Original Research
Hospital Centers of Excellence Defy
Geographic Trends
By F. Jack Witt III, MPA, JD, MBA
In this article…
A study of “centers of excellence” of hospitals finds
that dominant hospitals of excellence—those with
citations in many specialties—are in relatively
smaller metropolitan areas.
Over the past several years, there has been a great deal
of discussion in the health care field about “centers of excellence.” The term “center” implies location—a geographic-specific designation. The word “excellence” is in a sense
self-explanatory. However, to be meaningful, there need to
be metrics that are used to delineate gradations—grades or
degree of quality.
While “center of excellence” has been a health care
term often used for marketing purposes—in some cases to
the point that it is mere jargon—certain standards for the
application of the term have evolved.
For example, Blue Cross Blue Shield of California
several years ago designated a bariatric surgery program
at the University of California - Davis Medical Center in
Sacramento a center of excellence. 1 This was after the insurer and a panel of medical experts reviewed data on surgery
volume, mortality, readmission, and complication rates.
The UC - Davis data were then compared with commonly used benchmarks for care quality. The result of a
subsequent excellence designation was that Blue Cross Blue
Shield would steer patients to this surgery center, the rationale being that the steerage would affect higher long-term
quality outcomes and lower overall costs.
More fundamentally, the question arises as to what
qualifies as a “health care center.” For example, is a surgery
program itself a center; or is it a service within a center? At
the same time, within a surgery “program” there are ser-
vices—laboratory, operating room, CT scan, ICU, etc. These
are some of the components of a possible program
(of excellence).
Hospitals
One can argue that the hospital is a health care center properly subject to review with respect to the quality
(or excellence) of its service lines or departments. In this
regard, one of the established routines of review is that
provided by the U.S. News & World Report annual rankings
of “Best Hospitals.” Now in place for 21 years, the purpose
of the rankings is “to guide patients who need an unusually
high level of hospital care.” 3
Under the U.S. News procedure, hospitals are ranked in
16 specialties. These include:
Cancer
Diabetes & Endocrinology
Ear, Nose & Throat
Gastroenterology
Geriatrics
Gynecology
Heart & Heart Surgery
Kidney Disorders
Neurology & Neurosurgery
Orthopedics
Pulmonology
Urology
Ophthalmology
Psychiatry
Rehabilitation
Rheumatology
In the 2010 survey, 4,852 hospitals were evaluated.
With the rankings limited to the top 50 in most specialty
