For the first time, Consumer Reports has rated U.S. hospitals on how patients fare during and after surgery. The ratings include an overall surgery rating, which combines results for 27 categories of scheduled surgeries, as well as individual ratings for five specific procedure types: back surgery, hip replacement, knee replacement, angioplasty, and carotid artery surgery.
Up to 30 percent of hospital patients suffer infections, heart attacks, strokes, or other complications after surgery. But consumers have very little to go on when selecting a hospital because it's not clear which hospitals are doing the best job at keeping surgery patients safe. Although hospitals are required to report to government agencies and some submit data to national registries to see how they stack up against one another, vital safety information remains largely hidden from consumers.
Consumer Reports' Surgery Ratings are based on an analysis of billing claims that hospitals submitted to Medicare for patients 65 and older, from 2009 through 2011, and cover 2,463 hospitals in all 50 states, Washington, D.C. and Puerto Rico.
The surgery ratings are based on the percentage of a hospital's Medicare patients who died in the hospital or stayed longer than expected for their procedure. Research shows that mortality and length of stay correlate with complications, and some hospitals themselves use this approach to monitor quality. To develop the ratings, Consumer Reports worked with MPA, a health care consulting firm with expertise in analyzing billing claims and clinical records data and in helping hospitals use the information to improve patient safety.
"We wish we had access to more comprehensive, standardized information, but this is the best that is available," says John Santa, MD, MPH, medical director of Consumer Reports Health. "We know the ratings aren't a perfect measurement but we think they're an important first step in giving patients the information they need to make an informed choice," he adds. "And we hope that by highlighting performance differences, we can motivate hospitals to improve."
The complete report is available in the September issue of Consumer Reports and online at www.ConsumerReports.org/cro/hospitalratings0913. These ratings evaluate hospitals and not individual surgeons.
Though there are many dimensions to hospital quality, and no single measure captures everything, Consumer Reports' surgery Ratings give patients more of the information they need to make informed choices about hospital performance before choosing where to have surgery. Some interesting and surprising findings include:
- Some hospitals do a much better job than others. Consumer Reports' Ratings reflect wide variation, sometimes between hospitals only a few miles apart. For example, the Greater Baltimore Medical Center earned high marks in our overall surgery rating, as well as for several individual procedures. But the Johns Hopkins Bayview Medical Center, also in Baltimore, got a low overall surgery rating.
- Teaching hospitals often fell short. Teaching hospitals, thought to represent the nation's best and the recipients of generous federal funding, on average performed no better than other hospitals in Consumer Reports' surgery Ratings. Nonetheless, some standouts earned a high rating.
- Urban and rural hospitals can and do excel. Several urban hospitals did well despite often serving poorer, sicker patients, including Mount Sinai Hospital in New York and University Hospitals Case Medical Center in Cleveland. And rural hospitals did better, on average, than other hospitals.
- Big-name hospitals don't always live up to their reputation when it comes to these Ratings. For example, though several Mayo Clinic hospitals did well, others rated only average. And the Mayo Clinic Health System in Austin, Minn., got a low overall rating.
- Specialty hospitals tended to do better. Six of the top performers for carotid artery surgery were heart hospitals. But that's not always the case. For example, despite earning high marks in other Consumer Reports' ratings that focus on infections related to surgical incisions, Hospital for Special Surgery in New York, which specializes in orthopedics, got low marks in our new hip and knee surgery ratings, which look at how surgery patients fare over their entire hospital stay.
- Hospital choice matters more for some procedures than for others. For example, Consumer Reports found wider variation for several surgeries, including hip and knee replacements and back surgery, than for others, such as colon surgery and hysterectomy.
Fortunately, experts have developed ways to reduce many complications. For example, some hospitals have actually eliminated infections introduced through intravenous catheters by following a checklist. By highlighting performance differences in its new study, Consumer Reports hopes not only to provide consumers with more information, but to motivate more hospitals to improve their performance on quality measures.
Gradually, more information is becoming available to the public. Thanks to healthcare reform, hospitals are encouraged to move to electronic record keeping, which will make it easier to track data. And several professional medical organizations have started publishing some of the quality information they collect on hospitals. However, participation is voluntary, so those databases often involve only a small number of hospitals.
"Consumers have very little to go on when trying to select a hospital for surgery, not knowing which ones do a good job at keeping surgery patients safe and which ones don't," says Lisa McGiffert, director of Consumers Union's Safe Patient Project. "They might as well just throw a scalpel at a dartboard."
Consumers Union, the advocacy arm of Consumer Reports, works to expand hospitals' public reporting and establish a standardized way for patients to report medical errors.
Consumers Union also seeks to bring the consumer voice into the discussion about quality healthcare. Its Safe Patient Project works with patient advocates to highlight the things that can go wrong in hospitals and to urge state and federal governments as well as hospital administrators to take steps necessary to improve patient safety.
These new surgery ratings are part of an ongoing effort by Consumer Reports to shed light on hospital quality and to push the health care industry toward more transparency. For example, Consumer Reports has developed a Safety Score for more than 2,000 hospitals nationwide, which includes information from surgical and nonsurgical patients, as well as Ratings on other measures, such as bloodstream infections, readmissions, and communicating drug information to patients.
The complete list of surgery Ratings for all 2,463 hospitals, and a basic description of the methodology, is available at www.ConsumerReports.org/surgeryratings. A more detailed description of the methodology for these and all Consumer Reports' hospital Ratings is available at www.ConsumerReports.org/hospitalratingsmethodology.