Medicare hospital comparison website may not help patients locate best places for high-risk surgery

Oct 18, 2010

Information available on a government Web site designed to help patients choose high-quality hospitals does not appear to help Medicare beneficiaries identify facilities with better outcomes for high-risk surgeries, according to a report in the October issue of Archives of Surgery.

In an effort to reduce variations in , the Centers for Medicare and Medicaid Services (CMS) now requires hospitals to report data from the national Surgical Care Improvement Project involving measures taken to prevent infection and blood clots, according to the background information in the article. "Hospitals are required to submit data quarterly, which are posted on the Hospital Compare Web site (, to receive annual Medicare payment updates," the authors write. "This reporting is believed to aid patients and payers in choosing high-quality hospitals and to stimulate quality improvement among reporting hospitals. It is unclear whether these efforts will translate into better outcomes for surgical patients."

Lauren H. Nicholas, Ph.D., and colleagues at the University of Michigan and Michigan Surgical Collaborative for Outcomes Research and Evaluation, Ann Arbor, analyzed Medicare inpatient claims data for 325,052 patients undergoing one of six high-risk surgical procedures at 2,189 hospitals in 2005 or 2006. They used Hospital Compare data to calculate a score for each facility based on the number of times a hospital complied with recommended measures for each eligible patient per year.

These compliance scores ranged widely, from 53.7 percent in low-compliance hospitals to 91.4 percent in high-compliance hospitals. "We found little evidence of a consistent relationship between hospital compliance with processes of care and operative mortality rate," the authors write. "In univariate analysis, mortality rates in the lowest compliance hospitals were statistically indistinguishable from those in the highest quintile of compliance for all procedures studied except aortic valve replacement, in which the highest compliance hospitals had lower ."

Compliance scores accounted for only 3.3 percent of the variance in hospitals' death rates. In addition, the 95,387 facilities that did not report data at all had similar rates of death to the one-fifth of hospitals with the highest compliance scores. Scores were also not associated with outcomes when each of the six procedures—abdominal aortic aneurysm repair, aortic valve repair, coronary artery bypass graft, esophageal resection, mitral valve repair or pancreatic resection—were considered individually.

Several potential explanations exist for the lack of association, the authors note. "The Surgical Care Improvement Project measures are low-leverage because they relate to secondary and relatively less important outcomes," they write. "Even when processes are tied to an important outcomes such as pulmonary embolism [a blood clot that has traveled to the lungs], these events are rare and offer insufficient variation to differentiate between high- and low-quality hospitals."

"Despite the intentions of the CMS to provide patients with information that will facilitate patient choice of high-quality hospitals, currently available information on the Hospital Compare Web site will not help patients identify hospitals with better outcomes for high-risk surgery," they conclude. "The CMS needs to identify higher leverage process measures and devote greater attention to profiling hospitals based on outcomes for improved public reporting and pay-for-performance programs. Future research should ascertain whether process measures become more useful as indicators of surgical quality as public reporting programs mature."

Explore further: Is UK shale gas extraction posing a risk to public health?

More information: Arch Surg. 2010;145[10]:999-1004.

add to favorites email to friend print save as pdf

Related Stories

Top-rated hospitals don't always have superior outcomes

Jan 26, 2010

New research published in the January issue of the Journal of the American College of Surgeons finds that while popular hospital rating systems can help identify high-quality hospitals for cardiovascular operations, patien ...

Lower-cost hospital care is not always lower in quality

Feb 22, 2010

The costs that hospitals incur in treating patients vary widely and do not appear to be strongly associated either with the quality of care patients receive or their risk of dying within 30 days, according to a report in ...

Recommended for you

Obama: 8 million signed up for health care (Update)

3 hours ago

President Barack Obama said Thursday 8 million Americans have signed up for health care through new insurance exchanges, besting expectations and offering new hope to Democrats who are defending the law ahead ...

User comments : 0

More news stories

Turning off depression in the brain

Scientists have traced vulnerability to depression-like behaviors in mice to out-of-balance electrical activity inside neurons of the brain's reward circuit and experimentally reversed it – but there's ...

Researchers discover target for treating dengue fever

Two recent papers by a University of Colorado School of Medicine researcher and colleagues may help scientists develop treatments or vaccines for Dengue fever, West Nile virus, Yellow fever, Japanese encephalitis and other ...

Our brains are hardwired for language

A groundbreaking study published in PLOS ONE by Prof. Iris Berent of Northeastern University and researchers at Harvard Medical School shows the brains of individual speakers are sensitive to language univer ...

Better thermal-imaging lens from waste sulfur

Sulfur left over from refining fossil fuels can be transformed into cheap, lightweight, plastic lenses for infrared devices, including night-vision goggles, a University of Arizona-led international team ...

Hackathon team's GoogolPlex gives Siri extra powers

( —Four freshmen at the University of Pennsylvania have taken Apple's personal assistant Siri to behave as a graduate-level executive assistant which, when asked, is capable of adjusting the temperature ...