Reputation vs Reality What Outcomes Data Reveals About America s Best Hospitals The Cleveland Clinic looms large in the American healthcare landscape. It s a renowned institution. Wealthy patients from all over the world travel to The Clinic for care. But 23 years ago, cardiologist and statistician Dr. Michael Pine proved that, in some cases, these patients might be better served elsewhere. Anthem, the insurance giant, hired him to conduct a 6-year study evaluating coronary units in hospitals across Ohio. His risk-adjusted, outcomes-based comparison was the first of its kind. It yielded some surprises. Judged by number of adverse events, the best place for heart surgery in Ohio was not, as many might expect, at the Cleveland Clinic. That title belonged instead to the humble St. Elizabeth's Medical Center, just across the Ohio River. How might surgical outcomes at other prestigious institutions look, if they were held to the same standard? Would Johns Hopkins results live up to its reputation? Should patients always make the pilgrimage to The Mayo Clinic? For almost two decades, these questions have been impossible to answer because hospitals were not keen to release outcomes data to researchers. But thanks to a 2013 Freedom of Information court order, MPIRICA Health was able to use Dr. Pine s methodology to explore if hospitals measure up to their reputations. And, unlike 23 years ago when Anthem s private database was used, MPIRICA has no restriction in publishing its research describing outcomes at hospitals across the nation. This report will use the MPIRICA Quality Score, developed by Dr. Pine and his team, to evaluate 10 highly reputable blue-chip hospitals - starting with The Cleveland Clinic. Rather than using a general ranking system, like the U.S. News & World Report, the Score will measure how surgeons perform on specific surgical procedures. The results show that a prestigious brand can t guarantee a smooth surgery. surgery quality scores 640 MPIRICA stands behind its data, and invites expert scrutiny. If you d like to review the Quality Score s technical white paper, please email quality@mpirica.com to request it. To calculate the Quality Score, MPIRICA analyzes millions of Medicare claims from 123,465 surgeons across the country. It adjusts outcomes for patient risk, and then it rates how these surgeons perform on a scale from 100 to 800, similar to a credit score. MPIRICA QUALITY SCORE SCALE 100-190 200-290 300-390 400-490 500-590 600-690 700-800 Below Average Outcomes Fair Outcomes Excellent Outcomes This scale gives patients, payers, and businesses an intuitive way to understand a hospital s outcomes. It ranges from 100-800 and is similar to a FICO score but for surgical procedures. MPIRICA Health Analytics, Inc. www.mpirica.com 2017 MPIRICA Health Analytics, Inc.
Finally, MPIRICA aggregates surgeon scores for each hospital. The result is a clear rating of the surgical outcomes that 4,914 hospitals deliver, across 864 procedures. Judging by reputation, patients might think that facilities like The Mayo Clinic or Johns Hopkins attract world-class surgical talent. They should have near-perfect 800 scores, across the board. But the data shows that s not the case. In fact, MPIRICA scores show that for certain procedures at these Top 10 Hospitals, reputation doesn t quite match up with reality. Patients would be better served visiting an alternative hospital nearby. MPIRICA's scoring methodology does not penalize providers for taking on higher-risk, sicker patients. See the Appendix at the end of the report for more info. NOT ALL HOSPITALS ARE BEST AT EVERYTHING Hospital Name Cedars-Sinai Medical Center Anorectal Surgery Aorta and Lower Limb Endovascular Surgery Aortic and Renal Vascular Surgery Breast Biopsy and Excision Cardiac Valve Surgery (Endovascular) Cardiac Valve Surgery (Open) Carotid Artery Surgery Cervical Spine Surgery with Fusion Coronary Artery Bypass Graft (CABG) Eye Surgery Foot and Toe Surgery Gallbladder Surgery Cervical Spine Surgery without Fusion Colorectal Surgery Hip Replacement Surgery Inguinal and Femoral Hernia Surgery Knee Replacement Surgery Lower Limb Vascular Surgery Non-cervical Spine Surgery with Fusion Pacemaker Percutaneous Coronary Intervention (PCI) Spinal Procedures Upper Extremity Orthopedics Ventral Hernia Surgery Cleveland Clinic Duke University Hospital Johns Hopkins Hospital Massachusetts General Hospital Mayo Clinic Hospital Rochester New York-Presbyterian Hospital Northwestern Memorial Hospital NYU Langone Medical Center UCSF Medical Center Excellent Fair Below Average No score A gray dot within the heat map indicates that either the facility does not perform any surgeries within the particular procedure category, or that the facility has insufficient Medicare volume to produce a score.the Johns Hopkins Hospital is missing scores for hip and knee replacement categories because the Johns Hopkins Department of Orthopaedic Surgery is located in their Bayview facility while the described outcomes are from their main facility. 2
