NCPA - National Center for Policy Analysis

For Surgery, Big and Famous Hospitals Aren't Always the Best

August 7, 2013

Patients going to a hospital for surgery care about many things, from how kind the nurses are to how good the food is, but what they care about most is whether they stay in the hospital longer than they should and whether they come out alive, says Reuters.

In the first effort of its kind, Consumers Union, the policy and action division of Consumer Reports magazine, released ratings of 2,463 U.S. hospitals in all 50 states, based on the quality of surgical care.

  • The group used two measures: the percentage of Medicare patients who died in the hospital during or after their surgery, and the percentage who stayed in the hospital longer than expected based on standards of care for their condition.
  • Both are indicators of complications and overall quality of care, says Dr. John Santa, medical director of Consumer Reports Health.

The ratings will surely ignite debate, especially since many nationally renowned hospitals earned only mediocre ratings.

  • The Cleveland Clinic, some Mayo Clinic hospitals in Minnesota, and Johns Hopkins Hospital in Baltimore, for instance, rated no better than midway between "better" and "worse" on the Consumers Union scale, worse than many small hospitals.
  • Because Consumers Union had only limited access to data, the ratings also underline the difficulty patients have finding objective information on the quality of care at a given facility.

Consumers Union's ratings are based on Medicare claims and clinical records data from 2009 to 2011 for 86 kinds of surgery, including back operations, knee and hip replacements, and angioplasty. The rates are adjusted to account for the fact that some hospitals treat older or sicker patients, and exclude data on patients who were transferred from other hospitals. These are often difficult cases that, Consumers Union felt, should not be counted against the receiving hospital.

  • Although the ratings do not explicitly incorporate complications such as infections, heart attacks, strokes or other problems after surgery, the length-of-stay data captures those problems.
  • Some of the findings are counterintuitive. Many teaching hospitals, widely regarded as pinnacles of excellence and usually found at the top of rankings like those of U.S. News & World Report, fell to the middle of the pack.

Source: Sharon Begley, "For Surgery, Big and Famous Hospitals Aren't Always the Best," Reuters, July 31, 2013.


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