. Hospitals received additional credit if they have an accredited trauma center

Each of the measures indicated above were weighted according to a survey of over 1,000 women on their relative priority, and listed above in order of importance. In addition, hospitals that fell within the bottom 25th percentile for patient recommendation scores were eliminated from consideration for the award.

For each Emergency Department measure, the top 25th percentile and the top 50th percentile are determined for all hospitals reporting the measure. Hospitals that ranked in the top 25% nationwide for a measure received points according to the measure’s relative importance. Hospitals that ranked between 25% and 50% received half the points. Additionally, points were provided for the various trauma level centers.  Points were then totaled for all measures, per hospital. In addition to their score, these selected hospitals were then given a numerical score based on their patient recommendation rating from the Centers for Medicare and Medicaid Services’ (CMS) Hospital Consumer Assessment for Healthcare Providers and Systems (HCAHPS). Hospitals that received at or above the national average (70%) on the HCAHPS survey and with total scores that placed them in the top 10% nationally, earned the Women’s Choice Award.

Best for Extended Care

The Extended Care award was given to those facilities that have 25 or more beds, and have received at least 18 combined stars in the four categories in the Centers for Medicare and Medicaid Services (CMS) five-star rating system. No three-star ratings are accepted – only four and five stars. The CMS rating categories are:

1. General Staffing
2. Registered Nurse staffing
3. Quality rating
4. Inspection survey rating

Recipients must also have:

• Medicare certification
• Full sprinkler systems
• No recent history of penalties or fines.

Approximately 900 facilities were awarded out of over 15,000 across the nation.

Best Hospitals for Heart Care

The Best Hospitals for Heart Care list is determined by first identifying hospitals across the nation that offer a minimum of six of the following cardiac and/or vascular services:

• Cardiac Catheter Lab
• Cardiac Rehabilitation
• Cardiac Surgery
• Carotid Stenting
• Coronary Interventions
• Electrophysiology
• Vascular Intervention
• Vascular Surgery
• Coronary Intensive Care (CCU)

The above cardiovascular services are the most universal clinical procedures that are offered by hospitals. Only qualified hospitals that performed well clinically with regard to heart care measures of mortality and readmission as reported to Medicare, and also have a high Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) recommendation score, are selected. Hospitals that received above the national average (70%) on HCAHPS survey along with low mortality and readmission rates that placed them in the top 10.3% nationally, earned the Women’s Choice Award.

Best Hospitals for Mammogram Imaging

Hospitals that received above the national average (70%) on HCAHPS survey and that are accredited for Mammograms (MAP) and carry the Breast Imaging Center of Excellence (BICOE) seal from the American College of Radiology earned the Best Hospitals for Mammogram Imaging award.

Best Mammogram Imaging Centers (Independent)

These imaging centers are independent and not hospital affiliated. To start, these centers must carry the Breast Imaging Center of Excellence (BICOE) seal from the American College of Radiology and be accredited for Mammograms (MAP). Facilities that met that requirement were then checked for their web reviews. A minimum of 50 reviews from publicly available review sites was required with Google and Yelp reviews being the predominate sources. Centers must have a minimum overall average rating of 4.0 stars or higher to earn the award.

Best Hospitals for Minimally Invasive Surgery

1. Hospitals must be listed by the American Hospital Directory (AHD.com) as providing Robotic Surgery (More than 10 Medicare claims for computer assisted robotic surgery (ICD 17.41-17.49 and selected CPT codes)). Alternatively, a hospital can meet this qualification if they have accreditation from the American Institute of Minimally Invasive Surgery (AIMIS), or designation by Surgical Review Corporation (SRC) as a Center of Excellence for Robotic Surgery, Minimally Invasive Surgery or Minimally Invasive Gynecology.
2. The hospitals that achieve #1, must also have a HCAHPS recommendation rating of 70% or more (i.e. higher than the national average). Hospitals with HCAHPS footnotes (generally for inadequate survey responses or discrepancies) are excluded.
3. Each qualifying hospital receives a score that is equal to their recommendation rating plus 2 points for robotic surgery and 12 points for AIMIS accreditation, SRC Designation (or comparable accreditation).
4. Any hospital with a "Worse than the national rate" rating from CMS for Deaths from Serious Complications, or Surgical Site Infections - Hysterectomy or Colon Surgery are disqualified from consideration.

