Joint Replacement Surgery Risks May Be Higher At Rural Hospitals Due to Workloads: Report

A new report suggests that small, rural hospitals may be taking on more and more orthopedic surgeries to generate revenue, possibly at the cost of patient health and safety. 

The Wall Street Journal indicates that an analysis of Medicare billing records found that joint replacement surgeries covered by Medicare have increased 42.6% at rural health care facilities, known as critical-access hospitals, from 2008 to 2013. However, the investigative report also indicates that patients at those hospitals undergoing the most common types of joint replacement surgeries are 34% more likely to die within a month of the surgery when compared to those who get the procedures done at large general hospitals.

There are about 1,300 critical-access hospitals nationwide, which usually are in rural locations and have 25 beds or fewer. Even with the increased rates of orthopedic surgeries at such facilities, they still only performed about 26 each year, according to the report. That compares to about 132 inpatient joint replacement procedures at general hospitals.

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Experts say that hospitals performing 100 or more of a procedure each year tend to perform them more safely, with fewer patient deaths or severe complications. That is generally believed to be because those surgeons are more practiced at those procedures, having to perform them almost once every three to four days.

The findings are similar to those in the U.S. News & World Report on Hospital Quality in May, which found that patients who underwent hip replacement surgery at a low volume hospital, which performed fewer than 25 such procedures in one year, had a 77% higher risk of death than someone who received the procedure at a high-volume hospital.

The same study found that patients undergoing knee operations at low-volume hospitals had double the risk of death.

The Wall Street Journal report questions whether the increase in volume at critical-access hospitals is due to a 1997 program that pays those hospitals more than general hospitals for the same surgeries. The program is designed to help such small facilities stay profitable, keep their doors open, and thus be available for patients in need.

In addition, those small hospitals are exempt from some federal reporting requirements and are not required to report the rate of surgical complications. This means that patients are unable to compare their success rate to those of a larger hospital, which is required to report such data.

Critics say as many as 11,000 deaths nationally might have been prevented from 2010 to 2012 if patients who went to low volume hospitals had gone to higher volume hospitals with more experienced doctors.


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