Outpatient Specialty Excellence Awards Methodology

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TABLE OF CONTENTS

  • Performance Measurement: Ratings & Awards
  • Complications-Based Procedures & Conditions
  • Using Ratings to Communicate Performance
  • Using Awards to Communicate Performance
  • Outpatient Specialty Excellence Awards
  • Specialty Excellence Awards
  • Outpatient Specialty Excellence Award Determination
  • America's 50 Best Hospitals for Specialty Care
  • Outpatient Specialty Award Categories & Requirements
  • Outpatient Joint Replacement
  • Outpatient Orthopedic Surgery

Performance Measurement: Ratings & Awards

To help consumers evaluate and compare hospital performance specific to specialty areas, Healthgrades communicates performance in two ways—through ratings and awards.

To measure outpatient performance, Healthgrades used Medicare outpatient and inpatient data from the Standard Analytics Files (SAF) purchased from the Centers for Medicare and Medicaid Services (CMS) for years 2020 through 2022.

Patient outcomes data for four outpatient procedures were analyzed (see list below) for virtually every hospital in the country.

Complications-Based Procedures & Conditions

Outpatient Back and Neck Surgery (Without Spinal Fusion)Outpatient Total Hip Replacement
Outpatient Rotator Cuff SurgeryOutpatient Total Knee Replacement

Using 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 including risk factors, and multivariate logistic regression model details, see Healthgrades' patent-pending Outpatient Complications Outcomes 2024 Methodology.

The purpose of risk adjustment is to obtain fair statistical comparisons of 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 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 patient deaths or patients with 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 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.

Using Awards to Communicate Performance

The second way Healthgrades communicates hospital performance is through awards. Awards determine and communicate a hospital’s superior performance when compared to other eligible hospitals.

Each award has eligibility requirements specific to the nature and intent of the award. All awards require that a hospital receive a rating in the cohort(s) included in the determination of the award. Awards may reference a singular cohort or require the combination of a grouping of cohorts. Specific information on the cohorts included is outlined in the Specialty Award Categories and Requirements section.

Outpatient Specialty Excellence Awards & America's Best for Specialty Care

Two Healthgrades awards recognize hospitals for superior performance in outpatient care:

  • Healthgrades Outpatient Specialty Excellence Awards
  • America's 50 Best Hospitals for Specialty Care

Outpatient Specialty Excellence Awards

The Healthgrades Outpatient Specialty Excellence Awards recognize hospitals for superior performance in two specialty areas. Healthgrades 2024 Outpatient Specialty Excellence Awards include:

  • Outpatient Joint Replacement Excellence Award™
  • Outpatient Orthopedic Surgery Excellence Award™

Outpatient Specialty Excellence Award Determination

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 the Specialty Award Categories and Requirements section for a list for each award.

The top 5% or 10% of hospitals within each specialty area are recognized as Healthgrades Outpatient Specialty Excellence Award™ recipients, as measured by best combined risk-adjusted complication z-scores.

America's 50 Best Hospitals for Specialty Care™

From the lists of Outpatient Specialty Excellence Award recipients, Healthgrades identified the top 50 hospitals for two specialty care areas based on overall z-scores:

  • Outpatient Joint Replacement
  • Outpatient Orthopedic Surgery

Outpatient Specialty Excellence Award Categories & Requirements

The following section provides a list of conditions, procedures and analyses that are included for each Outpatient Specialty Excellence Award.

Outpatient Joint Replacement

The Outpatient Joint Replacement Excellence Award recognizes hospitals with superior clinical outcomes in outpatient knee and outpatient hip replacement.

The Outpatient Joint Replacement Excellence Award is based on:

  • Outpatient Total Hip Replacement
  • Outpatient Total Knee Replacement

To be considered for an award in outpatient joint replacement, a hospital must be evaluated and categorized into one of three performance categories for both outpatient total knee replacement and outpatient hip replacement. We evaluate both procedures based on our patent-pending Outpatient Complications Outcomes Methodology. For the outpatient cohort ratings, the clinical outcome evaluated was the occurrence of one or more complications during the outpatient visit, or in any subsequent inpatient or outpatient encounter with an unplanned adverse event up to one year after the initial procedure, as defined by clinical and coding experts. The Outpatient Joint Replacement Excellence Award is based on a volume-weighted average of the z-scores for these procedures.

Outpatient Orthopedic Surgery

The Outpatient Orthopedic Surgery Excellence Award recognizes hospitals with superior clinical outcomes in outpatient hip replacement, outpatient knee replacement, outpatient back and neck surgery (without spinal fusion), and outpatient rotator cuff surgery.

The Outpatient Orthopedic Surgery Excellence Award is based on:

To be considered for an award in outpatient orthopedic surgery, a hospital must be evaluated and categorized into one of three performance categories for at least three of the four procedures listed above. We evaluate the procedures based on our patent-pending Outpatient Complications Outcomes Methodology. For the outpatient cohort ratings, the clinical outcome evaluated was the occurrence of one or more complications during the outpatient visit, or in any subsequent inpatient or outpatient encounter with an unplanned adverse event up to one year after the initial procedure, as defined by clinical and coding experts. The Outpatient Orthopedic Surgery Excellence Award is based on a volume-weighted average of the z-scores for these procedures.

Click here to download a PDF version of the complete Outpatient Specialty Awards 2024 Methodology.

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