Elective surgeries, unlike emergencies, may give a person some time to plan for the procedure. But any patient trying to figure out which hospital has the best success history for, say, a hip replacement, "may as well just throw a scalpel at a dartboard," according to a new Consumer Reports study.
To get some kind of a fix on surgical success rates, Consumer Reports mined Medicare billing data from 2,463 U.S. hospitals between the years 2009 and 2011, zeroing on on mortality rates and length of hospital stays for 37 types of elective surgeries.
The thinking here was that longer-than-expected post-operative stays and high mortality rates could indicate that something is amiss at a given hospital. The group then rated high-volume surgical hospitals on a scale of 1 to 5, with 5 indicating a better-performing hospital and 1 indicating a worse one.
Local hospital results
The ratings may surprise people, according to Doris Peter, an associate director at Consumer Reports.
Peter found that rural hospitals generally performed better than urban ones. Also, said Peter, "some of the more recognizable brand name hospitals did not do as well as expected" — though some did perform better.
Of the several dozen Pennsylvania hospitals examined, the report shows two hospital in Philadelphia — Thomas Jefferson University Hospital and Pennsylvania Hospital — joined Allegheny General Hospital in Pittsburgh in receiving the lowest score of 1.
Saint Vincent Health Center in Erie and Williamsport Regional Medical Center received the highest score of 5.
Consumer Report's elective surgery ratings for some Philadelphia hospitals:
Taking ratings with 'a grain of salt'
For Peter, the main takeaway is that patients "can't rely on reputation alone" or the experience of friends or family in deciding where to go for surgery.
"You need to check up on the hospital that you're planning to go to," she said.
Curt Schroder, with the Delaware Valley Health Care Council, an association of hospitals from throughout the region, warns against taking one report as the final word, though he does think such reports can be helpful in initiating conversations with doctors about the most appropriate health setting.
"I think the reports can be taken as a snapshot, but not something that a consumer can definitively base a health care decision on," Kirk said.
Schroder said access to data is a good thing, but a recent influx of such studies and hospital rankings offers conflicting results. Hahnemann Hospital, in Philadlephia, which had a poorer rating, echoed Schroder's view, saying in an emailed statement that safety and quality "is the utmost priority," and that one rating system can't paint a complete picture of care.
While Schroder didn't want to comment on specifics of the Consumer Reports study, he said other factors, unrelated to quality, may skew hospital ratings.
"It could also be reflective of various demographics, various health conditions of a community served by a particular hospital, that might lead to outcomes that are not as good as the next hospital," Schroder said.
Pennsylvania Hospital said in an emailed statement that Consumer Reports' ratings are a "disservice to patients" because they're based only on Medicare claims data, not a hospital's total patient population.
Dr. Robert Uzzo, chair of surgery at Fox Chase Cancer Center, which got scored as a “better” hospital in the report, counters that there is something to be said for the Consumer Reports methodology. Uzzo said using Medicare data may not cover an entire population, but it’s still very comprehensive, focusing on a large population set “that has one of the highest risks for safety issues, for medical complications and for outcomes concerns.”
Peter said Consumer Reports' surgical data set, which comes from billing information, as opposed to directly from medical records, does have limitations. But so do all ratings.
"There's a grain of salt to be taken with all of these," she said. Hospitals or other groups with a stake in reporting, for example, may be able to "game" data, making results look better or worse.
Peter said the Consumer Reports' study offers some valuable information for patients. While not all surgical complications are avoidable, some are. One example is hospital-acquired infections, which is the kind of problem that can keep someone in the hospital longer. Peter said she hopes the ratings will lead to a more robust understanding of the causes and possible fixes for poor surgery outcomes.
"First of all, what are the complications?" Peter said. "Is it happening during the surgery or after the surgery? If it's after the surgery, then is it a coordination of care between different care teams? You know, is it drug errors. What systems can [hospitals] put in place?"
Peter says having even more data, and being able to measure it, is an important start.