ROCHESTER, Minn. — For the fourth year in a row, Mayo Clinic Hospital-Rochester has been named the best hospital in the nation by U.S. News & World Report. It was followed by Massachusetts General Hospital Boston in second place, and Johns Hopkins Hospital Baltimore in third.

The 2019-2020 U.S. News rankings were published on Tuesday, July 30. Beyond the listing’s signature Best Hospitals Honor Roll of twenty hospitals, the annual publication includes dozens of rankings for medical and surgical specialty areas, as well as rankings for children's hospitals, state rankings and regional honorees.

Befitting the clinic’s reputation as a hothouse of specialization and all-purpose authority for puzzling cases at the far corners of medical practice, Mayo Rochester departments were designated best in the nation in five under-the-radar specialty areas: Diabetes and Endocrinology, Ear, Nose and Throat, Gastroenterology and Gastroenterologic Surgery, Nephrology, and Urology.

Rounding out the clinic’s command of the major organ systems, Mayo departments came in second in six higher-profile treatment areas, including Cardiology and Heart Surgery, Neurology and Neurosurgery, Orthopedics, Pulmonology and Lung Surgery, and Gynecology. Mayo came in second in Geriatrics, as well, and in arguably the highest-profile illness of our time, the clinic came in third for its Cancer care, trailing perennial honorees MD Anderson and Memorial Sloan-Kettering.

As was the case last year, the rankings placed Mayo Clinic-Phoenix among the top 20 hospitals in the country, making Mayo the only health system with two hospitals on the magazine’s annual Best Hospitals Honor Roll. The Phoenix campus tied with the University of Pennsylvania at 18 on the list, just ahead of Yale-New Haven Hospital, and Houston Methodist Hospital, both of whom tied for 20.

“Mayo Clinic is ranked at or near the top more often than any other health care provider in the United States,” said Dr. Henry Ting, chief value officer, Mayo Clinic. “For our patients and families, it helps them to make informed decisions about where to go for their care. For our staff, this a terrific acknowledgment of what they do every day, embracing our primary value that the needs of the patient come first.”

“This award belongs to our staff,” Ting added. “We believe we have the best doctors, the best nurses, the best administrators, and the best social workers. I would say we even have the best volunteers. They’re the reason the clinic is so consistently recognized as a leader in the field of patient-centered care.”

The rankings, now in their 30th year, aspire to something of an impossible task -- the collating and weighing with discretion a disparate, ever-changing mixture of objective and subjective metrics in the provision of complex specialty care. Though the most widely-known of rankings, the U.S. News listing is but one of a growing number of hospital rankings available, from Yelp to the CMS.

They have been subject to continual revision in methodology since their launch in the late 1980s. Once reliant largely on the opinions of other physicians, the U.S. News rankings have gradually incorporated hard measures of quality, data on safety and mortality rates, first in-hospital, then eventually 30 days after leaving the hospital.

Critics have highlighted the need for refining these analyses further, building them out to address missing variables like the cost of care, patient knowledge of treatment options and the effective use of expensive technologies.

Yet in an increasingly competitive national health care marketplace, where large hospital systems vie for attention in commercials, on the side of arenas and office towers, they are destined for private bragging rights and public banners. With four consecutive years at number one, you could say the New England Patriots haven’t put together a string of titles like the Mayo outcome for 2019-2020.

But that would violate the wishes of the analysts at U.S. News, who have asked media this year to avoid making comparisons between the 2019-2020 rankings and those of years’ past. The magazine changed has its methodology yet again, and believes this now changes the award.

The new rankings incorporate patient satisfaction surveys, the destination of patients when they leave the hospital, and statistical corrections to control for the care of sicker patients and those on low-income. The fourth win is because these are all developments that reward value, says Ting, or the efficiency of care. “I think what we are known for is that we make that diagnosis correctly the first time.”