CLEVELAND CLINIC CLEVELAND, OH Cleveland Clinic has a long history of leadership among American hospitals. Its main campus is one of the largest hospitals in the US 41 buildings on 160 acres. The Clinic, as it s known in the area, is internationally recognized for treatment of cardiovascular disease, and for innovation in technology and management. Some of their top MPIRICA Quality Scores include a 640 score for cardiac valve surgery, which is considered excellent, but for a knee replacement, data shows the Clinic is not the best choice. With an MPIRICA Quality Score of just 100, knee replacement outcomes from the Cleveland Clinic s main campus are at the bottom 1% of national performance. Euclid Hospital Euclid, OH 11 Miles from Cleveland Clinic Knee replacement patients in Cleveland may want to consider visiting Euclid Hospital, just an hour s drive away. MPIRICA scores their knee replacement outcomes at 750, which means this hospital scores better than 98% of all US hospitals. It s also one of the Cleveland Clinic s satellite locations. This makes Cleveland Clinic a very instructive example patients should take care to discern which campus, not just which hospital, has produced the best results historically. CEDARS-SINAI MEDICAL CENTER LOS ANGELES, CA The largest hospital in Los Angeles, Cedars-Sinai has been an LA fixture since 1902. It s a recognized national leader in cardiology - Cedars-Sinai heart surgeons perform nearly 100 transplants every year, more than anywhere else in the world. 100-190 Knee Replacement Scores within 50 miles of Los Angeles, CA 200-290 300-390 400-490 500-590 600-690 700-800 Below Average Outcomes Fair Outcomes Excellent Outcomes Cedars-Sinai receives several high marks from MPIRICA in areas such as pacemaker and heart bypass surgery, as well as an impressive 720 score for anorectal surgery. But results for one procedure fall well below that benchmark: knee replacements. Based on historical outcomes, Cedars-Sinai earned an MPIRICA Quality Score of 100 for knee replacement surgery, sitting alongside the Cleveland Clinic among the bottom 1% nationally. Hoag Orthopedic Institute Irvine, CA 57 Miles from Cedars-Sinai Medical Center Less than an hour from LA, patients can find some of the country s best knee replacement outcomes at Hoag Orthopedic Institute. Their knee replacement surgeries earn a 720 from MPIRICA, making this hospital one of 9 hospitals in the state of California with a score above 700 for knee replacement surgery. But if patients don t want to drive to Orange County, there are plenty of solid choices in the Los Angeles area, as the regional heat map shows, there are high quality scores for knee replacement surgery throughout the region. While Cedars-Sinai produces poor outcomes for knee replacements, the LA area has lots of hospitals where patients can find outstanding results. 3
NYU LANGONE MEDICAL CENTER NEW YORK, NY This Manhattan mainstay is affiliated with NYU Medical School, which has minted four recipients of the Nobel Prize for Medicine. Its largest campus overlooks the East River, and it received the Magnet Award for Excellence in Nursing an honor given to less than 6% of hospitals. They receive an impressive 790 MPIRICA Quality Score for their outcomes in spinal procedures as well as a 780 score in percutaneous coronary intervention (PCI) surgeries. Despite excellent results across many fields, MPIRICA found poor outcomes in a few procedures. NYU Langone Medical Center scored especially low for hip replacement surgery at only 120 placing them in the bottom 1% in the US. Riverview Medical Center Red Bank, NJ 53 Miles from NYU Langone Medical Center Patients can find much stronger hip replacement results across the New Jersey border. MPIRICA scores Riverview Medical Center s hip replacement outcomes an excellent 630. NEW YORK PRESBYTERIAN HOSPITAL NEW YORK, NY Founded in 1771 and with 2,478 beds, NY Presbyterian is both the oldest and largest hospital in the country. It s affiliated with not one, but two Ivy League Medical Schools: Columbia and Cornell. They receive especially high MPIRICA Quality Scores with cardiac valve surgery, inguinal and femoral hernia surgery, and percutaneous coronary intervention (PCI) surgeries. Payers: Share your provider network with us, and we ll give you a heatmap showing not only how each provider performs on procedurelevel quality but also how cost-efficient they are in delivering successful outcomes. Just send an email to quality@mpirica.com. But this prestigious institution produces poor outcomes for spinal surgeries, scoring in the bottom 7% of the US with a quality score of only 320. NYU Langone Medical Center New York, NY 10 Miles from New York Presbyterian While NYU Langone Medical Center scored poorly with hip replacements, the facility scored an outstanding 790 for spinal procedures, the highest score for spinal procedures in the state of New York another example of quality variance within a single organization. To control for risk, MPIRICA s physician-researchers created predictive models, using over 500 risk factors to assess patient populations. 4
