Specialty State Ranking Award Recipients & Methodology

To help consumers evaluate and compare local hospital performance specific to specialty service lines and specialty focus areas, Healthgrades analyzed and identified the top ranked hospitals in each state across 18 key specialty areas for 2024: Cardiac Care, Cardiac Surgery, Cardiology, Coronary Interventional Procedures, Cranial Neurosurgery, Critical Care, Gastrointestinal Care, Gastrointestinal Medical, Gastrointestinal Surgery, Joint Replacement, Neurosciences, Orthopedic Surgery, Prostate Surgery, Pulmonary Care, Spine Surgery, Stroke Care, Surgical Care, and Vascular Surgery. This analysis, rooted in clinical performance, builds on the 2024 Healthgrades Specialty Excellence Awards Methodology.

To measure performance, Healthgrades used Medicare inpatient data from the Medicare Provider Analysis and Review (MedPAR) file purchased from the Centers for Medicare and Medicaid Services (CMS) for years 2020 through 2022.

Patient outcomes data for 31 conditions or procedures were analyzed (see list below) for virtually every hospital in the country. Hospital performance in these 31 conditions form the base of the final Specialty Excellence Award and State Ranking results (See Appendix 1 for a list for each area.)

Mortality-Based Procedures & Conditions

Bowel Obstruction	Pancreatitis
Chronic Obstructive Pulmonary Disease (COPD)	Pneumonia
Colorectal Surgeries	Pulmonary Embolism
Coronary Artery Bypass Graft (CABG) Surgery	Respiratory Failure
Coronary Interventional Procedures	Sepsis
Cranial Neurosurgery	Stroke
Gastrointestinal Bleed	Upper Gastrointestinal Surgery
Heart Attack	Valve Surgery
Heart Failure

In-Hospital Complications-Based Procedures & Conditions

Abdominal Aortic Aneurysm Repair	Pacemaker Procedures
Back and Neck Surgeries (Without Spinal Fusion)	Peripheral Vascular Bypass Graft
Carotid Procedures	Prostate Removal Surgery
Defibrillator Procedures	Spinal Fusion
Diabetic Hospitalizations	Total Hip Replacement
Gallbladder Removal Surgery	Total Knee Replacement
Hip Fracture Treatment	Transurethral Prostate Resection Surgery

The first and most fundamental way that Healthgrades communicates performance is through star ratings. Star ratings are an evaluation of the hospital’s actual performance as compared to the predicted performance for that hospital based on a specific risk-adjustment model applied to that hospital. For more details, see the Healthgrades Mortality and Complications Outcomes 2024 Methodology.

The purpose of risk adjustment is to obtain fair statistical comparisons of mortality and complication rates between hospitals while accounting for differences in underlying risk factors observed in the data among disparate populations or groups.

Significant differences in clinical and demographic risk factors are found among patients treated in different hospitals. Therefore, it is necessary to make accurate and valid comparisons of clinical outcomes with a methodology using risk-adjustment techniques. Risk factors may include age, sex, specific procedure performed, and comorbid conditions (e.g., hypertension, chronic heart failure, and diabetes).

Developing the Healthgrades hospital star performance categories involves four steps:

1. The hospital predicted value (predicted number of deaths or complications at each hospital) is calculated by summing the individual patient record predicted values determined from logistic regression models discussed above.  

1. The hospital predicted value is compared with the actual or observed value (e.g., actual number of deaths or complications at each hospital).  

1. A test is conducted to determine whether the difference between the predicted and actual values was statistically significant. This test is performed to make sure that differences were very unlikely to be caused by chance alone. A z-score is used to establish a 90% confidence interval. 

1. Hospital performance categories are determined based upon the outcome of the test for statistical significance. 

For each condition or procedure, hospital performance is evaluated and stratified into three categories:

★★★★★ Better Than Expected – Actual performance was better than predicted and the difference was statistically significant at alpha = 0.1.

★★★ As Expected – Actual performance was not statistically significantly different from what was predicted at alpha = 0.1.

★ Worse Than Expected – Actual performance was worse than predicted and the difference was statistically significant at alpha = 0.1.

Healthgrades uses z-scores (individual or aggregate) to determine performance. A z-score is a standardized statistical test that calculates the difference between the actual and predicted complication and mortality rates, taking into account patient variability and volume. A higher z-score means better performance.

