Consumer Reports rates hospitals for surgeries

Consumer Reports rates hospitals for surgeries

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 procedure types: back surgery, hip replacement, knee replacement, angioplasty, and carotid artery surgery.

Up to 30% of hospital patients suffer infections, heart attacks, strokes, or other complications after surgery, Consumer Reports says. However, 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, according to the organization.

"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 said in a released statement.

The surgery ratings are based on an analysis of billing claims that hospitals submitted to the Centers for Medicare and Medicaid Services (CMS) from 2009 through 2011. The claims cover 2,463 hospitals in all 50 states, Washington, DC, 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, Consumer Reports said. To develop the ratings, the organization worked with MPA, a healthcare 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," said 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. And we hope that by highlighting performance differences, we can motivate hospitals to improve."

In its statement, Consumer Reports said, "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."

According to the organization, some interesting and surprising findings include:

• 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 the 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. 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, although several Mayo Clinic hospitals did well, others rated only average, and one received a low overall rating.
• Specialty hospitals were more likely 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, the Hospital for Special Surgery in New York, which specializes in orthopedics, received low marks in the new hip and knee surgery ratings, which look at how surgery patients fare over their entire hospital stay.
• For patients, 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.

Lisa McGiffert, director of Consumers Union’s Safe Patient Project, said, "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. They might as well just throw a scalpel at a dartboard."

These new surgery ratings are part of an ongoing effort by Consumer Reports to shed light on hospital quality and to push the healthcare industry toward more transparency.

The complete report is available in the September issue of Consumer Reports and online at www.ConsumerReports.org/cro/hospitalratings0913.