Healthgrades hospital rankings in specialty care tell a bigger story

Healthgrades recently revealed its awards recognizing top hospitals and health systems in a variety of specialties and outpatient care, and Brad Bowman sees some noteworthy trends.

Brad Bowman, chief medical officer of Healthgrades, says more procedures are being done on an outpatient basis. Healthgrades recently announced awards for top hospitals in specialty and outpatient care.

Bowman is the chief medical officer for Healthgrades, the popular website that helps consumers search for providers in their area. In late October, Healthgrades released its 2025 Specialty Excellence Awards, identifying leading performers in 16 different specialties. Healthgrades also honored hospitals in outpatient care and top providers in specialty care in 31 states.

In an interview with Chief Healthcare Executive®, Bowman talked about some of his insights from Healthgrades’ analysis of hospitals and their performance in specialty care and outpatient procedures.

Bowman says the analysis sheds more light on the changes in the hospital industry.

“Probably the big headline is the continued shift from inpatient to outpatient procedures,” Bowman said.

• Read more: Healthgrades names America’s top 50 hospitals for 2024

Indeed, some statistics regarding common procedures are eye-popping.

From 2020 through 2023, the number of knee replacements performed in outpatient settings surged 87%, while inpatient procedures fell 57% in that same span.

The numbers were even more dramatic with hip replacements. The number of outpatient hip replacements soared 154% from 2020 through 2023, while inpatient replacements fell 60% in that same period.

Bowman says the biggest shift toward the outpatient procedures was among larger health systems. Some smaller providers with more modest resources haven’t moved as quickly to shifting some common procedures to outpatient settings.

• Read more: Outpatient services see surge in demand

Health systems who have made the investment into providing more outpatient options are starting to see the dividends. Still, Bowman acknowledges that health systems receive reduced reimbursements from outpatient procedures, compared to inpatient surgeries. “They’re probably losing dollars,” Bowman said.

Still, given that patients are showing a decided preference for procedures that don’t require a hospital stay, Bowman says the investment into such facilities makes sense.

For Healthgrades, evaluating performance of health systems in outpatient procedures can be a bit trickier. If a patient admitted to a hospital develops an infection during their stay, that’s a little easier to identify than if a patient suffers a complication after an outpatient surgery.

Often, outpatient care appears to have lower complication rates, Bowman says, before adding, “We think.” Again, he notes that complications are harder to measure, and those getting outpatient procedures reflect a different population than those admitted to the hospital.

‘They’re doing younger, healthier patients in outpatient procedures, and older sicker patients are done inpatient,” Bowman said.

In its analysis, Healthgrades examined more than 4,500 hospitals and outcomes in 31 common procedures, using federal data from 2020 through 2023.

If all hospitals performed at the level of five-star recipients in Healthgrades analysis, the site says more than 224,000 lives could have potentially been saved and more than 141,000 complications could have been avoided.

Looking at the results of the awards, Bowman said some familiar names fared well, including the Cleveland Clinic, Mass General Brigham and HCA Healthcare.

One other takeaway from the Healthgrades analysis: High-quality specialty care isn’t quite evenly distributed nationwide, Bowman said. California, New York and Texas each had about 10% of the nation’s high-performing hospitals in specialty care, so 30% nationwide were found in those three states.

Still, plenty of other states offer quality care. He noted 13 states have 20 or more hospitals that were recognized as a top performer in some type of specialty care.

And in this year’s Healthgrades awards, every state, along with Washington, D.C., has at least one high-performing hospital in at least one facet of specialty care. He notes that hasn’t always been the case.

Consumers can gain some insights from Healthgrades if they’re looking for a hospital for a certain procedure. He notes that some patients often go to the facility referred to by their primary care doctor, but he notes doctors are increasingly employed by health systems and often are pressured to keep patients in the system.

Patients should ask questions and look to see if there’s a hospital outside the system better suited for their particular needs, Bowman suggests.

“They also need to do their own research and decide if there’s a better option to go elsewhere,” Bowman said.

That’s part of the reason why Healthgrades has leaned into ratings of top performers in specialties in many states. “It seems to simplify it for the patient,” he said.

Hospitals and health systems pay attention to the awards and the Healthgrades analysis of how providers fare in certain specialties, and some aren’t shy about voicing their displeasure over a lower ranking, Bowman said. Some health systems also contract with Healthgrades to identify where they can improve.

“Some hospitals hire us to try and find something where they can do better,” Bowman said.