Around a million people get hip or knee replacements a year, and those operations cost Medicare and private insurers a lot of money. For the first time, the federal government is evaluating how good a job individual hospitals are doing.
Medicare has identified 95 hospitals where elderly patients were more likely to suffer significant setbacks and another 97 hospitals where patients tended to have the smoothest recoveries. (It's a long list that you can sift through here.)
The analysis is the latest part of the government's push to improve quality at the nation's hospitals instead of simply paying Medicare patients' bills.
Medicare already assesses hospital death rates, how consistently hospitals follow basic medical guidelines and how patients rate their stays. The evaluation of hip and knee surgery results is significant because for the first time, Medicare is rating hospitals' performance on two common elective procedures.
Of the 95 hospitals where knee and hip surgery patients experienced difficulties after the operation, nine were rated as having both high readmissions and high complication rates. Those hospitals were:
Some of those hospitals complained Monday that Medicare's assessments were outdated since they covered operations between July 2009 through June 2012, and said they have since improved. A spokeswoman for Southside Regional Medical Center said that the hospital adopted a new treatment model in 2012 for joint and spine patients and that their outcomes have "drastically improved."
Out of the 97 hospitals that did better than average in avoiding either readmissions or complications, 25 were rated as being better at both measures. The assessments for all hospitals is published here.
Hospitals may soon feel a financial pinch from the evaluations. Medicare plans to add hip and knee readmission rates to the criteria it uses when deciding whether to penalize hospitals each year.
Many patients needing joint replacements want to know a hospital's record when choosing where to have the procedure done. This isn't the case for conditions Medicare has evaluated previously, such as heart attacks. Still the ratings may be of limited use, as Medicare categorized 19 out of 20 hospitals as average.
Medicare evaluated how often the patients ended up being readmitted to the hospital within 30 days of discharge. It also assessed how often a hospital's patients suffered one of eight complications after the operation, including a blood clot, mechanical complication from the implant or death.
The quality of joint implants has been under scrutiny for several years. Some of the surgical devices have been plagued by quality problems, especially among artificial hips made of interlocking metal parts.
Dr. Eric Coleman, an expert on readmissions at the University of Colorado Anschutz Medical Campus, said some hospitals are trying to prevent joint replacement patients from returning by educating them ahead of the surgeries about how to take care of themselves and warning signs of problems. This approach provides "a chance to walk you through what to expect, what your family would expect, how to arrange your home," Coleman said. "In most of the cases of readmission reductions, we're still very reactive."
KHN reporters Ankita Rao and Marissa Evans contributed to this story.