Medicare Lists Best, Worst Hospitals for Hip and Knee Replacements

By Kaiser Health News, December 17, 2013 02:16 PM

By Jordan Rau, Senior Correspondent, Kaiser Health News

Medicare has begun tracking the outcomes of hip and knee replacement surgeries, identifying 95 hospitals where elderly patients were more likely to suffer significant setbacks. The government also named 97 hospitals where patients tended to have the smoothest recoveries.

The analysis, which was released last week, is the latest part of the government's push to improve quality at the nation's hospitals instead of simply paying Medicare patients' bills. Medicare already assesses hospital death rates, how consistently hospitals follow basic medical guidelines and how patients rate their stays. The evaluation of hip and knee surgery outcomes is significant because for the first time, Medicare is rating hospitals' performance on two common elective procedures.

Many patients needing joint replacements want to know a hospital's record when choosing where to have the procedure done. This is not usually the case for treatment of conditions Medicare has evaluated previously, such as heart attacks.

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Medicare was cautious in how it marked hospitals, only categorizing them as outliers when their records in hip and knee replacements were statistically different from the national average. The overwhelming majority of hospitals - about 19 out of 20 - were branded average, a Kaiser Health News analysis found.

About 600,000 patients in the traditional Medicare program have their hips or knees replaced each year. The growing popularity of these operations has made them a more significant expense for Medicare and private insurers. In 2010, there were 719,000 knee replacements costing nearly $12 billion and 332,000 hip replacements nearly $8 billion, according to the National Center for Health Statistics.

Medicare published the new outcomes data on its Hospital Compare website. While few consumers use that site, this information may reach a greater audience later on through groups and publications, such as Consumer Reports, that tap Medicare's data in devising their own hospital ratings.

"With elective procedures, consumers like to do a lot of research to pick the right doctor and the right hospital, so this is a good first step," said Leah Binder, CEO of the Leapfrog Group, a nonprofit funded by employers that judges hospital quality. However, she said the new ratings would be of limited use for most patients because the Centers for Medicare & Medicaid Services judged most hospitals' performance as normal.

Hospitals may soon feel a financial pinch from the evaluations. Medicare plans to add hip and knee readmission rates to the criteria it uses when deciding whether to penalize hospitals each year.

Since October, Medicare has been paying less than it normally does to 2,225 hospitals after determining their rates of rebounds for patients with pneumonia, heart attacks and heart failure were too high, even by a small amount. Starting in the fall of 2014, when the joint replacements are to be factored into the penalty program, hospitals are at risk of losing as much as 3 percent of Medicare payments for each patient stay.

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In its new evaluation of hip and knee replacement patients, Medicare used two measures. One was how often the patients ended up being readmitted to the hospital within 30 days of discharge. The other was how often they suffered one of eight complications after the operation. Those included a heart attack, pneumonia, sepsis or shock within seven days of admission. They also included bleeding at the site of the surgery, a blood clot in the lung or death within a month of admission. Medicare also counted mechanical complications with implants and infections of the joint or wound within 90 days of admission.

In Medicare's new analysis, on average, hip and knee patients had a 5.4 percent chance of having to return to the hospital. Nationally, the average complication rate for patients after hip and knee replacement surgery was 3.4 percent.

Read KHN's full report here and see the list of best and worst hospitals for hip and knee replacements here.

KHN reporters Ankita Rao and Marissa Evans contributed. This article was produced by Kaiser Health News with support from The SCAN Foundation.

Photo: MSRPhoto/istockphoto

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