US News' hospital rankings questioned by San Francisco city attorney

U.S. News & World Report’s hospital ranking system is being investigated by the San Francisco city attorney’s office, which alleges the annual report is fraught with bias, questionable methodology and undisclosed financing.

In a letter sent to the media company Tuesday, City Attorney David Chiu alleged U.S. News’ rankings incentivize hospital systems to focus on certain specialties, including treatments primarily used by white people, to score higher in its ranking system.

This ranking system puts less weight on primary care, specialties that reduce health care costs, or treatment for conditions typically experience by people of color, according to the letter obtained by USA TODAY.

“(U.S. News) holds itself out as an expert on ranking hospitals, but medical experts have recently raised concerns that (its) rankings suffer from poor and opaque methodology, mislead those using the rankings, and create perverse incentives for hospitals nationwide,” he wrote.

The city attorney’s office is also demanding U.S. News publicly disclose the payments it receives from the hospitals included in their rankings, claiming the media company receives fees from medical institutions to display a “Best Hospital” badge on their online or print advertising.

“Many (San Francisco) hospitals aren’t even ranked in this that we think are providing good services and it’s just been mystifying to us on how these rankings are happening. So, that’s why we were digging into it,” Chiu told USA TODAY Tuesday.

“In the recent wake of public scrutiny of (U.S. News’) ranking methodology of other institutions, which has led law schools, medical schools, and colleges to withdraw from its rankings, the public deserves answers to many questions,” he wrote.

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U.S. News “categorically” disagreed with the city attorney’s “assumptions and conclusions,” in a statement sent to USA TODAY, and said the media company’s rankings are “an important public service” to Americans making critical health care decisions.

“We have consistently stated that our rankings should be one factor in that decision-making process, and any medical decisions should be made in consultation with a physician,” the statement read. “Families facing a serious or complex medical problem deserve to have a place where they can easily identify the factors that are important to them and help determine which hospital is the best suited for their individual needs.”

The media outlet did not respond to questions about receiving “badge fees” or other undisclosed payments.

U.S. News had previously received backlash before from dozens of ranked medical and law schools who said they would no longer provide information to the outlet in recent years. The institutions argued the rankings formula discouraged them from admitting promising graduates of less-prestigious colleges who hadn’t performed as well on entrance tests as applicants from top schools, and that they were penalized in the rankings when their graduates chose careers in public service over more lucrative options.

“That piqued interest from the past year and as we were looking at a variety of reports, we realized that the data in the hospital context is just as questionable. But the stakes are arguably much higher,” Chiu said.

Considering ‘all legal options’

Under California state law, Chiu’s letter is requesting U.S. News substantiate advertising claims that the outlet is an “authoritative resource” for hospital rankings, and provide more information about its ranking methodology and financing.

“If U.S. News & World Report is violating (Federal Trade Commission) regulations, we will look at all legal options,” he said. This “is more than a heads up.”

Chiu’s letter comes a day before U.S. News was expected to release its 2023-24 rankings for the nation’s best children’s hospitals. Americans have widely relied on its annual hospital rankings, which began publishing in 1990, to help make informed health care decisions. U.S. News’ pediatric hospital rankings have been publishing annually since 2007.

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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.