2023 Spine Surgery State Ranking Award Recipients & Methodology

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Click here for the full PDF of 2023 Spine Surgery State Ranking Award Recipients & Methodology

TABLE OF CONTENTS

Performance Measurement

To help consumers evaluate and compare local hospital performance specific to specialty service lines and specialty focus areas, Healthgrades analyzed and identified the top ranked hospitals in each state across 18 key specialty areas for 2023: Cardiac Care, Cardiac Surgery, Cardiology, Coronary Interventional Procedures, Cranial Neurosurgery, Critical Care, Gastrointestinal Care, Gastrointestinal Medical, Gastrointestinal Surgery, Joint Replacement, Neurosciences, Orthopedic Surgery, Prostate Surgery, Pulmonary Care, Spine Surgery, Stroke Care, Surgical Care, and Vascular Surgery. This analysis, rooted in clinical performance, builds on the 2023 Healthgrades Specialty Excellence Awards Methodology.

To measure performance, Healthgrades used Medicare inpatient data from the Medicare Provider Analysis and Review (MedPAR) file purchased from the Centers for Medicare and Medicaid Services (CMS) for years 2019 through 2021.

Patient outcomes data for 31 conditions or procedures were analyzed (see list below) for virtually every hospital in the country. Hospital performance in these 31conditions form the base of the final Specialty Excellence Award and State Ranking results (See Appendix 1: Specialty Award Categories and Requirements for a list for each area.)

Mortality-Based Procedures & Conditions

Bowel ObstructionPancreatitis
Chronic Obstructive Pulmonary Disease (COPD)Pneumonia
Colorectal SurgeriesPulmonary Embolism
Coronary Artery Bypass Graft (CABG) SurgeryRespiratory Failure
Coronary Interventional ProceduresSepsis
Cranial NeurosurgeryStroke
Gastrointestinal BleedUpper Gastrointestinal Surgery
Heart AttackValve Surgery
Heart Failure

In-Hospital Complications-Based Procedures & Conditions

Abdominal Aortic Aneurysm RepairTotal Hip Replacement
Back and Neck Surgeries (Without Spinal Fusion)Pacemaker Procedures
Carotid ProceduresPeripheral Vascular Bypass Graft
Defibrillator ProceduresProstate Removal Surgery
Diabetic EmergenciesSpinal Fusion
Gallbladder Removal SurgeryTotal Knee Replacement
Hip Fracture TreatmentTransurethral Prostate Resection Surgery

Using Star Ratings to Communicate Performance

The first and most fundamental way that Healthgrades communicates performance is through star ratings. Star ratings are an evaluation of the hospital’s actual performance as compared to the predicted performance for that hospital based on a specific risk-adjustment model applied to that hospital. For more details, see the Healthgrades Mortality and Complications Outcomes 2023 Methodology.

The purpose of risk adjustment is to obtain fair statistical comparisons of mortality and complication rates between hospitals while accounting for differences in underlying risk factors observed in the data among disparate populations or groups.

Significant differences in clinical and demographic risk factors are found among patients treated in different hospitals. Therefore, it is necessary to make accurate and valid comparisons of clinical outcomes with a methodology using risk-adjustment techniques. Risk factors may include age, sex, specific procedure performed, and comorbid conditions (e.g., hypertension, chronic heart failure, and diabetes).

Developing the Healthgrades hospital star performance categories involves four steps:

  1. The hospital predicted value (predicted number of deaths or complications at each hospital) is calculated by summing the individual patient record predicted values determined from logistic regression models discussed above. 
  2. The hospital predicted value is compared with the actual or observed value (e.g., actual number of deaths or complications at each hospital). 
  3. A test is conducted to determine whether the difference between the predicted and actual values was statistically significant. This test is performed to make sure that differences were very unlikely to be caused by chance alone. A z-score is used to establish a 90% confidence interval.
  4. Hospital performance categories are determined based upon the outcome of the test for statistical significance.

For each condition or procedure, hospital performance is evaluated and stratified into three categories:

★★★★★ Better Than Expected – Actual performance was better than predicted and the difference was statistically significant at alpha = 0.1.

★★★ As Expected – Actual performance was not statistically significantly different from what was predicted at alpha = 0.1.

Worse Than Expected – Actual performance was worse than predicted and the difference was statistically significant at alpha = 0.1.

Healthgrades uses z-scores (individual or aggregate) to determine performance. A z-score is a standardized statistical test that calculates the difference between the actual and predicted complication and mortality rates, taking into account patient variability and volume. A higher z-score means better performance.

