CMS Picks “Good” and “Bad” Hospitals for Joint Surgery

Medicare (CMS) is using the outcomes of hip and knee replacement surgeries to measure the effectiveness of U.S. hospitals. The agency has identified 95 hospitals where elderly patients are more likely to experience significant setbacks in their recovery and 97 “good” hospitals—meaning that they have a higher recovery rate.

The analysis and reporting is the latest effort on the part of the government to bring about improvement in quality in hospitals. According to Jordan Rau, writing for Kaiser Health News, this is the first time Medicare has rated hospitals’ performance based on two common elective procedures: hip and knee joint replacements.

Medicare officials downgraded the 95 hospitals because knee and hip surgery patients experienced too many difficulties after their operations. They faulted nine hospitals for having both high readmissions and high complication rates.

In its evaluation of a hospital’s professional services and the care provided to hip and knee replacement patients Medicare is using two measures. They are (1) how often patients are readmitted to the hospital within 30 days of their initial discharge and (2) how often patients suffered from one or more of eight complications following their surgery. The complications include a heart attack, pneumonia, excess bleeding at the surgical site, a blood clot in the lung, and infections within 90 days of admission or death within 30 days of the surgery.

Since the fall of 2013 Medicare has been paying less to some hospitals for joint replacement surgeries because those institutions’ rebound rates were too high. Beginning in the fall of 2014, when joint replacement surgery will be factored into the penalty program, unless quality improves, hospitals could lose as much as 3% of Medicare payments for each patient stay, Rau estimates.