A complete description of the methodology including risk factors, multivariate logistic regression model, and other relevant information is available in the Healthgrades Mortality and Complications Outcomes 2024 Methodology. A full list of ICD-10 codes used to define each model can be found in Healthgrades' ICD-10 Mapping Tool.

Another way Healthgrades communicates information on hospital performance is with State Rankings for Specialty Excellence, helping patients more easily identify top performers in their state. Rankings determine and communicate a hospital’s superior performance when compared to other eligible hospitals.

Each ranking has eligibility requirements specific to the nature and intent of the achievement and is aligned with requirements for Specialty Excellence Awards (See Appendix 1). State Rankings may reference a singular cohort (e.g., Stroke Care) or require the combination of a grouping of cohorts (e.g., Critical Care). Healthgrades will issue state rankings for the Top 3 or Top 5 performers, across 18 specialty areas, following the State Ranking Determination & State Eligibility Requirements outlined below. Specific information regarding the cohorts included is outlined in the Specialty Award Categories & Requirements section.

For each hospital, Healthgrades assigns an overall score for each specialty area based on hospital performance as determined by a single z-score or average of volume-weighted z-scores when more than one condition or procedure is included in the award. (See Specialty Award Categories and Requirements for a list for each award.) The strength of a hospital's single z-score or average of volume-weighted z-scores when more than one condition or procedure is included in the award, is a key driver in ranking determination. Additionally, hospital eligibility for State Ranking awards requires a hospital receive a rating in the cohort(s) included in the determination of the award, no 1-Star ratings in the cohort(s) included in the determination of the award, and at least one 5-Star rating in a cohort included in the determination of the award.

For a state to be eligible to have hospitals rankings, either in the Top 3 or Top 5, there need to be substantive count of hospitals eligible in each state for the individual award area. States with 6 or fewer hospitals that meet the requirements in an individual award area are NOT eligible for rankings in that area. When a state has between 7 and 10 eligible facilities (inclusive) for an individual award area, the top 3 facilities (ranked by z-score and following the Ranking Determination criteria) will be named the Top 3 Facilities (#1, #2, #3) in the state for that award area. When a state has 11 or more eligible facilities for an individual award area, the top 5 facilities (ranked by z-score and following the Ranking Determination criteria) will be named the Top 5 Facilities (#1, #2, #3, #4, #5) in the state for that award.

The following sections provide a list of conditions, procedures, and analyses that are included for each Specialty Excellence Award.

The Cardiac Care Excellence Award recognizes hospitals with superior clinical outcomes in heart bypass surgery, coronary interventional procedures, heart valve surgery, and the treatment of heart attack and heart failure.

The Cardiac Care Excellence Award is based on:

• Coronary Artery Bypass Graft (CABG) Surgery 
• Coronary Interventional Procedures (PCI) 
• Heart Attack 
• Heart Failure 
• Valve Surgery 

To be considered for an award in cardiac care, a hospital must be evaluated in four of the five procedures listed above based on MedPAR data. The four must include coronary interventional procedures, heart attack, heart failure, and either coronary artery bypass graft (CABG) surgery or valve surgery. The z-scores for in-hospital mortality and in-hospital + 30-day mortality are used in calculating the area scores. The in-hospital + 30-day mortality outcome receives 60% of the weight in the calculations and in-hospital mortality receives 40% of the weight.

A volume-weighted average z-score is calculated for the combination of cardiac surgery (CABG surgery and Valve Surgery). A volume-weighted average z-score is also calculated for heart attack and heart failure. A z-score is also calculated for coronary interventional procedures. The Cardiac Care Excellence Award is based evenly on average of the combined cardiac surgery (CABG surgery and Valve Surgery) z-score, the combined heart attack and heart failure z-score, and the score for coronary interventional procedures.

The Cardiac Surgery Excellence Award recognizes hospitals with superior clinical outcomes in heart bypass surgery and heart valve surgery.

The Cardiac Surgery Excellence Award is based on:

• Coronary Artery Bypass Graft (CABG) Surgery 
• Valve Surgery 

To be considered for an award in cardiac surgery, a hospital must be evaluated in both of the above procedures based on MedPAR data. The Cardiac Surgery Excellence Award is determined by the volume-weighted average of coronary artery bypass graft (CABG) surgery and valve surgery z-scores. The z-scores for in-hospital mortality and in-hospital + 30-day mortality are used in these calculations. The in-hospital + 30-day mortality outcome receives 60% of the weight in the calculations and in-hospital mortality receives 40% of the weight.