Best Hospitals for Obstetrics

The Best Hospitals for Obstetrics scoring process is unique in that it is the only national list that is evidence-based and focuses on patient satisfaction. Our awarded hospitals ranked above the national average for patient recommendations (70%+), as indicated by the data reported by the U.S. Department of Health and Human Services in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys.

Recent statistics from the American Pregnancy Association state that women under the age of 35 have a 15% chance to miscarry whereas women who are 35-45 years have a 20-35% chance of a miscarriage. Most women that have high risk pregnancies may require a higher level of care for the baby after birth. In addition to high patient recommendation ratings, hospitals were rewarded extra points for having a Level III/IV Neonatal Intensive Care Units (NICU). Levels III/IV intensive care units are designed for babies that require high level of care where level IV centers have the most comprehensive capabilities for the care of the most complex and critically ill newborns.

Additional points were also granted to hospitals who reported early elective delivery rates between 0-1%, better than the national average. We also recognized hospitals that were designated as baby-friendly facilities and those whose infection and complication surgical scores were ranked below the weighted national average for patient safety.  Hospitals with a high patient safety ranking based on 12 Centers for Medicare and Medicaid Services’ measures of infection and complication rates received additional points.

Points were also given to hospitals participating in the Baby Friendly program, that have successfully implemented the Ten Steps to Successful Breastfeeding.

Best Hospitals for Orthopedics

The Best Hospitals for Orthopedics are hospitals that provide comprehensive orthopedics services, such as arthroscopy, joint replacements and spine surgery services, as well as offering onsite MRI and physical therapy. In addition to providing a spectrum of orthopedic services, these full-service hospitals are then judged based on their results through the Hospital Consumer Assessment for Healthcare Providers and Systems (HCAHPS) survey for patient recommendations and post-operative recovery instructions, measures that are very important to women when choosing a hospital. Both recommendation and recovery ratings must be equal or above the national average in order to qualify (70%and 86% respectively). Only the top 7% hospitals in the nation have been awarded for Best in Orthopedics.

In a 2017 surgical complication prevention guide by the Agency for Healthcare Research and Quality (AHRQ), studies indicated surgical adverse effects ranged from 3 to 27% amongst surgical patients. Apart from being a comprehensive facility and have high recommendation and recovery ratings, surgical event scores for all hospitals were also a criterion to earn the Women’s Choice Award. Award recipients are measured on their incidence of surgical complications and infections, including:

• A wound that splits open after surgery
• Accidental cuts and tears
• Deaths from serious treatable complications
• Rate of complications for knee or hip replacement patients
• Catheter associated urinary tract infections (CAUTI)
• Methicillin-resistant Staphylococcus Aureus (MRSA) infections

Hospitals who were rated Worse Than the National Benchmark were disqualified for abnormally high rates of surgical complications and infections.

Best Hospitals for Outpatient Experience

The Best Hospitals for Outpatient Experience is predominantly determined on patient satisfaction with a hospital visit. The scoring process is unique in that it is the only national list that focuses on the opinion of females. Over 500 women were initially surveyed to determine which questions in the Outpatient and Ambulatory Surgery Survey (OAS-CAHPS) are most important to them in terms of satisfaction. The most weight is given to the communication and care provided by the healthcare providers and staff, overall facility’s rating, patients’ recommendation and pre- and post-surgical coordination respectively.

The responses to OAS-CAHPS questions are compared to the nation’s average and a ranking is assigned to each hospital based on its overall numeric score in conjunction to the weights obtained from the survey. In addition, only facilities that are accredited can qualify for the award.

To receive the award, hospitals must first be accredited by the Joint Commission (JC), The Healthcare Facilities Outpatient Program (HFAP) or Det Norske Veritas Healthcare (DNV). Accredited facilities are continuously improving the safety and quality of patient care and this certification signifies the facility’s commitment in meeting regulations and best practices for the medical industry.  The categories in the OAS-CAHPS survey are assigned weights based on the feedback received from the Women’s Choice Award Survey.  Only hospitals that achieve rankings higher or equal to the national average in communication and care by hospital staff, pre- and post-surgical coordination, facility ratings and patients’ recommendation are eligible for the outpatient experience award. 

