Purpose: Health plans are increasingly offering procedure-specific hospital designations (e.g., Centers-of-Excellence [COE]) to signify high quality care. Further, many self-insured employers are instituting benefit designs to incentivize employees to preferentially utilize these centers. Consumers often seek publicly available quality information when choosing a facility for elective surgical procedures. If these data conflict with COE designations, consumer confusion could increase. The purpose of this study is to evaluate the publicly reported quality metrics for facilities designated as COEs.
Methods: We evaluated two publicly-reported quality metrics from the healthcare.gov consumer website on patient satisfaction and surgical safety practices for COE-designated facilities for a self-insured employer for five elective surgical procedures (hip replacement, knee replacement, spinal fusion, disc surgery, and bariatric surgery). The patient satisfaction measure used was the percent of patients responding “would definitely recommend this hospital” on the 2011 Hospital Consumer Assessment of Healthcare Providers and Systems [HCAHPS] survey. We only included those facilities in the HCAHPS evaluation if at least 100 patients responded to the survey. The surgical safety measure was a weighted composite score from the 2011 Surgical Care Improvement Project [SCIP]. We only included those facilities in the SCIP composite measure evaluation if at least 30 patients provided data for at least 7 out of 9 measures.
Results: 3,089 facilities met inclusion criteria for the HCAHPS comparison. 25% of the COEs for all five procedures were in the 0-25th percentile of patient satisfaction (range: 8% for disc surgery to 50% for bariatric surgery). 4% of the COEs for all five procedures were in the 95th-100th percentile (range: 0% for bariatric surgery to 6% for disc surgery and hip replacement). 2,455 facilities met inclusion criteria for the SCIP composite score. 1% of disc surgery and spinal fusion COEs and 11% of bariatric surgery COEs were in the 0-5th percentile. None of the bariatric surgery COEs and 9% of spinal fusion COEs were above the 95th percentile.
Conclusions: Health plan COE designations are inconsistent with publicly reported quality metrics—with some COEs performing among the worst facilities in the US. To avoid consumer confusion, employers implementing COE programs should carefully communicate with their employees about how the COEs are selected and how best to incorporate COE designations and publicly reported quality metrics in their decision making.