The Cardiology Excellence Award recognizes hospitals with superior clinical outcomes in the treatment of heart attack and heart failure, and coronary interventional procedures.

The Cardiology Excellence Award is based on:

• Heart Attack 
• Heart Failure 
• Coronary Interventional Procedures (PCI) 

To be considered for a Cardiology award, a hospital must be evaluated in all three procedures listed above based on MedPAR data. The in-hospital + 30-day mortality outcome receives 60% of the weight in the calculations and in-hospital mortality receives 40% of the weight.

A volume-weighted average z-score is calculated for the combination of cardiac medical (Heart Attack and Heart Failure). A z-score is also calculated for coronary interventional procedures. The Cardiology Excellence Award is based evenly on average of the combined cardiac medical (Heart Attack and Heart Failure) z-score, and the score for coronary interventional procedures. In all calculations, A hospital must also be eligible for the Cardiac Care Excellence Award.

The Coronary Intervention Excellence Award recognizes hospitals with superior clinical outcomes in coronary intervention procedures including angioplasty with stent.

The Coronary Intervention Excellence Award is based on a single cohort: coronary interventional procedures (angioplasty/stent). The Coronary Intervention Excellence Award is based on the average of in-hospital mortality and in-hospital + 30-day mortality z-scores based on MedPAR data. The in-hospital + 30-day mortality outcome receives 60% of the weight in this calculation and in-hospital mortality receives 40% of the weight.

The Cranial Neurosurgery Excellence Award recognizes hospitals with superior clinical outcomes in cranial neurosurgery.

The Cranial Neurosurgery Excellence Award—formerly the Neurosurgery Excellence Award—is based on one group of procedures: cranial neurosurgery. The cranial neurosurgery score is calculated using the average of in-hospital mortality and in-hospital + 30-day mortality z-scores based on MedPAR data. The in-hospital + 30-day mortality receives 60% of the weight in this calculation and in-hospital mortality receives 40% of the weight.

The Critical Care Excellence Award recognizes hospitals with superior clinical outcomes in treating pulmonary embolism, respiratory failure, sepsis, and diabetic hospitalizations.

The Critical Care Excellence Award is based on:

• Diabetic Hospitalizations
• Pulmonary Embolism   
• Respiratory Failure  
• Sepsis  

To be considered for an award in critical care, a hospital must be evaluated in at least three out of four of the conditions listed above based on MedPAR data. Healthgrades calculates the average z-scores for sepsis, pulmonary embolism, and respiratory failure using in-hospital mortality and in-hospital + 30-day mortality. The in-hospital + 30-day mortality receives 60% of the weight in this calculation and in-hospital mortality receives 40% of the weight. Healthgrades calculates the average z-scores for diabetic hospitalizations using in-hospital complications. The Critical Care Excellence Award is based on a volume-weighted average of these average z-scores.

The Gastrointestinal Care Excellence Award recognizes hospitals with superior clinical outcomes in colorectal surgeries, gallbladder removal, upper gastrointestinal surgery, as well as the treatment of bowel obstruction, gastrointestinal bleeds, and pancreatitis.

The Gastrointestinal Care Excellence Award is based on:

• Bowel Obstruction 
• Colorectal Surgeries 
• Gallbladder Removal Surgery 
• Gastrointestinal Bleed 
• Pancreatitis 
• Upper Gastrointestinal Surgery 

To be considered for an award in gastrointestinal care, a hospital must be evaluated in at least four out of six of the conditions or procedure cohorts listed above, based on MedPAR data. Healthgrades calculates the average z-scores for each cohort using in-hospital mortality and in-hospital + 30-day mortality. The in-hospital + 30-day mortality receives 60% of the weight in this calculation and in-hospital mortality receives 40% of the weight. The Gastrointestinal Care Excellence Award is based on a volume-weighted average of these average z-scores.

