Why Bigger Isn't Better When It Comes to Hospitals

Friday, 09 Aug 2013 09:33 AM

By Charlotte Libov

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For many years, the conventional wisdom was that if you had a serious health problem, you should go to a major medical center instead of local community hospital. The Mayo Clinic, Cleveland Clinic, Johns Hopkins, and other prestigious hospitals were thought to have best doctors, the latest technology, and top support staff.

However, a new survey has found that surgical patients actually have as good or better outcomes at smaller hospitals.
 
Consumer Reports recently rated 2,463 U.S. hospitals in all 50 states for surgical care. Surprisingly, many big-name medical centers were near the middle of the pack or lower. The survey looked at outcomes of common surgical procedures, such as back operations, knee and hip replacements, and angioplasty.
 
 
“What we’re finding is that the big centers like the Cleveland Clinic, Mayo Clinic, and Johns Hopkins are not necessarily better than the community hospitals,” cardiologist Chauncey Crandall, M.D., told Newsmax Health. “While the big centers may have been better in the past, this isn’t necessarily true any longer.”
 
Consumer Reports based its ratings on the percentage of Medicare patients who died in the hospital during or after their surgery, and those who had longer-than-expected hospital stays. Some of the larger institutions have complained that the survey didn’t take into account that major medical centers often treat more difficult cases. But Consumer Reports said its findings were adjusted to compensate for the difference.
 
The survey found that some hospitals with household names fare poorly in surgical outcomes. Massachusetts General in Boston, for example, got the lowest rating.

Cleveland Clinic’s flagship hospital got only an average rating. Mayo Clinic hospitals in Phoenix and Jacksonville, Fla., got top scores, but its branch in Austin, Minn., got the lowest rating. Johns Hopkins in Baltimore was rated only average. Some prestigious hospitals that did rank near the top include New York Presbyterian and Mount Sinai in New York.
 
According to Dr. Crandall, the survey reflects across-the-board shifts in quality from larger hospitals to the smaller ones. One key measure of quality, he noted, is staffing.
“Historically, there was more money in the system to hire properly trained nurses and other staff at the big clinics. But with today’s medical cuts, the hospitals that are doing better are the community ones with their smaller patient-to-nurse ratios,” he said.
 
Smaller hospitals are better able to respond to income cuts with local fundraising efforts, said Dr. Crandall, chief of the cardiac transplant program at the Palm Beach Cardiovascular Clinic.
 
Also, doctor turnover is greater at large hospitals, which can hurt patient care. “A famous heart surgeon will stay three or four years and then go to another large academic hospital, resulting in a constant shift of academic brain power,” said Dr. Crandall. “It’s like the NFL – the players jump from team to team.
 
“But in the smaller hospitals, doctors become members of the community. The doctors live there, and they put down their roots there. They perform well because they’ve been in the same environment, working with the same team for many years.
 
“Also, larger institutions often rely more on medical students to furnish care. Historically, you had seasoned interns and residents who spent thousands of hours in hospitals and became well-trained. But the government stepped in and limited this, so now they are not getting the same quality of training as before,” Dr. Crandall said.
 
Another factor is that the Internet has leveled the playing field when it comes to medical expertise, says Dr. Crandall, author of the Heart Health Report. “Once, there were conferences and training that you could only get at the great medical institutions. But now, thanks to the Internet, this high-caliber of education is available to doctors everywhere,” he said. 
 
When Dr. Crandall was on a medical mission to Haiti recently, few on his team had treated cholera. But they were able to use the Web to quickly get a handle on the state-of-the-art treatment for the deadly disease. “We had the best knowledge at our fingertips. Within a day or so, we were experts.”
 

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