A family member recently required open heart surgery to correct a genetic abnormality. While his prognosis was good, the surgery was highly complex and came with the risk of complications. I offered to use Garner’s data to help my family member find the best provider to perform the surgery, but he declined because he was already receiving care at “the best hospital in town.”
We often hear our members, employers and their advisors equating brand-name with quality in health care. But does the data support this connection? We rolled up our sleeves and dug deep to find out. We used data from several sources1 to create an index of the top 25 brand-name hospitals in the country and looked at whether these hospitals actually produce better quality using our database of 320 million patients and Garner’s library of over 500 quality metrics.
We found that brand-name hospitals do in fact deliver higher-quality care than the national average, although patients who receive care at these hospitals don’t always get the best treatment. In fact, the worst-performing doctors at brand-name hospitals deliver much worse care than the national average. Furthermore, patients receiving care at a brand-name hospital outside the main campus actually receive no better care than average, despite these facilities having significantly higher costs.
The worst-performing quarter of doctors at brand-name hospitals deliver much worse care than the national average
The chart below summarizes our finding: Patients getting care at brand-name hospitals have 10% fewer sick days2 than those seeking care elsewhere. However, patients seeing the bottom quarter of doctors at these brand-name hospitals have 24% more sick days than average.
Here’s an example showing the complication rate after joint replacement in Los Angeles. We chose this example because Los Angeles has a combination of brand-name hospitals (e.g., UCLA and Cedar Sinai) and also many lesser-known hospitals. In the chart below, each bar represents a single doctor. As you can see, doctors at top-performing hospitals tend to have slightly lower complication rates, but there are still many doctors at brand-name institutions who underperform their local peers.
Brand-name hospitals on main campus vs. outside of main campus
A common trend in recent years has been for brand-name hospitals to acquire community facilities. As a result, many patients believe they are getting better care because they are going to a facility with a brand-name logo. Unfortunately, they aren't. In fact, patients who receive care at a brand-name hospital outside of the main campus receive only average care.
It’s important to note that “other locations” of brand-name hospitals represent some of the worst values in U.S. health care. Not only do these facilities deliver mediocre quality, their cost per procedure is 27% higher than other facilities in their local markets.
A more robust measure of quality
The many existing measures of hospital quality have generally fallen short on two key categories:
They rely entirely on Inpatient Medicare Fee-For-Service data.3
They rely on a very small number of metrics, mostly mortality and hospital readmission rates.
To arrive at our view of hospital performance, Garner has created a significantly more detailed view into hospital quality, and our hospital quality scores represent a meaningful step forward in both of these dimensions.
First, Garner’s dataset contains data for all patient types, including commercial, Medicaid, Medicare Advantage and other payers. This means we have nearly 10X more data than what is typically used for quality measures.
Second, Garner uses more than 500 quality metrics to understand provider performance. This includes standard measures (e.g., infection and readmission rates) and goes further to understand all aspects of performance (e.g., the accuracy of diagnostics, the appropriateness of care and long-term health outcomes).
The result is a much more robust measure of performance than what has been made available previously.
Interested in understanding which hospitals and doctors are the top performers in your geography? Request a customized quality report in your specific market.
1. U.S. News & World Report, Brand Finance and Fierce Healthcare
2. Sick days defined as the expected number of days a patient would be unable to work. This is based on each doctor’s performance on Garner’s library of quality metrics. Sick days are risk adjusted for patient population.
3. For example, rankings such as U.S. News and World Report, HealthGrades Hospital Rankings, Quantros and Medicare Hospital Compare and others use only the Medicare Limited Dataset containing only inpatient claims for Medicare fee-for-service patients.