The Gastrointestinal Medical Excellence Award recognizes hospitals with superior clinical outcomes for the treatment of bowel obstruction, gastrointestinal bleed, and pancreatitis

The Gastrointestinal Medical Excellence Award is based on:

• Gastrointestinal Bleed 
• Bowel Obstruction 
• Pancreatitis 

To be considered for an award in gastrointestinal medical, a hospital must be evaluated in the treatment of all three of the conditions listed above, based on MedPAR data. Healthgrades calculates the average z-scores for each cohort using in-hospital mortality and in-hospital + 30-day mortality. The in-hospital + 30-day mortality receives 60% of the weight in this calculation and in-hospital mortality receives 40% of the weight. The Gastrointestinal Medical Care Excellence Award is based on a volume-weighted average of these average z-scores.

The Gastrointestinal Surgery Excellence Award recognizes hospitals with superior clinical outcomes in bowel obstruction treatment, colorectal surgeries, gallbladder removal, and upper gastrointestinal surgery.

The Gastrointestinal Surgery Excellence Award (formerly the General Surgery Excellence Award) is based on:

• Bowel Obstruction 
• Colorectal Surgeries 
• Gallbladder Removal Surgery 
• Upper Gastrointestinal Surgery 

To be considered for an award in gastrointestinal surgery, a hospital must be evaluated in at least three out of four of the conditions or procedure cohorts listed above based on MedPAR data. Healthgrades calculates the average z-scores for each cohort using in-hospital mortality and in-hospital + 30-day mortality. The in-hospital + 30-day mortality receives 60% of the weight in this calculation and in-hospital mortality receives 40% of the weight. The Gastrointestinal Surgery Excellence Award is based on a volume-weighted average of these average z-scores.

The Joint Replacement Excellence Award recognizes hospitals with superior clinical outcomes in knee and hip replacement.

The Joint Replacement Excellence Award is based on:

• Total Hip Replacement  
• Total Knee Replacement  

To be considered for an award in joint replacement, a hospital must be evaluated and categorized into one of three performance categories for both total knee replacement and total hip replacement. We evaluate both procedures based on in-hospital complications. The Joint Replacement Excellence Award is based on a volume-weighted average of the z-scores for these procedures.

The Neurosciences Excellence Award recognizes hospitals with superior clinical outcomes in stroke care and cranial neurosurgery.

The Neurosciences Excellence Award is based on:

• Cranial Neurosurgery 
• Stroke 

To be considered for an award in neurosciences, a hospital must be evaluated for both of these conditions and procedures based on MedPAR data. We first calculate the average z-scores for each condition or procedure using in-hospital mortality and in-hospital + 30-day mortality. The in-hospital + 30-day mortality receives 60% of the weight in this calculation and in-hospital mortality receives 40% of the weight. The Neurosciences Specialty Excellence Award is the volume-weighted average of these two z-scores.

The Orthopedic Surgery Excellence Award recognizes hospitals with superior clinical outcomes in back and neck surgery, spinal fusion, hip fracture treatment, and knee and hip replacement.

The Orthopedic Surgery Excellence Award is based on:

• Back and Neck Surgeries (Without Spinal Fusion) 
• Hip Fracture Treatment 
• Spinal Fusion 
• Total Hip Replacement
• Total Knee Replacement 

To be considered for an award in orthopedic surgery, a hospital must be evaluated in four of the five procedures listed above based on MedPAR data. Those four must include total knee replacement, total hip replacement, hip fracture treatment, and either spinal fusion and/or back and neck surgeries. These procedures are evaluated based on complication rates.

A volume-weighted average z-score is calculated for the combination of the joint replacement procedures (both are required) and for the combination of spinal fusion and back and neck surgeries (only one is required). A z-score is also calculated for hip fracture treatment. The Orthopedic Surgery Excellence Award is based on the evenly weighted average of the joint replacement z-score, the combined back and neck z-score, and the hip fracture z-score.

The Prostate Surgery Excellence Award recognizes hospitals with superior clinical outcomes in prostate removal surgery and transurethral resection of the prostate (TURP).

The Prostate Surgery Excellence Award is based on:

• Prostate Removal Surgery 
• Transurethral Prostate Resection Surgery 

To be considered for an award in prostate surgery, a hospital must be evaluated for either one or both conditions based on MedPAR data. We evaluate both procedures based on in-hospital complications. The Prostate Surgery Excellence Award is based on the volume-weighted average of the z-scores for these procedures or the direct z-score if only one type of procedure is performed.

