Consumer Reports Rates Surgery; Hospitals Push Back

We, patients, need user-friendly ways to answer this question: Where’s the best place to go for a knee replacement, or cardiac care, or to deliver a baby?

It is virtually impossible to find an answer even though hospitals have reams of information about how often patients recover smoothly and how often they suffer infections, complications or even die after surgery.

A few groups are stepping into the void. The latest issue of Consumer Reports rates hospitals in Massachusetts, and across the country, on surgery. The “overall” scores surprised me.

From Consumer Reports' “Your Safer-Surgery Survival Guide”

From Consumer Reports’ “Your Safer-Surgery Survival Guide”

Carney Hospital at the top is hardly a magnet for patients needing surgery in the Boston area. Some hospitals that are have the lowest overall ratings.

I called Mass General, where the hospital’s senior VP for quality and safety, Dr. Elizabeth Mort, praised the goal of giving patients more information about the quality of care. But she says Consumer Reports’ methods have so many flaws that these ratings “do the patient a disservice.”

The ratings, Mort says, don’t accurately take into account:

- how sick the patient was when he or she came in for surgery or the severity of their disease
- how many other conditions the patient may have
- how many complications actually occurred

The ratings are also misleading, Mort says, because they pool different types of procedures in single category. For example, they pool many prostate procedures, even though some hospitals perform very specialized and difficult surgeries and some hospitals only perform the most basic operations.

Consumer Reports’ ratings are based on two factors: how often patients died in the hospital following surgery and how often they had an extended stay, which is often a sign there were complications. Researchers combed through Medicare billing records. Consumer Reports doesn’t have medical reports that would allow it to adjust for the issues Mort mentioned above.

“That’s a little bit of the point,” says Doris Peter, with Consumer Reports Health Ratings Center, “that clinical data is not widely available to the public and we can’t base our ratings on clinical data if it’s not made available.”

Dr. John Santa, medical director of Consumer Reports Health, says in the magazine that while the ratings aren’t perfect, “we think they’re an important step in giving patients information they need to make an informed choice.” And, he adds, “we hope that by highlighting performance differences, we can motivate hospitals to improve.”

The Massachusetts Hospital Association (MHA) says it supports “greater transparency regarding quality and financial data to better inform the public,” but that “Consumer Reports’(CR) continued efforts to rate US hospitals result in greater confusion rather than clarity with an oversimplification of this extremely complex and important subject.”

This tug and pull between employers and consumers, on the one hand, who want to know where to get the best care, and providers, on the other hand, who say, trust us, we’re improving our quality, is getting more intense as health care costs rise.

The MHA says patients “will be far better served if CR joins other responsible parties to develop a common national framework for quality measurement and reporting – one based on scientifically-validated and broadly-endorsed methods.”

OK. Where’s the working group? Who’s calling the meeting of orthopedists (for example), quality specialists and consumers to figure out which four or five knee replacement measures everyone will use so that we, consumers, can chose a surgeon and hospital based on something more than the name we got from our best friend’s brother-in-law, who had the surgery five years ago.

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  • Lilly’s mom

    Maybe the smaller hospitals do not get the multiple trauma who happens to meed a gall bladder removed and has a prolonged stay fro the trauma and not the gallbladder, but what this does say is that the TOP, SMALL hospitals do, what they do, WELL and with patient safety in mind. What was the old saying…Avis tries has to try harder than the supposed number 1 Hertz.

  • Can’t Believe It

    …Or maybe you’re just better off going to an unassuming little 159-bed hospital like Carney rather than a 950-bed behemoth like Mass General where it looks like administrators are more concerned with promoting their “World-Class Patient Care” image and maintaining those $750 million in research grants than in doing the exhausting and thankless work of helping actual patients get better.

  • Reasonable?

    If health care consumers de-identify and share there claims with a trusted aggregator of information. MA (and other states) could quickly get “consumer-driven” transparency that would cut through much of our current morass.

    • Martha Bebinger

      Hi Reasonable? – can the All Payer Claims Database serve this purpose? The info will always be a little old, but could still be a useful reference point, right?

  • Undersecretary Barbara Anthony

    Healthcare consumers have been in the dark, but Consumer Reports continues to shine a light on information consumers can use to make informed decisions in the healthcare marketplace. As Ms. Bebinger states, there is a “void” of groups providing information to answer the question: Where should I get my health care? Usable information that is accessible or even available at all to healthcare consumers is in short supply. Consumers want this data. The Mass Insight polling group performed a survey this past April that showed that consumers do want to have more information. But more than their desire, consumers have a right to this information. As with any other major consumer purchase, consumers should shop around for their health care. Consumers should use price and quality information when seeking out health care, just as would when they look for a television or car.

    While this data may not be perfect, it is a step in the right direction. The Massachusetts Office of Consumer Affairs and Business Regulation is working on an “Empowering Healthcare Consumers” campaign to advocate for price and information transparency in the healthcare marketplace. The way that this campaign will work is through bold moves by various groups to get information to consumers and fill that “void” that Ms. Bebinger writes about. The continued effort by Consumer Reports should be praised. It seeks to fill the vacuum of groups willing to step up and provide crucial information to empower healthcare consumers.

    Undersecretary Barbara Anthony
    MA Office of Consumer Affairs and Business Regulation

  • ErinJH

    Fascinating, and on the heels our dreadful, dreadful MGH experience. Wound infection continues.