City ranks No. 4 in nation, though some patients may disagree

The Portland area is a fine place to run a hospital, with a growing market populated by a homogeneous citizenry that mostly keeps itself healthy, and no one dominant hospital or hospital chain to inhibit competition, according to a new national study that ranks the best U.S. cities for hospitals.

Using data showing the cost of standardized procedures, the study gave high marks to Portland metro hospitals for efficiency of care. From a patient’s perspective, however, the study found that Portland-area hospitals are not quite so special, ranked right around the national average for six outcome-of-care measures, though significantly higher than average in patient satisfaction surveys.

The study, by Portland, Maine, health industry consultant iVantage Health Analytics, is the first to look at hospital rankings city by city in such a detailed way. Portland-area hospitals, according to the study, ranked fourth in the nation, behind only Washington, D.C., Boston and Minneapolis.

But the iVantage study comes with a qualifier. In a study intended mostly for health care industry insiders, the rankings are weighted toward issues such as financial health that may benefit hospitals more than consumers.

“It was designed to help business people who are running hospitals,” says John Morrow, executive vice president of iVantage.

In contrast, the most recent city hospital rankings by U.S. News & World Report, which favors anecdotal rankings of medical specialties, had New York, Chicago, Los Angeles, Detroit and Washington, D.C., ranked as its top hospital cities.

The iVantage study used data to rank 4,299 hospitals in 283 metro areas across the country, then looked at cities where the top hospitals were clustered. Morrow notes that the top 10 cities were bunched together at the top of the scale with only small variations in their overall scores, and all had a number of highly ranked hospitals. But further down the list of U.S. cities, the variations become greater. Morrow says that most metro areas ranked below about No. 30 on the list have only one top-ranking hospital dominating the health care landscape.

Three of the study’s 10 categories provide measurements of particular interest to consumers. The first, the Outcomes Index, compares hospitals for their quality of care. An average U.S. hospital would earn a score of 50; Portland hospitals collectively scored 52.

In the study’s Patient Perspective Index, which compares patient satisfaction surveys, Portland hospitals scored 73, with 50 being the average.

The Costs and Charge Index looks at the dollar per procedure efficiency of hospitals. In that category Portland hospitals scored 66. According to Morrow, data show that Portland-area hospitals spend significantly less per Medicare patient getting the same procedures at hospitals in most other cities.

In the iVantage study, Portland-area hospitals scored highest marks for a category the study calls Population Risk, which is basically a measurement of the demographics in a hospital’s neighborhood. That’s important from a hospital perspective, Morrow says, because data show a clear correlation between a hospital’s performance and factors such as the education and income level of nearby residents. Cities dominated by white, well-educated, employed residents generally score highest in this category. Portland was near the top at 96.

Morrow says the correlation might simply be a reflection of the fact that better educated and wealthier residents are more careful about taking care of their own health through healthy diets, exercise and screenings.

The study’s Market Size & Growth Index compares five-year predictions of health care demand. Portland’s 81 score, with 50 representing average, is an indication, Morrow says, that hospitals here should see plenty of new patients in the coming years.

“It’s a good place to run a hospital and a decent place to be a consumer of health care,” Morrow says of the Portland area.

As far as Morrow is concerned, the study shows that the best hospitals don’t necessarily become best hospitals in a vacuum, but instead participate in a local culture of excellence.

“I think our findings show the variability of performance is explained by geography,” he says. “When you have the conditions of good performance, you have a model environment.”

The 2014 Hospital Strength Index can be found online at

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