100 Top Hospitals list is a hot benchmark source
Top performers are identified by type and size
If you’re looking for a hospital to benchmark, 100 Top Hospitals Benchmarks for Success. is particularly fertile with cutting-edge organizations. Published for the past four years by HCIA in Baltimore and William M. Mercer Inc. in Boston, this list recognizes top-performing hospitals across the country for excellence in clinical quality practices, operations, and financial management. (For a breakdown of top hospitals by size and type, see charts, pp. 86-88.)
HCIA and Mercer estimate that if all hospitals performed as well as the 100 top hospitals, consumers would save $27 billion in health care costs, inpatient mortality would decreased by 23%, and complications by 17%, while average lengths of stay would decrease by almost a full day.
8 measures of excellence
To select hospitals for the list, HCIA and Mercer use these eight performance measures:
• risk-adjusted mortality index;
• risk-adjusted complications index;
• severity-adjusted average length of stay;
• expense per adjusted discharge;
• profitability (cash flow margin);
• index of outpatient activity;
• long-term growth in equity;
• productivity (total asset turnover ratio).
(How these measures are applied is detailed in the "Performance Measures" chart, p. 89.)
The list is not just a list of top performers, but also a barometer for the industry. Among the significant findings in the 1996 survey (released in December) were:
• The median performance of this year’s benchmark hospitals is significantly better than the median performance of all study hospitals in all but one measure: the proportion of outpatient revenue.
• The median performance of this year’s benchmark hospitals exceeds the median performance of last year’s benchmark hospitals in all but three measures: complications, average of length of stay, and profitability.
• On a regional basis, the West has overtaken the South in the proportion of top-performing hospitals represented. Some 23% of all the benchmark hospitals are concentrated in Florida and Texas, where there are large concentra- tions of investor-owned hospital systems and a high degree of managed care. At the same time, the study shows that the not-for-profits are maintaining their clinical, operational, and financial viability in an increasingly competitive market.
• Nearly half of last year’s benchmark hospitals (42) qualified as benchmarks this year, compared with 29 repeats last year. Fourteen hospitals have been on the list for the past three years. Brigham and Women’s Hospital in Boston has made the list all four years of the survey.
• Both not-for-profit and investor-owned hospitals continue to compete successfully in terms of quality, efficiency, and financial performance.
One trouble spot for major teaching hospitals is that their costs continue to increase disproportionally to the quality of care given, says Mercer principal Michael D. Blaszyk. Of course, that disparity exists because teaching hospitals do the bulk of research and training for the industry as a whole. Due to state and federal cutbacks and the way hospitals are reimbursed under managed care, teaching hospitals cannot recoup their costs for these services.
"[This] trend, if continued, could seriously and negatively affect the entire health care delivery system in the long term," Blaszyk says.
Although the study shows that the industry is improving overall, financial pressures will continue. In the South, where integrated delivery systems have formed, competition will be fiercest and innovation the most important, the study indicates.
[Editor’s note: Copies of the study are available from HCIA customer service at (800) 568-3282, on the HCIA Web site at www.hcia.com, or on the William M. Mercer Web site at www.mercer.com.]
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