By Rick Sobey
Consumer Reports is sparking controversy in the Massachusetts medical community over the national magazine's first-of-its-kind surgical-care hospital ratings.
The September issue rates 2,463 U.S. hospitals on the results of five surgical procedures -- back, hip and knee replacement, angioplasty and carotid artery surgery -- and places some of the Bay State's most prestigious hospitals at or near the bottom. Lahey Clinic & Medical Center of Burlington and Boston's Mass. General Hospital and Brigham & Women's Hospital received CR's lowest overall rating, scoring 1 point on a 1-to-5-scale.
Several area community hospitals fared better while receiving an "average" grade of 3 points. They are Lowell General Hospital, Emerson Hospital in Concord, HealthAlliance Hospital in Leominster, and Heywood Hospital in Gardner.
Lawrence General Hospital received a below-average rating of 2. Nashoba Valley Medical Center of Ayer was not rated.
The area's highest-rated hospital for overall surgical care, according to the CR analysis, was Holy Family of Methuen with an overall score of 4.
CR officials said a key evaluation factor was the percentage of patients who died in the hospital or stayed longer than expected for surgery. The analysis was conducted by Michael Pine and Associates of Chicago, a health-care consulting firm, which reviewed hospital claims submitted to Medicare from 2009-2011.
"There's a fair amount of variation here -- it does matter where you go for surgery," said Doris Peter, associate director for CR's Health Ratings Center. "Consumers don't know how to select a hospital because they don't know which hospitals are doing the best job, but this makes it transparent."
But medical experts questioned whether CR's 5-point rating does justice to a complex system of care.
Catherine Bromberg of the Massachusetts Hospital Association said the Consumer Reports' ratings are an "oversimplification of this extremely complex and important subject." She said the public would be better served if CR joins other groups to develop a common national framework.
"Until this happens, the conflicting and confusing messages sent to the public by numerous sources will continue to be a barrier to truly informing and engaging healthcare consumers," Bromberg said.
Peter, however, defended the CR process. She said the consultants estimated mortality rates and post-surgery complications based on prediction models for surgeries and specific patients. Consumer Reports then divided the observed number of complications by the prediction number to arrive at hospital ratings.
She noted that the state's four lowest-rated hospitals, which also included Southcoast Hospitals Group in Fall River, had the highest rate of mortality and infections, heart attacks, strokes, or other complications after surgery. Overall, in all five surgery categories, Lahey Clinic had 24 percent more adverse events than predicted, according to the CR report.
According to Peter, Lahey's hip-replacement surgery had 119 percent more adverse events than the predicted model; its knee-replacement surgery had 65 percent more than predicted.
However, Carol Kerbaugh, a Lahey Clinic spokesperson, issued a statement to The Sun of Lowell taking issue with CR's findings.
"These particular ratings are inconsistent with a broad array of extensive metrics that we look at on a regular basis when evaluating our own performance," wrote Kerbaugh.
She noted that the National Surgical Quality Improvement Project -- the clinical-quality database for the American College of Surgeons -- "demonstrates excellent results for Lahey Hospital and Medical Center over the past six years."
Erin Donovan, director of quality for Lowell General Hospital, also cited the National Surgical Quality Improvement Project, which provides valuable information that helps compare surgery results at hospitals across the country.
"This approach helps us continue to reinforce our team's good work and focus on areas needing improvement," Donovan said.
Amanda MacFadgen, director of public relations at Gardner's Heywood Hospital, said CR's data is two to four years old, and "things have changed over the years." She said it's difficult to paint a "black-and-white scenario" to compare hospitals because there are variables among patients, including how sick they are at the start of surgery.
While CR admits that the surgery ratings are only one indication of a hospital's performance, the researchers said its ratings offer vital information to patients and hospitals.
"We wish we had access to more comprehensive, standardized information, but this is the best that is available," said John Santa, medical director of Consumer Reports Health. "We hope that by highlighting performance differences, we can motivate hospitals to improve."