The Pulmonary Care Excellence Award recognizes hospitals with superior clinical outcomes in treating chronic obstructive pulmonary disease (COPD) and pneumonia.

The Pulmonary Care Excellence Award is based on:

• Chronic Obstructive Pulmonary Disease (COPD) 
• Pneumonia 

To be considered for an award in pulmonary care, a hospital must be evaluated in both conditions based on MedPAR data. We first calculate the average z-scores for these conditions using in-hospital mortality and in-hospital + 30-day mortality. The in-hospital + 30-day mortality receives 60% of the weight in this calculation and in-hospital mortality receives 40% of the weight. The Pulmonary Care Excellence Award is based on a volume-weighted average of these average z-scores.

The Spine Surgery Excellence Award recognizes hospitals with superior clinical outcomes in back and neck surgeries and spinal fusion.

The Spine Surgery Excellence Award is based on:

• Back and Neck Surgeries (Without Spinal Fusion) 
• Spinal Fusion 

To be considered for an award in spine surgery, a hospital must be evaluated in both procedures based on MedPAR data. We evaluate both procedures based on in-hospital complications. The Spine Surgery Excellence Award is the volume-weighted average of these z-scores for these procedures.

The Stroke Care Specialty Excellence Award recognizes hospitals with superior clinical outcomes in the care and treatment of stroke.

The Stroke Care Excellence Award is based on one condition: stroke. To be evaluated, a hospital must have a transfer-out rate of less than 10% for the three years of data used. The Stroke Care Excellence Award is based on the average z-scores for in-hospital mortality and in-hospital + 30-day mortality. The in-hospital + 30-day mortality receives 60% of the weight in this calculation and in-hospital mortality receives 40% of the weight.

The Surgical Care Excellence Award recognizes hospitals with superior clinical outcomes in overall surgical care across 15 of the most common in-hospital surgical procedures including cardiac, vascular, joint replacement, prostate, spine, and gastrointestinal surgeries.

The Surgical Care Excellence Award is based on:

• Back and Neck Surgery (except Spinal Fusion)  
• Back and Neck Surgery (Spinal Fusion)  
• Bowel Obstruction  
• Carotid Procedures  
• Cholecystectomy  
• Colorectal Surgeries  
• Coronary Bypass Surgery  
• Hip Fracture Treatment
• Peripheral Vascular Bypass  
• Prostate Removal Surgery  
• Resection/Replacement of Abdominal Aorta  
• Total Hip Replacement  
• Total Knee Replacement  
• Upper Gastrointestinal Surgery 
• Valve Replacement Surgery  

To be considered for an award in surgical care, a hospital must be evaluated in 8 of 15 procedures and conditions based on MedPAR data. The Surgical Care Excellence Award is based on a volume-weighted average of these average z-scores for mortality- and complication-based procedures.

Specifically, Healthgrades calculates the average z-scores for bowel obstruction, colorectal surgery, coronary bypass surgery, upper gastrointestinal surgery, and valve replacement surgery using in-hospital mortality and in-hospital + 30-day mortality. The in-hospital + 30-day mortality outcome receives 60% of the weight in the calculations and in-hospital mortality receives 40% of the weight.

Healthgrades also evaluates the following procedures based on in-hospital complications: back and neck surgery (except spinal fusion), back and neck surgery (spinal fusion), carotid procedures, cholecystectomy, hip fracture treatment, peripheral vascular bypass, prostate removal surgery, resection/replacement of abdominal aorta, total hip replacement, and total knee replacement.

The Vascular Surgery Excellence Award recognizes hospitals with superior clinical outcomes in abdominal aortic aneurysm repair, carotid surgery, and peripheral vascular bypass surgery.

The Vascular Surgery Excellence Award is based on:

• Abdominal Aortic Aneurysm Repair 
• Carotid Procedures 
• Peripheral Vascular Bypass 

To be considered for an award in vascular surgery, a hospital’s performance must be evaluated for at least two of any three procedures based on MedPAR data. We evaluate each procedure based on in-hospital complications. The Vascular Surgery Excellence Award is based on the volume-weighted average of the z-scores for at least two of three procedures. If a hospital meets eligibility requirements for ratings in all three procedures, the Vascular Surgery Excellence Award will be based on the volume-weighted average z-score of all three procedures.

For a downloadable version of the complete 2024 Specialty State Ranking Recipients & Methodology, click here.