America's Best Hospitals: Smoke & mirrors?

There's an interesting new study in the latest Annals of Internal Medicine, which critically analyzes U.S. News & World Report's famous ranking of  hospitals. The overall ranking is derived from a composite score that includes objective measures, such as mortality rates and nurse staffing, as well as a single subjective measure, reputation, which is determined by a survey of 250 randomly selected physicians in each specialty. What the author of the paper found is that the top ranked hospitals achieve their lofty spots on the list almost exclusively on the basis of the reputation score. In fact, there was little relationship between the rankings and objective quality measures.