2022 Spine Surgery State Ranking Award Recipients & Methodology
- Performance Measurement
- Using Star Ratings to Communicate Performance
- Using State Rankings to Communicate Performance
- State Ranking Determination & State Eligibility Requirements
- 2022 Spine Surgery Award Recipients
- New York
- State Ranking Categories and Requirements
- Spine Surgery
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 8 key specialty areas for 2022: Joint Replacement, Spine Surgery, Cardiac Surgery, Coronary Interventional Procedures, Stroke Care, Critical Care, Pulmonary Care, and Prostate Surgery. This analysis, rooted in clinical performance, builds on the 2022 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 2018 through 2020.
Patient outcomes data for 16 conditions or procedures were analyzed (see list below) for virtually every hospital in the country. Hospital performance in these 16 conditions 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
|Chronic Obstructive Pulmonary Disease (COPD)||Pneumonia|
|Coronary Artery Bypass Graft (CABG) Surgery||Respiratory Failure|
|Coronary Interventional Procedures||Sepsis|
In-Hospital Complications-Based Procedures & Conditions
|Total Hip Replacement||Back and Neck Surgeries (Without Spinal Fusion)|
|Prostate Removal Surgery||Spinal Fusion|
|Diabetic Emergencies||Total Knee Replacement|
|Transurethral 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 2022 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:
- 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.
- The hospital predicted value is compared with the actual or observed value (e.g., actual number of deaths or complications at each hospital).
- 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.
- 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 2022 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 2022, 4 states met the eligibility requirements for state rankings in Spine Surgery. The 4 states evaluated were:
#1 Los Robles Regional Medical Center (Thousand Oaks)
#2 Kaiser Permanente San Jose Medical Center (San Jose)
#3 Saint Agnes Medical Center (Fresno)
#4 Sutter Medical Center - Ose Adams Medical Pavilion (Sacramento)
#5 Palomar Medical Center Escondido (Escondido)
#1 Ascension St. Vincent's Southside Hospital (Jacksonville)
#2 Ocala Regional Medical Center (Ocala)
#3 Doctors Hospital Of Sarasota (Sarasota)
#4 Brandon Regional Hospital (Brandon)
#5 Adventhealth Ocala (Ocala)
#1 HSHS St. John's Hospital (Springfield)
#2 OSF Saint Anthony Medical Center (Rockford)
#3 Mercyhealth Javon Bea Hospital - Rockton (Rockford)
#1 Albany Medical Center Hospital (Albany)
#2 Hospital For Special Surgery (New York)
#3 Saint Peter's Hospital (Albany)
State Ranking Categories and Requirements
The Spine Surgery specialty award recognizes hospitals with superior clinical outcomes in back and neck surgeries and spinal fusion.
The Spine Surgery specialty award is based on:
- Back and Neck Surgeries (Without Spinal Fusion)
- Spinal Fusion
To be considered for an award in this specialty area, a hospital must be evaluated in both procedures based on MedPAR data. We evaluate both procedures based on in-hospital complications. The Spine Surgery award is the volume-weighted average of these z-scores for these procedures.