100 Best Hospitals for Patient Experience

The 100 Best Hospitals for Patient Experience scoring process is unique in that it is the only national list that focuses on patient satisfaction and female preferences. The process begins with a survey of hundreds of women. Our survey determines which questions in the HCAHPS* survey, completed by patients after discharge, are most important to them in determining their satisfaction with their hospital stay. A weight is given to each of the most important questions. For 2023, the most weight is given to those regarding the patient’s willingness to recommend, doctor communications, staff help, cleanliness, providing recovery information, explanation of medications, communication by nurses and peacefulness of room at night respectively.

The responses to those questions, weighted accordingly, results in a numeric score for each hospital that reported valid HCAHPS data to the Centers for Medicare and Medicaid Services. The scoring is totally objective and uniform. The best 100 scores in each of the five hospital bed size categories (Under 25 beds, 25- 100 beds, 101-250 beds, 251-400 beds, and over 400 beds) determine the recipients of the 100 Best Hospitals for Patient Experience award. WCA obtains hospital bed count from CMS publicly available data. For under 25 Bed category, WCA collects and averages 3 years of data to ensure a more meaningful data set. Additionally, downward trends were noted, eliminating any hospitals that had a downward trend over 8% over the determined period.
*Hospital Consumer Assessment of Healthcare Providers and Systems.

Best Hospitals for Patient Safety

The Best Hospitals for Patient Safety are hospitals that have a low incidence of problems arising from surgical errors and infections. The hospitals that report the frequency of these adverse surgical events to The Centers for Medicare and Medicaid Services (CMS) are ranked for each of the following twelve measures:

1. Deaths among patients with serious treatable complications after surgery,
2. Collapsed lung due to medical treatment,
3. Serious blood clots after surgery,
4. A wound that splits open after surgery on the abdomen or pelvis,
5. Accidental cuts and tears from medical treatment,
6. Broken Hip from a fall,
7. Sepsis,
8. Central line-associated blood stream infections (CLABSI),
9. Catheter-Associated Urinary Tract Infections (CAUTI),
10. Surgical Site Infection from colon surgery (SSI: Colon),
11. Methicillin-resistant Staphylococcus Aureus (MRSA) blood laboratory-identified events (bloodstream infections), and
12. Clostridium difficile (C.diff.) laboratory-identified events (intestinal infections).

Hospitals can be eliminated from consideration for the following reasons:

• Not reporting on at least 4 of the surgical complication measures (1-6) or 4 of the infection measures (7-12),
• Having a patient recommendation rating in the bottom 50% nationally,
• Receiving a CMS rating of “Worse than the U.S. National Rate” for any of the above measures
• Having a patient safety average rank greater than 20%,

For the remaining hospitals, the Women’s Choice Award averaged their rankings for all the measures (weighted slightly toward surgical errors as a result of a WCA women’s survey) and cut off the award list only including those that averaged in the top half nationally. Only the top 9% of hospitals are recognized for patient safety.

Best Hospitals for Stroke Care

The Best Hospitals for Stroke Care are hospitals that hold a Stroke Center Certification, recognizing centers that meet high standards for stroke care as determined by the Joint Commission (JC) and/or Det Norske Veritas (DNV).
Hospitals get credit for their certification on a scale based on the degree of care available to the stroke patient. The following certifications earn credit, from most to least:

• Advanced Comprehensive Stroke Center (JC) or Comprehensive Stroke Center Certification (DNV)
• Advanced Thrombectomy Capable Stroke Center (JC) or DNV Primary Stroke Center Certification Plus
• Advanced Primary Stroke Center (JC) or DNV Primary Stroke Center Certification
• Acute Stroke Ready Hospital (JC) or DNV Acute Stroke Ready Certification

To receive Advanced Primary certification, Stroke Centers must meet disease-specific requirements, clinically specific requirements, and expectations which include:

• Use of a standardized method of delivering care,
• Support for patient self-management activities,
• Tailoring of treatment and intervention to individual needs,
• Promotion of the flow of patient information across settings and providers, while protecting patient rights, security and privacy,
• Analysis and use of standardized performance measure data to continually improve treatment plans, and
• Demonstration of their application of and compliance with clinical practice guidelines published by the AHA/ASA or equivalent evidence-based guidelines.