JOHNS HOPKINS HOSPITAL BALTIMORE, MD It s one of the most important hospitals in the history of medicine. Since its founding in 1889, Johns Hopkins has made hallmark contributions to the industry. It s the birthplace of rounding, and of medical residency programs. Johns Hopkins researchers were also the first to identify the Polio virus. They have tremendous quality scores in breast biopsy and excision surgeries. Their renowned reputation makes Johns Hopkins poor performance on spinal procedures all the more surprising they earned a score of just 160. 40% 8% 52% Holy Cross Hospital Silver Spring, MD 35 Miles from Johns Hopkins Hospital Just 50 minutes away in Silver Spring, Holy Cross Hospital boasts a 730 score for spinal surgeries, which is one of only 34 hospitals in the US with a score above 720 for this procedure. Distribution of Spinal Procedures Quality Scores in Maryland. 8% poor, 52% fair, 40% excellent. Patient Reviews Aren't Reliable Of course it s important for hospitals to serve their patients, and leave them feeling satisfied. But subjective patient reviews are not a reliable guide to quality. Patients can be biased by factors that have no relationship to outcomes for example a hospital s parking situation can dramatically swing reviews on Google. DUKE UNIVERSITY HOSPITAL DURHAM, NC This academic hospital has a storied history of medical innovation. Duke built the nation s first brain tumor program, and introduced using UV light to fight staph infections in operating rooms. In anorectal surgery they have excellent outcomes, scoring an impressive 800 with MPIRICA. Despite its innovations, Duke University Hospital doesn t excel at everything. MPIRICA found Duke University Hospital scores a 160 for hip replacement outcomes. The Alternatives: Rex Hospital Raleigh, NC 22 Miles from Duke University Hospital Duke Regional Hospital Durham, NC 6.6 Miles from Duke University Hospital North Carolina patients have two better options nearby. Less than half an hour away, Rex Hospital in Raleigh scores 770 in hip replacements among the country s very best. Only 11 hospitals in the US score above 750 in hip replacement surgery. But Duke University proves that patients should note which campus has the best outcomes. Duke Regional Hospital, also in Durham, earned a superb 650 score for hip replacements. 5
NORTHWESTERN MEMORIAL HOSPITAL CHICAGO, IL Northwestern is an important hub for diabetes, neurology, and gastroenterology in the Midwest. The affiliated Feinberg School of Medicine has won three Nobel Prizes, and they score quite well in several surgical categories with MPIRICA. 100-190 Anorectal Surgery Scores within 50 miles of Chicago, IL 200-290 300-390 400-490 500-590 600-690 700-800 Below Average Outcomes Fair Outcomes Excellent Outcomes For one surgical niche, however, Chicagoans might consider going elsewhere. MPIRICA puts Northwestern s anorectal surgery outcomes at just 280 - the bottom 4%. Evanston Hospital Evanston, IL 14 Miles from Northwestern Memorial Hospital Chicago s northern suburb, Evanston, hosts Evanston Hospital, which holds an 800 score for anorectal surgeries. That s the highest score MPIRICA can give a rare and significant achievement. Only three hospitals in the nation have performed well enough to receive the top score for this surgical category. The Chicago suburbs offer some outstanding choices for anorectal procedures -- just a short drive out of the city-proper. MASSACHUSETTS GENERAL HOSPITAL BOSTON, MA Mass General is the third oldest hospital in the US, and it s affiliated with Harvard Medical School. It was the site of the first demonstration of anesthesia, and it has the largest hospital-based research program in the US, with a $750 million budget. Their outcomes for percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgeries score 640 which is considered excellent by MPIRICA. Strong as it is, Mass General underperforms in cardiac valve surgery. MPIRICA gives it only 310 for past outcomes. Brigham and Women s Hospital Boston, MA 3.8 Miles from Massachusetts General Hospital If patients need cardiac valve surgery, another Boston hospital has a much better track record. Brigham and Women s hospital scores 710. It is less than 15 minutes away and this hospital scores better than 99% of all US hospitals performing this surgical procedure. With the Quality Score, primary care physicians are able to refer patients with high confidence. They now have an objective way to assess the referred surgeon s outcomes. Learn more in the FAQ at the end of the report. 6
