Consumer Reports rates surgical safety at U.S. hospitals

Provonost, other quality experts take issue with the ratings' methodology

Consumer Reports on Wednesday released ratings (subscription required) for 2,463 U.S. hospitals based on surgical care quality as part of the consumer watchdog's ongoing efforts to promote greater transparency in health care.

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To develop the ratings, Consumers Union (CU)—the not-for-profit publisher of Consumer Reports—analyzed Medicare claims data for 27 types of surgery, including back operations, knee and hip replacements, and angioplasty, from 2009 to 2011.

Researchers then adjusted the data to account for hospitals that treat primarily older and sicker patients, and excluded data on patient transfers.

The ratings are based on two measures that have a strong correlation with overall quality of care, according to John Santa, medical director of Consumer Reports Health:

  • The percentage of Medicare patients who died in the hospital during or after their surgery; and
  • The percentage of patients who stayed in the hospital longer than expected based on care standards for their condition.

CU released an overall surgery rating for each hospital based on the rates for the 27 procedures. It also developed ratings for five specific procedures: back surgery, replacements of the hip or knee, angioplasty, and carotid artery surgery.

Report reveals some unexpected trends

The final report uncovered several counterintuitive findings:
    1. Several 'big-name' hospitals earned only average ratings. Some of the nation's most renowned facilities rated halfway between "better" and "worse" on the CU scale.

    2. Teaching hospitals fell short. Teaching hospitals, which are widely regarded as providing excellent care and are often found atop of rankings for U.S. News & World Report, only rated in the middle of CU's pack.

    3. Urban and rural hospitals both performed well. Rural hospitals did better on average than other hospitals; however, several urban facilities also scored well, despite their poorer, sicker patient populations.

    4. Hospital choice matters more for some procedures than for others. Length of stay for hip and knee replacements and back surgery varied widely, while hospitals' scores for colon surgery and hysterectomy were relatively similar.

The findings underscore the difficulty patients have finding objective information on the quality of care offered at a certain hospital, Santa says. "I think the public would be surprised at all the data they're not allowed to see," he told Reuters, adding, "One of the reasons we did this was to stimulate debate and irritate people" enough to force hospitals and others to share their quality data with the public.

Critics take issue with the methodology

Michael Henderson—Cleveland Clinic's chief quality officer—said CU's methodology "doesn't give you a true picture" of the quality of surgical care.

"One of the reasons we did this was to stimulate debate and irritate people."
- John Santa, Consumer Reports

Instead, Henderson recommended using actual outcome data—such as how patients undergoing any given procedure fared—which the clinic had made available on its website.

Johns Hopkins safety expert Peter Provonost also questioned the ratings, arguing that the "accuracy of claims data… is very low or unknown."

However, Provonost commended CU for its efforts to provide patients with the quality information they need to make informed choices. He has called for a medical version of the Securities and Exchange Commission that requires hospitals to report patient outcomes (Begley, Reuters, 7/31; Fox, NBC News, 7/31; Consumer Reports, July 2013 [Subscription required]).

Want a more efficient, higher-performing surgical service line?

Hear from Yaw Fellin on how the Advisory Board's Block Manager can help maximize surgical performance, and why hospitals must learn to succeed at block management moving forward.

Keep reading: Learn how more than 300 hospitals are using Surgical Profitability Compass to better control surgery supply costs and benchmark their performance against other organizations.

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