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In a first, Healthgrades releases rankings on outpatient joint replacement


Most hospitals fared well, but there was a wide range in performance and risk of complications. Brad Bowman, chief medical officer of Healthgrades, talks about the inaugural report card.

After focusing on doctors and hospitals treating patients who have been admitted, Healthgrades is now taking a look at outpatient procedures.

Healthgrades has released its inaugural report card on how hospitals fared in knee and joint replacements on an outpatient basis. (Image credit: ©Issara - stock.adobe.com)

Healthgrades has released its inaugural report card on how hospitals fared in knee and joint replacements on an outpatient basis. (Image credit: ©Issara - stock.adobe.com)

Healthgrades released its inaugural Outpatient Joint Replacement Award and Ratings Tuesday. The group has published well-known ratings examining the performance of physicians and hospitals, and now it is analyzing common outpatient procedures.

The organization has released ratings and awards for hip replacement, knee replacement, and a “Joint Replacement Specialty Excellence Award.”

Brad Bowman, chief medical officer of Healthgrades, tells Chief Healthcare Executive®, “You have to go where the action is.”

“A lot of healthcare is shifting to outpatient, both procedures and treatments,” Bowman said.

About 500,000 Medicare patients underwent hip or knee replacements on an outpatient basis between 2019 and 2021, the company notes.

Here’s a quick look at the number of health systems earning top marks in outpatient procedures. (The full rankings can be found here.)

  • Knee replacement: Healthgrades awarded five-star ratings to 146 hospitals.
  • Hip replacement: 78 hospitals received five-star ratings.
  • Joint Replacement Specialty Excellence: Heatlhgrades gave this honor to 112 hospitals who excelled at both knee and hip replacements.

In an interview with Chief Healthcare Executive, Bowman talks about the challenges of ranking outpatient procedures, the benefits for consumers and hospitals, and some key takeaways from the study. (See part of our conversation in this video. The story continues below.)

‘Good peace of mind’

Healthgrades looked at complications involving outpatient knee and hip replacements among Medicare recipients. While Bowman said most hospitals had a small number of complications, there was substantial difference in the performance of some facilities.

If all hospitals performed as well as those with five-stars in outpatient knee and hip replacements, over 10,000 complications could have been avoided, according to Healthgrades.

Patients who had a knee replacement at a five-star hospital had a nearly 85% lower risk of having one or more complications than a patient at a one-star facility. Similarly, patients who had a hip replacement performed at a five-star facility were 76% less likely to have a complication than an individual at a facility that had a one-star ranking, Healthgrades says.

“Fortunately, the complication rates for most of these things are very small,” Bowman says. “However, the difference between a top-performing (hospital) versus even just an average (facility) is about a 50% lower complication rate.

“And if you're looking at the better hospitals to the worst hospitals, it’s closer to 70% or 80%,” he continues. “And anything that you can do to stack the odds, reduce your complication by 50% to 70%, even if it's a small number to start with, I think it's just good peace of mind.”

Bowman says he hopes the rankings of outpatient facilities drive people to do a little more homework before undergoing procedures, or at least “half as much time as you would spend researching your refrigerator.”

“I say that as kind of a joke, because still, to this day, consumers spend way more time researching consumer appliances than they do on where they're going to have their next surgery,” Bowman says. “And it makes like, absolutely no sense other than I just think that there may not be general awareness that this information is available, and it's really easy to access.”

Repetition matters

Since this is Healthgrades’ first attempt at ranking the performance of outpatient procedures, Bowman cautioned against drawing too many conclusions.

But he said in the analysis, hospitals and facilities that scored higher marks on knee or hip replacements typically did them much more often than some of their peers.

“You just always want to have the odds in your favor and you want to just go to places that consistently perform well,” Bowman says. “One of the things we found with providers is that experience matters.”

With experience, Bowman says he isn’t referring to training or education. He says hospitals who performed knee and hip replacements more often typically witnessed fewer complications.

“Once you start doing a medical procedure, the more you do generally, the better results you get,” he says.

“It's fairly striking,” he says, “The places that are doing the most of these …. tend to have lower complication rates.”

While most hospitals did well in general, Bowman suspects that’s because they are choosing patients that are healthier to handle on an outpatient basis.

“I think that's probably a function of patient selection,” Bowman says. “Generally, you're going to do your younger, healthier patients in this kind of outpatient setting.

“And so I think in some ways, you expect the complication rates are probably going to be lower because you're operating on healthier patients, whereas the ones that maybe have like heart disease, or breathing problems and stuff like that, those are going to be the ones you're probably going to want to do inpatient, where you just have more resources and support.”

‘Ridiculously hard’

When Healthgrades first decided to evaluate performance in outpatient procedures, Bowman says he expected some challenges.

But the task ended up being more daunting than he anticipated.

“It turned out to be ridiculously hard,” he says.

When Healthgrades typically examines hospitals and their performance, it involves patients who have been in the facility for a certain amount of time and it’s easier to track the complications.

It’s trickier when the patient is in the facility for just a few hours, he says.

“It was a lot of work,” Bowman says. “But it was really exciting, because we actually made a new methodology. And we were able to still stick to just measurable, objective, clinical outcome findings, while looking at these outpatient facilities.”

Bowman says he hopes the rankings are useful to consumers, and that high-performing hospitals can have another tool to market their services.

Eventually, Bowman says Healthgrade plans to look at the performance of ambulatory surgical centers, but that will take some time.

“This was like our baby step to ambulatory surgery centers, which is kind of our next target,” Bowman says. “But we needed to solve this nut first.”

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