The Best Orthopedic Hospitals in America

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.

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

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

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

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

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:

1. Reputation
2. Mortality Index
3. Patient Safety Index
4. Nurse Staffing
5. Key Technologies
6. Patient Services
7. Leapfrog Ranking
8. HHS Patient Survey

Table 5: The Top 50 Orthopedic Hospitals in America

Source: Orthopedics This Week composite ranking