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- Ranking and Understanding U.S. Hospital Health Care, Part Two
Ranking and Understanding U.S. Hospital Health Care, Part Two
A surprising region stands out for top quality patient care and patient satisfaction
Frequent readers are probably learning by now that I have a fair bit of interest in two subjects: the art (not science) of ranking various endeavors, and health care — specifically, hospital health care (I use a VAMC for my own health care). Using the government’s Care Compare site, which employs a tool developed by Yale’s CORE that evaluates and sorts Medicare and Medicaid data, we’re looking at VA and non-VA “acute care” (versus “critical care” hospitals) across the U.S.
The U.S. census assigns nine divisions to four regions across the U.S. We first evaluated “New England,” or region two, division one, because that’s where I’m from and the region with which I have the most familiarity. Today, I’m looking at region two, division three; “East North Central.” This area covers much of the northern part of the Midwest.
THE BIG STORY
Which VA Hospital is “Best in the Midwest?”
A surprising region stands out for top quality patient care and patient satisfaction
New England is made up of six states. The “East North Central” division of the Census Bureau’s Midwest Region has five: Illinois, Indiana, Michigan, Ohio, and Wisconsin.
There are 128 fully rated “acute care” hospitals (hospitals with the bed space and infrastructure to treat people longer than a couple days) in New England. In the East North Central division, there are 439.
Our last piece to evaluate a part of this system came out two weeks ago. One of the reasons it’s so important to establish “apples to apples” style baselines for comparison is that places vary. The culture of the midwest is different from the culture in the northeast. Their populations are not the same — the demographics of Rhode Island and Vermont do not track evenly against each other, let alone those of Indiana or Michigan. And, as it turns out, in terms of population, the East North Central division is nearly three times larger than the New England division. Bigger populations impact how and where infrastructure gets built, as well as its availability.

Of the 11 states we’ve looked at for hospital and VA excellence so far, the most surprising has been Wisconsin. Photo via DVIDS, U.S. Army Photo by Scott T. Sturkol, Public Affairs Office, Fort McCoy, Wis.
The five states of the East North Central division cover more than 47 million citizens over a much larger area than New England. The population of New England is a shade over 15 million.
The first thing one can see is that there are slightly more “rated” hospitals per capita in New England than in East North Central. We can also extrapolate from the data that the hospitals in New England cover more relative population, both because there are more of them on a per capita level, and, in addition, because they’re responsible for far less area.
But when we do state by state matchups — and the data here is better for East North Central, because in all cases the states that make it up have more data points than their New England counterparts — an interesting trend emerges. While one might expect that the New England hospital rankings would be better overall, both relatively speaking and in absolute terms, this simply isn’t the case. When it comes to top rated acute care hospitals — the “best” hospitals, where one might expect old and well-resourced New England with its powerful and prestigious medical and intellectual heritage would have an advantage — no such advantage exists.
A quick aside / reminder: Care Compare assigns two one-to-five-star ratings, the first for patient satisfaction, and the second for quality of care. Fully rated hospitals receive a rating of between 2 (1/1) and 10 (5/5) total stars, with the vast majority falling between those extremes.

The leaders are VT, WI, ME, and MI. 43% of Vermont’s seven hospitals are “top rated” hospitals, or rate nine stars or higher. 31% of Wisconsin’s 61 hospitals are “top rated.” 28% of Maine’s 18 hospitals are “top rated.” And 20% of Michigan’s 85 hospitals are “top rated.”
In general, I was always raised to believe that up to a certain point, decentralization, deregulation, and pushing authority to the lowest level possible should result in the best outcomes. But here we see that this isn’t necessarily the case; nobody, for example, would suggest that Connecticut or Massachusetts lack regulation. One would also assume that there was some correlation between wealth and resources and the quality of hospitals. Before crunching the numbers, I would not have put Wisconsin and Michigan even with Massachusetts or Connecticut, let alone far ahead of them. And I certainly would not have expected that Connecticut would come in last!
So we’ve established that there are more top-rated hospitals in East North Central — 18.4% of the hospitals in that region are rated nine total stars or better — than in New England, where 17.9% of the hospitals are rated nine total stars or better. What about the VA Medical Centers?
Over half the VA Medical Centers that were fully rated in East North Central were considered “top” hospitals — seven of 13. Of those seven, three received perfect scores of 10. There were only eight hospitals in the division to score perfect 10s (out of 439; a significant feat). And of the remaining VA hospitals that were fully rated, none scored lower than seven total stars. Not bad, all things considered.
In New England, three of the five VA Medical Centers were considered “top hospitals,” which matches up well with East North Central. None of them scored perfect ratings, however, and the worst rated hospital, in Rhode Island (which scored 5 stars), rated one star for quality.
What can we draw from this? In general, if you’re looking for the best possible health care, depending on where you live, it might be better to live in East North Central than in New England when it comes to health care, and veteran health care more specifically. Probably not what you expected to learn today, and not what I expected to write.
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