Duke University Medical Center finished first in North Carolina and 17th in the country in this year’s U.S. News and World Report annual hospital rankings.

The new rankings have Duke a spot below its No. 16 national ranking from the previous year. Duke was the only hospital representing the southeastern region in this year’s Honor Roll—the top 20 finishers. U.S. News placed Duke Hospital as the best in North Carolina, followed by Wake Forest Baptist Medical Center and the University of North Carolina Hospitals. Duke also finished in the top 25 for eight specialties—No. 6 for ophthalmology, No. 10 for urology, No. 11 for cardiology and heart surgery, No. 12 for pulmonology, No. 13 for orheumatology, No. 21 for gynecology, No. 21 for nephrology and No. 22 for orthopedics.

This will mark the third consecutive year since Duke’s 14th place finish in 2014-2015 that it has ranked either the same or lower than its ranking from the previous year. The hospital finished 14th again in 2015-2016 before dropping to No. 16 in 2016-2017.

Thomas Owens, vice president for medical affairs and chief medical officer of the Duke University Health System, said that while Duke’s numerical ranking has continued to decline over the years, he recognizes that there are many different ways that quality is ranked and that there are limitations in any methodology, including that of U.S. News and World Report.

He added that one of the major limitations of the U.S. News and World Report rankings is their reliance on a survival score metric, which assesses the survival rate of patients within 30 days of their admission. He explained that as care has become more specialized and admitted patients have become sicker, data from hospitals delivering care to the sickest of patients, such as Duke’s, are not necessarily being risk-adjusted to reflect this skewness.

“Because we help so many patients with so many life-threatening ailments, that hurts our survival score,” Owens said.

Owens added that hospitals located in more affluent areas with less socioeconomic diversity tend to have higher survival scores, explaining that this was the first year U.S. News attempted to adjust for socioeconomic status as a factor affecting health outcomes by analyzing whether patients qualified for Medicaid in addition to Medicare.

"While there is limited data available to make those kinds of adjustments, we are the only hospital in the southeastern United States that has been ranked, and states with more ranked hospitals tend to be more urbanized," he said.

When asked how much value he believes prospective hospital patients place in U.S. News and World Report's annual rankings in deciding where to seek care, Owens noted that most patients likely focus solely on local options.

“For the vast majority of Americans, they are appropriately seeking care in their communities so that they can rely on the support of their family and friends and their local providers,” he said.

Still, research has shown that physicians do consider hospital rankings when they are considering a new job or taking the next step of their career, Owens said. Given these hiring factors, Duke still takes its rankings seriously so that it can keep building its healthcare team.

He added that Duke Health takes all of the public rankings of Duke Hospital’s performance  seriously and that they hope all the major limitations associated with U.S. News ranking  will be corrected over time.

“We want to see our rankings move the other direction over the next several years,” Owens said.