MAYO CLINIC HOSPITAL ROCHESTER ROCHESTER, MN Mayo has been a world famous name in healthcare for more than 100 years. Among many other innovations, Mayo doctors were the first to isolate cortisone, and to demonstrate a link between insulin and diabetes. Its outstanding quality of care continues to attract patients from all over the world. For one procedure, Mayo s Rochester facility doesn t live up to its reputation. MPIRICA gives The Mayo Clinic in Rochester just 320 for percutaneous coronary intervention (PCI) surgery outcomes. Abbott Northwestern Hospital Minneapolis, MN 82 Miles from Mayo Clinic Hospital Rochester A short drive to the Twin Cities will lead patients to a hospital that has shown stronger PCI outcomes. Abbott Northwestern Hospital in Minneapolis scored a 700. UCSF MEDICAL CENTER SAN FRANCISCO, CA The MPIRICA Methodology Whitepaper explains the Quality Score s technical details. Readers can request it from quality@mpirica.com This Bay Area hospital offers a broad range of expertise. Five UCSF faculty members have earned the Nobel Prize for important discoveries in cancer, neurodegenerative diseases, aging, and stem-cell research. For surgeries, the data bears out UCSF s reputation, across every procedure category in MPIRICA s rankings. UCSF has an impressively consistent suite of surgical services. There are no outlier procedures with sub-par outcomes. Its best outcomes are in colorectal surgery, with an MPIRICA score of 640, and pacemaker surgery, at 630. US Knee Replacement Distribution MPIRICA scores facilities and surgeons all over the United States. Currently, MPIRICA provides quality scores for over 2000 facilities on their outcomes in knee replacement procedures. 7
THE MESSAGE FOR PATIENTS, PAYERS, EMPLOYERS: LOOK AT THE DATA FIRST The ten highly reputable hospitals in this report were chosen because they consistently appear on Best lists for overall hospital performance or safety. It s important to remind patients that these prestigious hospitals have certainly earned their reputations. For overall care and in many specialties and procedures, they re among the best providers in the world. But, this report has demonstrated that even world-class facilities have their shortcomings. When payers and patients search for quality care, reputation should not be their first concern. Instead, they should ask: What does the data say about this provider? MPIRICA strives to be the easiest, most intuitive way to answer that question, when it comes to surgery. FIND QUALITY CARE, WHEREVER YOU ARE This report also showed that, where the big name hospitals fell short, a high-performing provider was never too far away. That s a remarkable feature of healthcare in the US the wide variety of providers in any given region. Whatever procedure a patient needs, they re likely to find a high-quality hospital or surgeon in their area, if they are armed with the right information. Patients can find great care anywhere if they know how to look. And MPIRICA wants to help them search. You can find more about the outcomes in your area, at mpirica.com. APPENDIX Payers can see how providers in their network perform. Another MPIRICA product, the Cost Efficiency Score, reveals surgeons who provide the best value. Q: Who is MPIRICA? In 2014, MPIRICA s founder and CEO Shakil Haroon had a sick family member living overseas, who needed advanced surgery. He wanted to find the best possible hospital for the procedure. An engineer by training, Shakil was most interested in data backing up hospital claims to offering best in class care. But that proved much more challenging than he thought. After several frustrating weeks of research, Shakil realized this shouldn t be so hard. That s how he got his vision for the MPIRICA Quality Score. Shakil wanted to give patients an easy, reliable way to find high-quality surgical care. So he assembled a founding team to empower patient choice, using the best research available. He sought out and engaged Michael Pine, MD, and his team of physicians and statistician, who had researched the same problem for nearly 30 years. A Harvard-trained cardiologist, Dr. Pine has published dozens of peer-reviewed articles on ways to assess healthcare quality. His work, stemming from decades of clinical data analysis with health systems and large insurance companies, forms the backbone of MPIRICA s outcomes-based, apples-to-apples comparison of providers at the surgical procedure level. 8
Q: Who can use the MPIRICA Quality Score? For patients who need surgery, the MPIRICA Quality Score can help them find the best provider. But businesses can use the Quality Score, too. Payers can see how providers within their network perform. Another MPIRICA product, the Cost Efficiency Score, reveals surgeons who provide the best value. Payers can use this information to negotiate compensation rates. Self-insured employers can use the quality score to point employees to the best surgeons leading to reduced costs, and less time lost to complications. With the Quality Score, primary care physicians will be able to refer patients with confidence. They will have a way to assess the referred surgeon s outcomes based on actual data. Q: How do you calculate the score? How does MPIRICA make sure provider ratings are fair? The MPIRICA Quality Score incorporates measures of quality that are most important to patients having surgery: mortality, major complications (exhibited by extensive