In order to be certified as a Comprehensive Advanced Stroke Center, the center must meet additional requirements. Thrombectomy Capable Stroke Centers have the tools and the expertise to perform mechanical thrombectomy, a minimally invasive surgical procedure to remove a blood clot from an artery. Acute Stroke Ready hospitals are certified to provide immediate care for strokes, including life-saving medications, and then transport the patient to a primary or comprehensive stroke center.
Using data from the Centers for Medicare and Medicaid Services (CMS) and hospital certification sites:

• The hospital must meet the stroke center certification requirement and
• it cannot have received a rating of ‘Worse than the National Rate’ for the Deaths from Serious Treatable Complications measure.

In addition to the above requirements, hospitals receive points if they maintain a recommendation rating at or better than the national average of 70%, and additional points if they scored in the top 80% nationally for the time from emergency department arrival to head CT scan results.

Best Hospitals for Women’s Services

Hospitals that deliver a spectrum of  services that are most important to women for their own health earn this award. 

A hospital earning this award will, at a minimum, offer obstetric services, as that is the most common health reason for women to be hospitalized.  Award recipients will also provide at least three of the following:

• It will have a breast center, a dedicated department or facility for diagnosis and treatment of the breast, with particular emphasis on early detection of breast cancer.
• It will be designated a Breast Imaging Center of Excellence (BICOE) by the American College of Radiologists,
• It will have a Level III or IV Neonatal Intensive Care Unit (NICU), for the care and treatment of babies born prematurely or with other medical issues.
• Because heart disease is a major killer of women, the hospital must qualify as a heart hospital by providing a minimum of 6 of the following cardiovascular services: Cardiac Rehabilitation, Coronary Interventions, Cardiac Surgery, Vascular Surgery, Vascular Intervention, Carotid Stenting, Cardiac Catheter Lab, Electrophysiology, or Coronary Intensive Care (CCU)
• The hospital has been designated a Center of Excellence (or equivalent) for Minimally Invasive Gynecology.

Those hospitals that meet the above requirements can be disqualified if their recommendation rating from the Hospital Consumer Assessment of Healthcare Providers and Services (HCAHPS) survey does not meet or exceed the national average (70%).  They can also be disqualified if their most recent rating for Surgical Site Infections related to hysterectomies is given a rating of “Worse than the National Rate” by the Centers for Medicare and Medicaid Services (CMS).  Only the top 6% of hospitals are recognized for Women’s Services. 

Best Children’s Hospitals

It is our intent to identify children’s hospitals that mothers and fathers can take their children to with the expectation that they will receive excellent and comprehensive care.

The determination of the Best Children’s Hospitals was based on self-reported data from children’s hospitals across the nation. The award criteria looks at 5 different facility areas to determine which hospital is eligible for the Women’s Choice Award.  These areas are Pediatric Services, Technology and Family Resources, Board Certified Staff, Nurses and Support Staff and the facility’s Commitment to Quality. We arrive at the top hospitals through a point system as described below.

• Family Centered Care
• Family sleeping/living accommodations
• Dedicated pediatric emergency department
• Pediatric ICU
• Neonatal ICU
• Child Life specialists
• Use of telehealth technologies
• Participation in pediatric health research
• Accreditation by the Joint Commission
• Pediatric Trauma Center accreditation

Each of the above contributes five points to the hospital’s score, with the exception of NICU, which earns five points for a Level IV and two points for a Level III. A maximum of 50 points can be earned for these services.

We also assign points for hospital staffing based on the number of beds per board certified pediatric professional in the following specialties:

• Anesthesiology
• Radiology
• Orthopedics
• Cardiology
• Endocrinology
• Pulmonology
• Nephrology
• Gastroenterology
• Urology
• Neurology
• Oncology
• Neonatology

Points of 0 to 5 are assigned based on the relative number of beds per physician, with those having the least average beds scoring the most points. Each of the results was also weighted based on the average beds per physician for all the reporting hospitals, e.g. cardiology staffing was given twice times the weight of radiology staffing because the average number of beds per cardiology staff was 22 versus 52 for radiology.  We assigned up to six additional points for high levels of other professional, nursing and support staff.

We compared the point totals for all the hospitals and awarded those that scored above a point of discontinuity, where points declined rapidly.

Best Pediatric Emergency Care

The determination of the Best Pediatric Emergency Care was based on self-reported data from children’s hospitals across the nation. A children’s hospital earned the Best Pediatric Emergency Care award if they have all three of the following:

• Dedicated pediatric emergency department
• Pediatric intensive care unit (ICU)
• A high rating (4 or 5 on a 5 point scale) for their Emergency Department staffing