U.S. News and World Report (USN&WR) issued its list of top U.S. hospitals this week. For 20 years USN&WR has been ranking hospitals according to surgical specialty. More recently, the payer community has also started to rank hospitals. Medicare uses several measures to quantify hospital performance, including patient surveys. The Leapfrog Group for Patient Safety also measures hospital performance along a number of safety factors including infection control. Finally, private insurers are using their own data to evaluate hospitals.
The Best Orthopedic Hospitals in America
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After reading the USN&WR rankings last week, we decided to check the other sources and then combine rankings to arrive at a composite score. We used elements of the USN&WR rankings, the U.S. Department of Health and Human Services (HHS) patient survey data, and data from the private Leapfrog patient safety study to arrive at a composite ranking for orthopedic hospitals in the United States.
Based on that composite study, the #1 orthopedic hospital in the United States is the Hospital for Special Surgery (HSS) in New York City.
USN&WR ranked HSS #2 in the country in orthopedics and the Mayo Clinic #1. When we included HHS patient surveys and other data, we found that the Mayo Clinic fell one spot in the rankings and HSS emerged as #1. For example, while USN&WR gave the Mayo Clinic the top ranking for reputation, the Mayo Clinic failed to make the top 10 in terms of patient satisfaction (#11) or mortality index (#12). HSS, by contrast, may not have had a reputation as strong as the Mayo Clinic (HSS was #2), but it did have the lowest mortality index (#1) and the second-best HHS-derived patient survey rating.
To us, higher patient satisfaction and lower mortality rates trump reputation. HSS is #1.
An explanation of our methodology follows at the end of this article.
Table 1: The Top Orthopedic Hospitals in America
|
Total Score |
1
Hospital for Special Surgery, New York
63.5
2
Mayo Clinic, Rochester, Minnesota
61.4
3
Massachusetts General Hospital, Boston
48.6
4
Cleveland Clinic
41.1
5
Johns Hopkins Hospital, Baltimore
32.2
6
Duke University Medical Center, Durham, North Carolina
31.8
7
New York-Presbyterian University Hosp of Columbia and Cornell
29.6
8
NYU Hospital for Joint Diseases, New York
28.2
9
UPMC University of Pittsburgh Medical Center
27.5
10
Barnes Jewish Hospital / Washington University, St. Louis
27.1
Source: Orthopedics This Week composite ranking
What’s In a Reputation?
For more than 100 years the Mayo Clinic in Rochester, Minnesota, has been synonymous with the highest-quality health care and clinical research. That reputation made Rochester, Minnesota, one of the original medical tourism destinations. Today, that reputation is supporting an ever growing range of satellite Mayo Clinics. Patients can now visit the Mayo Clinic in Phoenix, California, Florida and, of course, Rochester, Minnesota.
More recently, the Mayo Clinic has been used to illustrate how to deliver the best health care at lower than average prices, and it is becoming a poster child for a new healthcare delivery paradigm.
Coming in #2 on the USN&WR orthopedic reputation scale (see Table 2) is the largest orthopedic hospital in the United States—the Hospital for Special Surgery (HSS) in New York City. According to USN&WR, HSS treats more than 12, 600 orthopedic patients annually. The next busiest institution in the USN&WR ranking was the Mayo Clinic with about 9, 600 orthopedic patients and then the Beaumont Hospital in Royal Oak, Michigan, with 8, 300 annual patients.
Table 2: USN&WR Orthopedic Reputation
|
Score |
1
Mayo Clinic, Rochester, Minnesota
40.5
2
Hospital for Special Surgery, New York
39.5
3
Massachusetts General Hospital, Boston
26.3
4
Cleveland Clinic
22.1
5
Johns Hopkins Hospital, Baltimore
12.4
6
Duke University Medical Center, Durham, North Carolina
11.2
7
New York-Presbyterian University Hosp of Columbia and Cornell
10.7
8
UPMC University of Pittsburgh Medical Center
9.2
9
University of Iowa Hospitals, Iowa City
8.7
10
Ronald Reagan UCLA Medical Center, Los Angeles
8.3
Source: U.S. News & World Report, 2009
Which Orthopedic Hospitals Do Patients Prefer?
The Centers for Medicare & Medicaid Services (CMS), the Hospital Quality Alliance (HQA) and the nation’s hospitals have collaborated to create and publicly report hospital quality information. The information collected from more than 4, 500 hospitals in the United States measures how well each hospital cares for its patients.
According to CMS, hospitals, doctors, scientists, and other healthcare professionals agree that the quality measures being tracked in this program give a good snapshot of the quality of care that hospitals give.
As part of the data collection process, CMS and the HQA created a patient questionnaire that, essentially, asked patients to rate their care on a series of measures on a scale of 1 to 10, with 10 being the highest score.
We used that patient survey data to determine which orthopedic hospital patients liked the best. Table 3 gives the percentage of patients who rated a hospital at “9” or “10” overall.
