Choose Hospitals on Performance Data, Consumers Urged

When compared with one-star hospitals, which have higher risk-adjusted complication and mortality rates, patients at hospitals with a five-star rating have a 71% lower chance of dying, according to Healthgrades.

Healthgrades is urging consumers to "do their homework" before choosing a hospital.

A report released Tuesday, Healthgrades 2016 Report to the Nation, notes that since 2011, one-in-six Medicare patients got their care from a hospital that had earned a one-star designation from Healthgrades. Had many of these patients done some research, they probably could have found a higher-rated hospital nearby for their particular procedure, says Evan Marks, chief strategy officer at Denver-based Healthgrades.

"The real message to consumers is to try to avoid hospitals with a one-star rating, especially if they can travel to a place that is not too far away or inconvenient for them," Marks says, "where they can at least find a hospital that is rated three stars or ideally one that is rated five stars. By the way, three stars is not bad. That means a hospital is performing as expected."

When compared with one-star hospitals, which have higher risk-adjusted complication and mortality rates, Marks says patients at hospitals with a five-star rating have a 71% lower chance of dying, and a 65% lower change of experiencing complications during their stay. If all hospitals met the five-star ranking, Marks says, more than 222,000 lives potentially could have been saved since 2011.

"It's a difficult challenge because consumers think about hospitals from a reputational standpoint, 'Oh that's a good hospital. That's where I'll get my care,'" Marks says. "They don't often think about the fact that different hospitals have different outcomes for differ procedures and service lines and you may want to consider different options based on this information."

Healthgrades says it continues to find "significant variation in health outcomes" among hospitals throughout the nation, and in local service areas. For example, outcomes among hospitals in Denver, CO for hip replacement surgery showed that complication rates varied from 3.9% to 13.6%. 

Not all hospitals are good at every procedure, Marks says, which could further confuse patients. In the Chicago area, 14 hospitals received a five-star rating for treating heart attacks, but eight of those same hospitals received a one-star rating for knee replacement surgeries.

Marks says it's becoming more important for patients to become better healthcare consumers now that they're shouldering more of the medical cost with rising premiums and high-deductible plans. He cited a Healthgrades-commissioned study showing that 85% of patients would pick a different physician if the patient were given "objective information" that included physician experience, patient satisfaction, and hospital outcomes.

"We urge consumers, especially for issues where the outcome is going to affect your life, and especially in cases where complications can be severe, to look for hospitals that have first demonstrated improved outcomes, i.e. low mortality, low complications, [and] find the doctor who has highest concentration of experience in that disease or procedure that treats at that hospital," Marks says.

"That is how we recommend patients go about seeking care. Not finding a doctor who you happen to like and find out that he may be practicing at a facility with worse-than-expected outcomes." There is no direct correlation between the number of hospitals in a particular area and the level of quality, Marks says. For example:

• In Chicago, of 46 hospitals that perform coronary artery bypass graft surgery, only two have a five-star rating for the procedure.
• In Houston, of 38 hospitals that treat chronic obstructive pulmonary disease, or emphysema, only one has a five-star rating for this condition.
• In the Los Angeles area, of 41 hospitals that perform coronary artery bypass graft surgery, only six have five-star rating for this procedure.
• In Philadelphia, of 34 hospitals that treat heart attack, only four have a five-star rating.
• In the New York City region, of 102 hospitals that perform colorectal surgeries, only two have a five-star rating for these procedures.

Healthgrades based its hospital ratings on approximately 45 million Medicare patient records for nearly 4,500 short-term, acute care hospitals nationwide. It assessed the hospitals' performance relative to common in-hospital conditions and procedures for the Medicare population using Medicare Provider Analysis and Review (MedPAR) data from 2012 through 2014 and one condition based on All-payer state data from 2011 through 2013.

Healthgrades adjust for risk factors that include age, gender, specific procedure performed, and co-morbid conditions, such as high blood pressure and diabetes. The outcomes reflect clinically based measures, including in-hospital complications or in-hospital and 30-day post-admission mortality.

"Much of what we measures, in terms of mortality and complications is not directly attributable to your physician," Marks says. "It has more to do with the overall care team at the hospital. Any one of them can make errors that result in complications or death, and it's choosing the hospital team, essentially, that is the most important thing, and then finding the doctor who concentrates on that particular disease or procedure."