How does Healthcare Bluebook* assign physician and hospital quality rankings?
Healthcare Bluebook* physician and hospital quality rankings (for inpatient procedures) are built upon a patient outcomes-based framework. Healthcare Bluebook* quality rankings are calculated for each clinical area by assessing performance by the hospital or physician in several measures such as patient complications, patient safety, and unplanned re-admissions. A green, yellow and red color-coding system is used to determine quality rankings on inpatient procedures. A Green Check Plus indicates top 3rd of all hospitals, a Yellow Check indicates the middle 3rd, and Red-Check minus is the lowest performing 3rd of all hospitals.
Will every hospital and doctor have a quality ranking for every procedure?
No, Healthcare Bluebook* only provides quality rankings for most inpatient procedures. Any outpatient procedure or service will NOT have a quality ranking available, only a Fair Price*.
For inpatient procedures, Healthcare Bluebook* will only provide a ranking when the amount of information available is sufficient to accurately evaluate the hospital or doctor for that specific inpatient procedure.
Why does my doctor have different rankings for different procedures, or their overall score?
Healthcare Bluebook* evaluates doctor inpatient quality for specific, individual clinical categories (joint replacement, spinal fusion, etc.) and on an aggregate level (all surgeries). For each clinical category, such as joint replacement, Healthcare Bluebook* looks at the doctor’s patient outcomes for the specific procedures in that clinical category. Healthcare Bluebook* evaluates doctors by the individual clinical category so that patients can make more informed decisions about the care they need.
Physicians frequently perform many different procedures, but just like hospitals, the doctor’s patient outcomes may not be the same for each procedure. For example, an orthopedic surgeon may perform both spinal fusions and joint replacements, but their patient’s outcomes may be better for joint replacements.
Similarly, a doctor’s overall score may be different from their individual clinical category scores. The overall doctor scores are calculated independently from the individual clinical category scores, and are not an average of the individual clinical category rankings. For example, overall surgical scores are calculated across a broad range of surgeries performed by the doctor. As a result, an orthopedic surgeon might have a very high joint replacement score (excellent performance on joint replacement surgeries) but a low overall surgical score (poorer performance on general orthopedic surgeries).
Are there hospitals that excel at all things (“Centers of Excellence”)?
No, very few hospitals are good at all things. Some quality metrics (not Healthcare Bluebook*) use a single overall ranking for each hospital. However, this approach is not helpful to consumers because a single ranking can mask important differences in the level of quality between clinical areas at the hospital. For example, a hospital can be among the highest performing facilities in the US for heart surgery, yet the same hospital can also be among the poorest performing facilities for joint replacement. If you are a patient in need of a knee replacement, it is critical that you are able to assess the hospital’s performance specifically for the care you need, as opposed to an overall score across all clinical areas. The same can be said of physicians. Even if a hospital excels at some procedures, it is very likely that not all physicians who perform that service are equal.
What is the data source for the inpatient quality information?
The Fair Price* hospital and physician quality rankings (for inpatient procedures) use data from the CMS Standard Analytical File and commercial bills. Rankings are calculated for each clinical area by assessing performance by the hospital or physician in several areas: patient complications, mortality, and unplanned encounters.
Is the Healthcare Bluebook inpatient quality ranking a guarantee that I will have a positive outcome?
The inpatient quality rankings highlight which hospitals and/or physicians have historically demonstrated better patient outcomes for a particular service. The quality score is a reliability score relative to other hospitals/physicians in the US – it is not a guarantee, but it increases the likelihood of having high quality care for inpatient procedures.
Why aren’t you able to provide pricing for a procedure if you have enough information to provide a quality score or why don’t you have a quality score if you can provide pricing?
The data sources and analytics approaches for quality and price are different, and so is the amount of information available. We will only provide a ranking when the amount of information needed to accurately evaluate a provider meets our standards.