Table 3: Orthopedic Hospitals Patients Like Best
| HHS Patient Surveys | ||
|
1 |
New England Baptist Hospital, Boston
83%
2
Hospital for Special Surgery, New York
78%
3
Texas Orthopedic Hospital, Houston
78%
4
Massachusetts General Hospital, Boston
77%
5
Brigham and Women’s Hospital, Boston
76%
6
Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
76%
7
St. Joseph Hospital, Orange, California
76%
8
John Muir Medical Center, Walnut Creek, California
76%
9
Central DuPage Hospital, Winfield, Illinois
75%
10
Poudre Valley Hospital, Fort Collins, Colorado
75%
11
Mayo Clinic, Rochester, Minnesota
74%
Source: HHS Patient Survey Data
Mortality:
CMS, in an effort to land on one statistic that would measure hospital performance, came up with mortality statistics. In terms of orthopedics, that is probably not the most powerful statistic. In fact, as Table 4 illustrates, the likelihood that a patient will die as a result of orthopedic surgery is extremely low. In many ways, for the purposes of these rankings, HSS has an inherent advantage over such multi-service hospitals as the Mayo Clinic or Mass General or Cleveland Clinic.
Table 4: Orthopedic Surgery
|
Mortality Index |
1
Hospital for Special Surgery, New York
0.11
2
New England Baptist Hospital, Boston
0.26
3
Bon Secours Cottage Health Services, Grosse Pointe, Michigan
0.28
4
Pennsylvania Hospital, Philadelphia
0.31
5
Methodist Hospital, Houston
0.39
6
Rush University Medical Center, Chicago
0.40
7
Texas Orthopedic Hospital, Houston
0.40
8
Tampa General Hospital
0.41
9
Union Memorial Hospital, Baltimore
0.42
10
Long Beach Memorial Medical Center, Long Beach, California
0.43
Source: CMS
Factors that determined the Orthopedics This Week composite rankings:
We considered many of the factors included in the U.S. News and World Report (USN&WR) rankings but added the HHS patient survey and the Leapfrog Group’s ratings, then excluded three of the USN&WR rankings (discharges, nurse magnet hospital, and existence of a trauma center).
So the eight factors we used to determine the relative attractiveness of orthopedic hospitals in the United States were:
- Reputation
- Mortality Index
- Patient Safety Index
- Nurse Staffing
- Key Technologies
- Patient Services
- Leapfrog Ranking
- HHS Patient Survey
Table 5: The Top 50 Orthopedic Hospitals in America
|
Total Score |
1
Hospital for Special Surgery, New York, New York
63.5
2
Mayo Clinic, Rochester, Minnesota
61.4
3
Massachusetts General Hospital, Boston, Massachusetts
48.6
4
Cleveland Clinic, Ohio
41.1
5
Johns Hopkins Hospital, Baltimore, Maryland
32.2
6
Duke University Medical Center, Durham, North Carolina
31.8
7
New York-Presbyterian University Hosp of Columbia and Cornell
29.6
8
NYU Hospital for Joint Diseases, New York, New York
28.2
9
UPMC University of Pittsburgh Medical Center, Pennsylvania
27.5
10
Barnes Jewish Hospital / Washington University, St. Louis, Missouri
27.1
11
Ronald Reagan UCLA Medical Center, Los Angeles, California
26.7
12
University of Iowa Hospitals, Iowa City, Iowa
26.5
13
Brigham and Women’s Hospital, Boston, Massachusetts
25.6
14
University of California, San Francisco Medical Center, California
25.2
15
Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
25.1
16
Rush University Medical Center, Chicago, Illinois
24.4
17
University of Washington Medical Center, Seattle
24.4
18
New England Baptist Hospital, Boston
24.1
18
University of Michigan Hospitals and Health Center, Ann Arbor, Michigan
24.1
20
Hospital of the University of Pennsylvania
23.7
21
Harborview Medical Center, Seattle
23.4
22
Ohio State University Hospital, Columbus, Ohio
23.1
22
Union Memorial Hospital, Baltimore, Maryland
23.1
24
Central DuPage Hospital, Winfield, Illinois
22.4
25
University Hospitals Case Medical Center, Cleveland, Ohio
22.2
26
Mount Sinai Medical Center, New York, New York
21.8
27
Holy Cross Hospital, Fort Lauderdale, Florida
21.4
27
Hackensack University Medical Center, New Jersey
21.4
29
Northwestern Memorial Hospital, Chicago, Illinois
21.3
29
Pennsylvania Hospital, Philadelphia, Pennsylvania
21.3
31
Dartmouth-Hitchcock Medical Center, Leganon, New Hampshire
20.9
32
Cedars-Sinai medical Center, Los Angeles, California
20.7
33
Texas Orthopedic Hospital, Houston, Texas
20.6
34
Stanford Hospital and Clinics, Stanford, California
20.4
35
Grant Medical Center – OhioHealth, Columbus, Ohio
20.1
36
Methodist Hospital, Houston, Texas
19.7
36
Abbott Northwestern Hospital, Minnesota
19.7
38
Christ Hospital, Cincinnati, Ohio
19.1
38
Clarian Health, Indianapolis, Indiana
19.1
40
St. Joseph Hospital, Orange, California
19.0
40
Sentara Leigh Hospital, Norfolk, Virginia
19.0
40
Poudre Valley Hospital, Fort Collins, Colorado
19.0
43
Good Samaritan Hospital, Baltimore, Maryland
18.8
44
Virginia Commonwealth University Health System, Richmond, Virginia
18.6
44
Beaumont Hospital, Royal Oak, Michigan
18.6
46
Greenville Memorial Hospital, Greenville, South Carolina
18.5
47
Long Beach Memorial Medical Center, Long Beach, California
18.4
48
John Muir Medical Center, Walnut Creek, California
18.1
49
Tampa General Hospital, Tanpa, Florida
16.6
50
Bon Secours Cottage Health Services, Grosse Pointe, Michigan
12.0
Source: Orthopedics This Week composite ranking
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Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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