Methodology

From 2019 to 2021, almost 500,000 Medicare patients underwent outpatient hip and knee replacements. With the number of Americans opting for outpatient treatments increasing, Healthgrades has released the first-ever outpatient quality ratings "to address this shift and help patients find the best care for their unique health needs."

To evaluate outpatient performance, Healthgrades analyzed Medicare outpatient and inpatient data from CMS' Standard Analytics Files from 2019 to 2021. Patient outcomes data for total knee replacement and total hip replacement procedures were analyzed for almost every hospital in the United States.

Based on that analysis, Healthgrades awarded each hospital between one and five stars to signify their outpatient performance. According to Healthgrades, hospitals that received:

• One star performed "worse than expected," meaning their "actual performance was worse than predicted and the difference was statistically significant."
• Three stars performed "as expected," meaning their "actual performance was not statistically different from what was predicted."
• Five stars performed "better than expected," meaning their "actual performance was better than predicted and the difference was statistically significant."

Hospitals that received the "Outpatient Joint Replacement Excellence Award" achieved "superior clinical outcomes in outpatient knee and outpatient hip replacement."

To be eligible, a hospital must meet at least one performance requirement for both outpatient total knee replacement and outpatient hip replacement.

The Outpatient Joint Replacement Award

For the list, Healthgrades assessed mortality and complication rates for patients who underwent outpatient total knee and total hip replacement procedures. Hospitals were recognized in three categories:

• Healthgrades outpatient total knee replacement five-star ratings, which was awarded to 146 hospitals
• Healthgrades outpatient total hip replacement five-star ratings, which was awarded to 78 hospitals
• Healthgrades outpatient joint replacement specialty excellence award, which was awarded to 112 hospitals among the top 10% in the United States

The analysis found that patient outcomes varied significantly across facilities. Overall, the hospitals that were recognized in the list had better-than-expected outcomes from 2019 to 2021.

According to Healthgrades, more than 10,000 complications could have been avoided if all hospitals performed as well as the facilities that were recognized with five-stars in outpatient knee and hip replacements.

Patients treated at facilities that received a 2023 Outpatient Joint Replacement Award distinction faced a 50% lower risk of experiencing complications than patients at hospitals that were not recognized.

Compared with patients treated at one-star hospitals, patients who underwent a hip replacement procedure at a facility with a five-star rating for total hip replacement faced a 76% lower risk of experiencing complications. Meanwhile, patients who underwent a knee replacement procedure at a facility with a five-star rating for total knee replacement faced an 85% lower risk of experiencing complications.

"It is imperative that consumers have the information they need to choose a doctor and hospital that excel in their procedure as the market for elective orthopedic care continues to shift towards outpatient settings," said Brad Bowman, Healthgrades' CMO and head of data science. "As a leader in health transparency for over 20 years, Healthgrades is proud to be the first to publish outcomes-based outpatient ratings, and we look forward to expanding our outpatient analysis further later this year."

Click here for the full list of award recipients.                                             

(2023 Outpatient Joint Replacement Award list, 5/9; Healthgrades press release, 5/9; Outpatient Specialty Excellence Awards 2023 methodology, 5/9; Outpatient complication outcomes methodology, 5/9)

Download our quick guides that summarize the methodology and metrics used in hospital quality rating programs.