A complete description of the methodology including risk factors, multivariate logistic regression model, and other relevant information is available in the Healthgrades Mortality and Complications Outcomes 2023 Methodology. A full list of ICD-10 codes used to define each model can be found in Healthgrades ICD-10 Mapping Tool at https://icd10mappingtool.healthgrades.com/.

Using State Rankings to Communicate Performance

Another way Healthgrades communicates information on hospital performance is with State Rankings and Specialty Excellence Awards, helping patients more easily identify top performers. Rankings and Awards determine and communicate a hospital’s superior performance when compared to other eligible hospitals.

Specifically for State Rankings, each Ranking has eligibility requirements specific to the nature and intent of the achievement and is aligned with requirements for Specialty Excellence Awards (See Appendix 1). State Rankings may reference a singular cohort (e.g. Stroke Care) or require the combination of a grouping of cohorts (e.g. Critical Care). Healthgrades will issue state rankings for the Top 3 or Top 5 performers, across 8 specialty areas, following the Ranking Determination & State Eligibility Requirements outlined below. Specific information regarding the cohorts included is outlined in the Specialty Award Categories and Requirements in Appendix 1.

State Ranking Determination & State Eligibility Requirements

For each hospital, Healthgrades assigns an overall score for each specialty area based on hospital performance as determined by a single z-score or average of volume-weighted z-scores when more than one condition or procedure is included in the award. (See Appendix 1: Specialty Award Categories and Requirements for a list for each award.) The strength of a hospital's single z-score or average of volume-weighted z-scores when more than one condition or procedure is included in the award, is a key driver in ranking determination. Additionally, hospital eligibility for State Ranking awards requires a hospital receive a rating in the cohort(s) included in the determination of the award, no 1-Star ratings in the cohort(s) included in the determination of the award, and at least one 5-Star rating in a cohort included in the determination of the award.

For a state to be eligible to have hospitals rankings, either in the Top 3 or Top 5, there need to be substantive count of hospitals eligible in each state for the individual award area. States with 6 or fewer hospitals that meet the requirements in an individual award area are NOT eligible for rankings in that area. When a state has between 7 and 10 eligible facilities (inclusive) for an individual award area, the top 3 facilities (ranked by z-score and following the Ranking Determination criteria) will be named the Top 3 Facilities (#1, #2, #3) in the state for that award area. When a state has 11 or more eligible facilities for an individual award area, the top 5 facilities (ranked by z-score and following the Ranking Determination criteria) will be named the Top 5 Facilities (#1, #2, #3, #4, #5) in the state for that award.

For 2023, five states met the eligibility requirements for state rankings in Spine Surgery. The five states evaluated were:

California
Colorado
Florida
New York
Texas

    2023 Spine Surgery Award Recipients

    California

    #1 Kaiser Permanente San Jose Medical Center (San Jose)

    #2 Kaiser Permanente Oakland Medical Center (Oakland)

    #3 Saint Agnes Medical Center (Fresno)

    #4 Sutter Medical Center - Ose Adams Medical Pavilion (Sacramento)

    #5 Palomar Medical Center Escondido (Escondido)

    Colorado

    #1 Presbyterian/St. Luke's Medical Center (Denver)

    #2 Medical Center of the Rockies (Loveland)

    #3 Penrose Hospital (Colorado Springs)

    Florida

    #1 HCA Florida Ocala Hospital (Ocala)

    #2 AdventHealth Orlando (Orlando)

    #3 HCA Florida JFK Hospital (Atlantis)

    #4 NCH Baker Downtown (Naples)

    #5 HCA Florida Fawcett Hospital (Port Charlotte)

    New York

    #1 Hospital for Special Surgery (New York)

    #2 Saint Peter's Hospital (Albany)

    #3 Albany Medical Center Hospital (Albany)

    Texas

    #1 St. David's Medical Center (Austin)

    #2 Valley Baptist Medical Center - Harlingen (Harlingen)

    #3 Medical City Fort Worth (Fort Worth)

    #4 St. Luke's Health - Lakeside Hospital (The Woodlands)

    #5 Houston Methodist West Hospital (Houston)

    State Ranking Categories and Requirements

    Spine Surgery

    The Spine Surgery Excellence Award recognizes hospitals with superior clinical outcomes in back and neck surgeries and spinal fusion.

    The Spine Surgery Excellence Award is based on:

    • Back and Neck Surgeries (Without Spinal Fusion)
    • Spinal Fusion

    To be considered for an award in spinal surgery, a hospital must be evaluated in both procedures based on MedPAR data. We evaluate both procedures based on in-hospital complications. The Spine Surgery Excellence Award is the volume-weighted average of these z-scores for these procedures.

    Click here for the full PDF of 2023 Spine Surgery State Ranking Award Recipients & Methodology

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