MD Anderson No. 1 (Again) in Rankings by U.S. News
By Paul Goldberg
MD Anderson Cancer Center has once again assumed its place at the top of the influential U.S. News & World Report rankings for 2015-2016.
The Houston-based center edged out New York’s Memorial Sloan-Kettering Cancer Center.
As MD Anderson returns to the paramount position it has held 11 times over the past 14 years, it does so despite turmoil between its faculty and administration (The Cancer Letter, July 13).
Last year, MD Anderson dropped to the No. 2 spot by a razor-thin 0.1 percent margin (The Cancer Letter, July 14, 2014).
This week, MD Anderson beat out its perpetual rival MSKCC by 5.3 percent.
“We’re honored by this tremendous national recognition, but the true measure of our success is the number of lives we’ve impacted with out care, research and support,” MD Anderson President Ronald DePinho said in a statement. “We owe our gratitude to the more than 20,000 cancer fighters, including world-class faculty and nurses, and 1,000 volunteers working every day to end cancer for our patients and others around the world.”
While scientific validity of the U.S. News index is often disputed, its value to cancer centers is high. A high rank and the license to display the U.S. News shield is one of the great prizes sought by marketing departments. A drop in ranking is believed to have led to removal of top administrators.
To understand how the U.S. News ratings of cancer centers work, it’s more useful to eyeball a table within the dense methodology document than a report that appears on the magazine’s website.
The tables, which are posted below, come from methodology reports that the magazine publishes alongside the rankings, explaining how the ranking process changes from year to year
Undeniably, an institution needs a spectacular “reputation with specialists” component of the score to get to the top spot. That portion of the score accounts for 27.5 percent of the overall grade.
MD Anderson and MSKCC, the highest-volume cancer centers in the country, have the highest reputation scores—64.7 and 62.5 respectively.
After these two front-runners, the reputation score plunges to Mayo Clinic’s level of 25.5. (Mayo took the third place overall in the rankings.)
At No. 4, Dana-Farber Cancer Institute and Brigham & Women’s Cancer Center has a reputation score of 37.4—and this year’s No. 5, Seattle Cancer Alliance, has a score of 10.5.
Some of America’s finest cancer centers—which have no problem with routine renewals of their NCI comprehensive cancer center designations—earn spectacularly low reputation scores.
Simple eyeballing of the table reveals that many of these centers have better grades for “outcomes,” “structure” and “patient safety” than either of the front-runners.
This year’s No. 50 institution on the U.S. News list—UT Southwestern—has the barely detectable reputation score of 0.3—while maintaining the incontrovertibly meaningful designation of NCI comprehensive cancer center, employing six Nobel laureates and, overall, receiving more money from the Cancer Prevention and Research Institute of Texas than its cross-state rival, MD Anderson.
“So much of what drives MD Anderson and MSK [grades] is the reputation score,” said Ashish Jha, the K. T. Li Professor of International Health and Health Policy at the Harvard T.H. Chan School of Public Health and director of Harvard Global Health Institute, after glancing at the tables on request from The Cancer Letter.
“On the stuff that matters, i.e. patient outcomes, Mayo and Dana Farber seem to be as good, maybe even better,” Jha said. “It seems that, indeed, the reputation score is driving the rankings when patient care should be a higher priority.
“I am not opposed to using reputation—but its weight should be very small compared to a hospital’s clinical outcomes and patient safety.”
The Question of Reputation
The physicians who get to decide the reputation score are asked to answer the following question:
“Please name up to five U.S. hospitals that you believe provide the best care in oncology for patients who have the most challenging conditions or who need particularly difficult procedures. Do not consider location or cost. Individual hospitals should be listed, not hospital systems or medical schools.”
The words “process” and “reputation” are used interchangeably by U.S. News and its contractor RTI International.
“For these rankings, the concept of reputation speaks to an institutional ability to develop and sustain a system that delivers high-quality care to especially challenging patients.”
The reputational score is composite of two surveys:
• Surveys were sent to 200 oncologists, of whom 34.5 percent (69 individuals) responded.
• The Doximity Masterfile member survey was conducted with a sample of 85,423 physicians across the 16 specialties. There were 6,843 cancer specialists in this group. Altogether, 17.3 percent of them responded to the survey.
The sample was stratified by census region and by specialty. The results are weighted, put through log transformation and averaged over three years.
In 2013, this publication reported that systematic misclassification of emergency patients at MD Anderson Cancer Center enhanced that institution’s rating by U.S. News over the past seven years (The Cancer Letter, July 19, 2013).
The miscounting led to exclusion of nearly 40 percent of admissions, was discovered and corrected in mid-2009, but no reliable way could be found to adjust the results to reflect the missing data, officials at U.S. News and MD Anderson stated.
Insiders say that MD Anderson had been submitting incorrect data to the Centers for Medicare and Medicaid Services. U.S. News doesn’t ask hospitals to provide data directly, relying instead on government databases, which are less prone to tampering.
The problem was caused by an error, MD Anderson officials said, discovered by MSKCC officials and acknowledged by their counterparts at MD Anderson, but U.S. News editors said a recount would be impossible, because of the volume of missing data. Just as importantly, a methodological pillar of the index—not accepting data from institutions directly—was at stake.
The U.S. News index was never intended to provide bragging rights—or a marketing advantage—based on minute differences in scores, magazine officials say.