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The top hospitals don’t always live up to their reputations when it comes to handling surgery, according to a new report released on Wednesday.
Consumer Reports used newly available federal government data to look at how patients fared after surgery at nearly 2,500 hospitals in 50 states. The report found some of the big-name hospitals did not always do well in preventing infections and other measures of quality care, while some busy urban hospitals that care for the poorest and sickest patients often did surprisingly well.
It also breaks down detailed findings for five common procedures: back surgery, hip and knee replacement, angioplasty to clear out clogged arteries of the heart, and carotid artery surgery to unplug the neck artery.
“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,” Lisa McGiffert, director of Consumers Union’s Safe Patient Project, says in a statement. “They might as well just throw a scalpel at a dartboard.”
Some of the surprise findings: Two of Washington D.C.’s flagship hospitals, MedStar Washington Hospital Center and Sibley Memorial Hospital, both get the poorest overall rating for patients receiving surgery. Johns Hopkins Hospital – associated with one of the country's most prestigious medical schools – only gets an average rating.
Brigham and Women’s Hospital in Boston – one of several hospitals associated with Harvard Medical School, also gets the poorest rating. In contrast, top ratings go to the Greater Baltimore Medical Center, other big-city hospitals like Mount Sinai and NYU Langone Medical Center in New York, as well as some regional hospitals like Nebraska Heart Hospital in Lincoln and Abilene Regional Medical Center in Texas.
Dr. Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins and one of the leaders in the fight to improve hospital quality, applauds the idea but says the data the report is based on is flawed. “I really applaud the Consumer Report effort to get information to consumers about complications,” he said.
“The overall concept is spot-on,” Pronovost told NBC News. “One of the concerns is they measured these complications using administrative data, which is completely understandable, but we know it’s not completely accurate.”
Unfortunately, he said, there’s not much better data out there yet. One of the measures – infections among patients fitted with a catheter – is only right 25 percent of the time when calculated using billing information filed to Medicare, Pronovost says.
“What we need to do is keep working to get better performance measures,” he said.
Dr. David Bates, chief quality officer at Brigham and Women's, agreed that billing data is often less than accurate. "Hospital rankings are a complex and important topic and better performance measures are needed to provide a true picture of the quality and safety of hospitals nationwide," Bates said in a statement.
In addition to Johns Hopkins, NBC News also reached out to officials from Brigham and Women’s Hospital and MedStar Washington Hospital Center but they were unable to provide immediate comment on the findings. (Sibley Memorial Hospital is affiliated with Johns Hopkins.)
Many of the biggest and most famous hospitals aren’t listed. Consumer Reports used Medicare reporting data for its report and could only include hospitals that reported data in a certain way.
The ratings are based on the percentage of a hospital’s surgery patients who either died while in the hospital or who stayed longer than would have been expected, based on national averages for each procedure considered. “Research shows those measures are correlated with complications, and some hospitals themselves use this approach to monitor quality," Consumer Reports said in a statement.
“It is, unfortunately, the best we can do using billing data,” says Doris Peter, manager of the Consumer Reports Health Ratings Center. “We don’t have ratings for Veterans Affairs hospitals and hospitals that see mostly Medicare Advantage patients, such as many Kaiser hospitals, because they use another reporting system,” the group added in a statement.
Consumer Reports will add the findings to its subscription-only website. The non-profit is one of several organizations that now rate hospitals and doctors. U.S. News and World Report has such a website, as does The Commonwealth Fund, the LeapFrog Group, the Informed Patient Institute and the federal government.
Some experts have pointed out these measures can be flawed and give, at best, a distorted picture, in no small part because hospitals don’t release this information publicly. And Medicare has only just recently begun to do so. No one had the information needed to make accurate estimates of just what was going on, medically, with patients in hospitals.
Peter says this report is unique. “This is a measure that looks at patients who died or who stayed in the hospital longer than required for their procedures. I don’t think there is anything out there like this for anyone,” she said in a telephone interview.
“There have never been hospital-level results published to the public.”
Leah Binder, CEO of the LeapFrog Group, a patient safety organization, calls the report a breakthrough.
“It is one of the first reports I’ve seen for the public that uses newly available Medicare data,” Binder said in a telephone interview.
“In the past, Medicare data was not made public for use by researchers. After quite a bit of struggling and political battles by groups like mine and Consumer Reports, it has been publicly released.”
She says consumers should have a look before they choose a hospital for surgery – but notes no single report gives a full picture of what a hospital does.
“Hospitals are complex places,” Binder said. “I think it is reasonable that there might be several different perspectives on how they do. It is not like rating even a restaurant. Hospitals do surgery, they save lives, they make mistakes. There is a whole array of incredibly complex services they provide to the public.”
Peter says there’s still no one-stop shopping for consumers trying to get information about hospitals. “Unfortunately, all this data isn’t in one place that is easy to digest,” she says. And anyone considering surgery should speak to the surgeon.
“You can ask your surgeon for rates of death. You can ask how many of those procedures they have done before,” she said. Surgeons who won’t give that information might not be the right surgeon to do the work.
“It really does work,” Peter says. “Some surgeons, especially cardiac surgeons, are used to tracking their performance. They already know.”
Groups from LeapFrog to the Commonwealth Fund and the independent Institute of Medicine have been pressing for hospitals to improve their safety records. There have been reports like the landmark 1999 study from the IoM, which documented that up to 98,000 people died every year in the hospital because of mistakes. And the 2010 Affordable Care Act aims to lower costs and improve care by forcing hospitals to report and correct their mistakes.
One of its first targets is readmission rates – the number of patients who have something done in the hospital and come back days or a few weeks later because of a mistake such as an infection or a failure to prescribe the right medication.
“The beauty of this approach is that preventable complications correlate with post-operative length of stay,” Dr. Arnold Milstein, director of the Clinical Excellence Research Center at Stanford University, said in a statement. “This is about as good as complications measurement can be when using existing claims data.”