Johns Hopkins, for decades ranked the best hospital in the country, has been through this before. Two years ago, it fell to No. 2 in the annual U.S. News and World Report rankings, regaining the top spot last year.
But No. 3?
"What a disaster!" said Dr. Ashish K. Jha, professor of health policy at Harvard School of Public Health, before quickly adding: "Just kidding. While these rankings are interesting, the bottom line is that Hopkins remains one of the very best hospitals in the world. I am unaware of anything meaningful that has changed."
Hopkins was bumped down to the third spot behind the Mayo Clinic in Rochester, Minn., and Massachusetts General.
While the news may have been an ego bruise, Hopkins officials insisted they were happy to be counted among the nation's best facilities, and plan to send Mayo a basket of local goodies — with the expectation of reciprocity when Hopkins regains the top spot.
The rankings are considered a widely used consumer tool, but health care experts say the fall to third isn't likely to affect Hopkins' ability to attract patients, doctors or research dollars. And Hopkins doesn't expect to make any changes to marketing material, said Ronald Peterson, president of the hospital and health system.
"There are other forces in this world that may impact some of those things. Not this," Peterson said.
He added, "On balance, we are still very pleased."
Jha said small tweaks in the rating methods can change where hospitals end up being ranked. And, he said, "No one in Baltimore should worry that they have anything short of a world-class institution there."
Previously, analytical tweaks contributed to breaking Hopkins' 21-year streak in the top spot among almost 4,800 hospitals across the country in 2012.
The judging appeared to be close this year. All three of the top hospitals were nationally ranked in 15 out of 16 specialties evaluated. Hopkins ranked in the Top 10 in 11 categories and in the Top 3 in rheumatology, neurology, urology, ophthalmology, psychiatry and ear, nose and throat.
The magazine updated criteria this year to emphasize patient safety more and reputation less, and both Mayo and Massachusetts General out-performed Hopkins on safety, according to U.S. News officials. Other important criteria included patient survival rates and nurse staffing.
"Our objective is to provide health care consumers with a decision-support tool, but certainly not to make a decision for them," said Ben Harder, managing editor of health care analysis at U.S. News.
"One hospital may rank higher in a particular specialty than another, but the latter hospital might be better at treating a particular diagnosis or a specific subgroup of patients. So patients should use our rankings as a starting point, not an end point, in their choice of hospital."
While Peterson said he's not sure much has changed at Hopkins, he plans to take a look at the ranking data to see what's different from last year.
"We constantly want to improve," he said. "So we'll take this in stride and use it as an opportunity to re-up our commitment to doing better."
Also pleased with the rankings was Mercy Medical Center, ranked second to Hopkins among hospitals in the state. The Baltimore hospital was singled out for specialties including gynecology, neurology and orthopedics. The University of Maryland Medical Center was next, also with two specialties nationally ranked.
U.S. News officials included the state rankings because most patients do not need the "high level, high-complexity care the best-hospitals rankings evaluate," Harder said. The local rankings can help steer patients who need more routine care.
But Mercy and other local hospitals in addition to Hopkins were singled out for providing some of the best care nationally, in the top 50.
Dr. Scott Spier, Mercy's senior vice president for medical affairs, said that when rankings consistently point to the same institutions, such as Mercy, patients can be reassured about the choices they made — usually based on personal experience or recommendations from doctors, friends and family.
He also said rankings of specialties can be useful in a town full of good hospitals. Nine of the top 10 hospitals in the state were located in the Baltimore region.
"We're honored and humbled by this kind of recognition," he said. "Maryland is blessed with many, many outstanding health care institutions. … We understand that we need to do things better than other hospitals."
Mayo Clinic, meanwhile, also expressed pride in being named No. 1.
"There are many external agencies that rate quality in health care, and Mayo Clinic is top-ranked for quality by more well-known national assessment organizations than any other academic medical center in the nation," said Dr. John Wald, Mayo's medical director for public affairs.
"While no single set of measures can perfectly represent health care quality, we are proud to be recognized by so many."