Consider where you might practice and what the quality of care you are able to  provide,  given its resources and reputation.

Do you want to Practice in an arena where the competition is fierece and the resources abound ?

OR do you want to make a difference and operate where things are not yet perfect. Resources are not plentyful and opportunites are not so financially rewarding.

Healthgrades, a healthcare quality reporting group, today released a list of 262 hospitals that represent the nation's elite when it comes to risk-adjusted mortality and complication rates for 27 common procedures and conditions involving Medicare patients.

These hospitals, the top 5% of the nearly 4500 graded by the group, posted mortality rates for 18 procedures and conditions from 2009 through 2011 that were 30.9% lower than those for all the others. If the remaining 95% of the hospitals had performed just as well during this period, more than 164,000 Medicare patients might not have died, according to Healthgrades.

Some hospitals score high on patient safety in a few specialties, but the institutions that earned the group's Distinguished Hospitals Award for Clinical Excellence excel across the board

Healthgrades said in a news release.

The 18 procedures and conditions that formed the basis of the mortality rate score include abdominal aortic aneurysm repair, coronary angioplasty and stenting, sepsis, bowel obstruction, pneumonia, and neurosurgery. Healthgrades weighed complication rates for another 9 procedures such as hip replacement, back and neck surgery, and carotid surgery.

To be eligible for a Clinical Excellence award, a hospital must have been evaluated for its performance in at least 19 of the 27 procedures and conditions based on Medicare inpatient data in the Medicare Provider Analysis and Review database. Roughly 1500 hospitals made this initial cut.

Some States Lack a Clinical Excellence Hospital

The Clinical Excellence awards bestowed by Healthgrades are intended to help patients make an informed choice about where to get treated. "All hospitals are not created equal" is a Healthgrades mantra.

However, some patients who choose a Clinical Excellence hospital might have to drive out of state to get there because of the uneven distribution of these institutions. There are no award-winners in 8 states and the District of Columbia. In 6 other states, including populous Texas, the percentage of eligible hospitals with Clinical Excellence status is less than 10%.

Table 1. States With Low Rates of 2013 Clinical Excellence Hospitals

Source: Healthgrades.

Some states abound in Clinical Excellence hospitals. California has 44, roughly 32% of its eligible hospitals. Eight other states — Colorado, Delaware, Iowa, Michigan, Minnesota, Montana, New Hampshire, and South Dakota — meet or surpass the 30% threshold.

Table 2. States with High Rates of Clinical Excellence Hospitals

Source: Healthgrades.

Different Methodologies Yield Different Rankings

The Healthgrades list of 262 Clinical Excellence hospitals omits some well-known institutions that dominate other ratings. Massachusetts General Hospital in Boston and John Hopkins Hospital in Baltimore, Maryland, were first and second in the top 17 hospitals, as judged by US News & World Report last year. However, these 2 big names and 11 others on the magazine's list do not appear in the Healthgrades roll call.

In another example of contrary rankings, the University of California Ronald Reagan UCLA Medical Center in Los Angeles received a failing grade on patient safety last year from the Leapfrog Group, a quality-improvement organization, only to earn a Clinical Excellence award from Healthgrades this year.

Evan Marks, executive vice president for informatics and strategy at Healthgrades, chalks up these incongruities to differing methodologies for measuring quality.

"If you were to rate cars, some people might say, 'I like these cars better because they have more passenger room,' " Marks told Medscape Medical News. "Others might say, 'I like speed and acceleration.' "

Marks stressed that Healthgrades relies solely on objective clinical outcomes data, in contrast to the US News & World Report ranking, which factors in a hospital's reputation. Furthermore, Healthgrades confines itself to mortality and complication rates, whereas Leapfrog looks at a far broader array of safety measures. That difference would explain why the University of California Ronald Reagan UCLA Medical Center in Los Angeles received a Clinical Excellence award from Healthgrades even though Leapfrog flunked it, said Marks.

The list of the Clinical Excellence hospitals is available at the Healthgrades Web site.

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