and risk-adjusted lengths of stay), readmissions, and ER visits. The data is evaluated from the time patients are admitted through 90 days after they are discharged. These figures offer objective insight into a surgeon s performance. They re the best tools available to compare one provider s outcomes with another s. But, no two patients are alike. Every hospital serves unique populations. Self-insured employers can use the quality score to point employees to the best surgeons leading to reduced costs, and less time lost to complications. Sicker, frailer patients will be at greater risk for mortality, readmissions, or complications regardless of the surgeon s skill. A truly fair scoring system won t penalize surgeons for taking on risky patients. Nor will it artificially reward hospitals for working with an affluent, healthy population. To level the playing field, MPIRICA s physician-researchers created predictive risk models. They use over 500 risk factors to assess patient populations. These factors include broad demographic information like the patient s birthplace, age, and gender. But they also go deeper into lifestyle factors, past diagnoses, and previous interventions. MPIRICA uses these data points to compute predicted outcomes for each provider. Based on their patient mix, every hospital and every surgeon will have an expected number of mortalities, readmissions, and complications. The Quality Score rates providers based on how they perform against these predictions. That s how MPIRICA ensures that every hospital and every surgeon gets a fair rating. 9
Q: Why does MPIRICA use Medicare data? Does that mean your score only applies for older patients? MPIRICA uses data from the Center for Medicare and Medicaid Services (CMS) to inform the Quality Score. MPIRICA invites all hospitals and insurance companies to provide their own clinical or claims data to fill in any gaps that may be left by using CMS data. But until such a time of transparent accessibility, consider 1 CMS has the largest, broadest, most frequently used dataset available. The vast majority of hospitals in America participate in Medicare. That means CMS has more provider data than any other payer or agency in the country. It s national in scope, accepting claims from hundreds of thousands of surgeons. Working at this scale, it takes CMS two years to process and release the data. So the most recent available outcomes results are from 2015. But despite the lag-time, there s simply no comparable database in the US. 2 CMS s database is the most reliable in the country. Hospitals have strong financial incentives to give correct information to CMS. The data s audited regularly, and hospitals face stiff penalties if they miss the mark. This makes CMS data a much better choice than hospitals self-reported measures. 3 Surgeons who care well for Medicare patients tend to care well for all patients. MPIRICA s data rates outcomes for Medicare patients over 65. This cohort of older Americans has more and more complex health problems than other groups in the country. Any surgeon that performs well with older, sicker patients will likely have good results with younger patients, too. Q: Why doesn t MPIRICA take patient satisfaction into account? Of course it s important for hospitals to serve their patients, and leave them feeling satisfied. But subjective patient reviews are not a reliable guide to quality. Patients can be biased by factors that have no relationship to outcomes for example a hospital s parking situation can dramatically swing reviews on Google. Patient ratings data also has serious weaknesses. For one, patients who leave online reviews tend to have extreme positions. Patients who had a middling experience often don t bother. Most reviews are either one- or five-star, and that gives an incomplete picture of a provider s quality. Patient satisfaction surveys also suffer from a time-lag. HCAHPS, the CMS-administered patient survey, won t arrive in a patient s mailbox until 4-6 weeks after the care event. By then, patients could have forgotten important details about their treatment. Their recollection may not help future patients make care decisions. That s why MPIRICA uses outcomes-based measures. They re unbiased, and always relevant. Q: Can MPIRICA guarantee a safe outcome for a doctor or hospital with an 800 score? Every surgery comes with risks. Every procedure has a chance of failure. The unfortunate reality: no doctor, no facility, no company can guarantee a healthcare result. And no credible professional would ever try. But, with strong data and with smart analysis, MPIRICA can offer a reasonable evaluation of past performance to help make future decisions. For surgical procedures, past performance can be the best predictor of future performance. The MPIRICA Quality Score succinctly captures a hospital s or a surgeon s track record of success. So although MPIRICA can t guarantee it, a surgeon with an 800 score has the best odds of producing a desirable outcome. quality@mpirica.com www.mpirica.com