Quality and Safety

Hospital for Special Surgery Response to Consumer Reports

Important Considerations When Reviewing the Consumer Reports 2013 Surgical Ratings

We were surprised by the Consumer Reports (CR) rating assigned to Hospital for Special Surgery (HSS) for hip and knee replacements, because it is not consistent with our strong track record of patient safety. In fact, the conclusions drawn in the report are contrary to the widespread recognition we have earned by providing exceptional care - No. 1 ranking in orthopedics by U.S.News & World Report 2013-14, top scores from the Centers for Medicare & Medicaid Services, the Agency for Healthcare Research and Quality, and the New York State Department of Health, among others.

At HSS, we base our decisions on evidence. To gain a better understanding of CR’s uncharacteristic findings, we conducted our own analysis. After careful evaluation of the available information by our own statistical team, it is clear to us that the methodology fails to take into account the complexity of measuring hospital performance and, in particular, as it relates to the patients in which we specialize. Our analysis shows that the CR rating methodology has a disproportionate negative impact on a specialty hospital like HSS.

Our primary concern is that prolonged length of stay (LOS) is inappropriately used as a surrogate measure of safety. The methodology used by CR is based on the assumption that a patient with a longer-than-expected LOS must have experienced a post-operative complication. Therefore, the report makes the leap that prolonged LOS is automatically a negative result. At HSS, we discharge patients when they are ready to return home safely, not when a statistical model tells us to do so. The CR model did not take into account many of the varied reasons HSS patients may stay in the hospital longer, which include:

  • Surgical Complexity - As the premier orthopedic referral hospital in the U.S., we perform hip and knee replacements on patients with complex surgical diagnoses – patients other hospitals have refused to treat. These patients typically require longer stays in the hospital.
  • Bilateral Surgery - We perform more bilateral hip and knee replacements than any other hospital in the country. While having both knees or hips replaced during the same hospitalization prolongs LOS, it also saves patients an extra hospitalization and anesthesia session.
  • Rehabilitation - We discharge more patients to their homes than to in-patient rehabilitation centers. We believe discharging to home is safer for our patients, although it may require a longer stay at HSS.
  • Referral Center - As a Center of Excellence, 75% of our hip and knee replacement patients come from outside our local area. For other hospitals in Manhattan, just 15% of hip and knee patients come from outside the local area. As you can imagine, it is more difficult logistically to discharge someone from the hospital who doesn't live in the area.

Consumer Reports considered none of these factors when rating hospitals. As a result, our surgical safety scores did not reflect the quality of care we deliver. The reality is that HSS delivers extremely high quality, individualized care to a complex and diverse patient population. We have very specific safety criteria and hundreds of quality indicators for surgeries we perform based on experience and long-term outcomes data, which we use to determine when patients can leave the hospital and return home safely. Based on almost any criteria, HSS represents an exceptional hospital for the safe delivery of orthopedic care.

If you want to learn more about HSS see www.hss.edu/quality for our quality and safety data or if you have any questions, please email us at pr@hss.edu or www.hss.edu/contact.

Download HSS Response to Consumer Reports pdf.