Shopping for a Hip Replacement in Florida? Go by the Numbers

Some hospitals have consistently shorter stays, fewer complications and readmissions, and lower mortality than others do.

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Each year, nearly 300,000 people have one or both hips replaced. Most of the time the results are dramatically for the better, allowing patients to cast off pain and immobility. About one in 15 patients, however, suffers complications that can be severe, among them infection, nerve damage, blood clots, and failure of the implanted artificial joint, according to a 2010 report in the American Journal of Orthopedics. And these problems can be prevented. Some hospitals have consistently shorter stays, fewer complications and readmissions, and lower mortality than others do.

Data tell the story; data that are recent and decent can help patients make informed choices about where to get surgery. Yet few patients can look at these important statistics. Few hospitals reveal them, and most states don't publish hospital-specific data, often blaming tight budgets and pushback from local hospitals and doctors.

Florida is an exception. Its Agency for Health Care Administration (AHCA) posts charge, length of stay, readmissions, and mortality data on FloridaHealthFinder.gov. U.S. News decided to examine Florida hip-replacement data as part of a long-term project that will assess how well the nation's hospitals perform relatively routine procedures. In previous reports, we've examined heart surgery data from New York and Cesarean-section rates in Virginia. We hope to learn from states that are leading the way in informing the public about hospital performance.

Hip replacement makes a good case study. The operation may be routine, but it's far from trivial. The operation demands precision. Moreover, all artificial hip joints are not equal. If the surgeon chooses a device that's less than optimal—perhaps because he had a hand in its design—the patient may pay the price.

 Florida's data, from 2011, are unusually fresh, covering 184 hospitals that performed hip replacements last year. Hospitals must submit the data to AHCA as a licensing requirement. A contractor verifies the data, analyzes it, and returns it to the state for posting.

(Skip table and continue reading.)

Florida hospital hip replacements, readmissions, and deaths
Hospital Number of hip replacements Total hospita-lizations Length of stay (avg.) Readmission rate within 15 days Readmission rating* Death rate, risk-adjusted Death rate rating*
Aventura Hospital and Medical Center
40
109
5.3 days
6.0%
★★
0.0%
★★
Baptist Hospital
142
254
3.9 days
4.4%
★★
0.0%
★★
Baptist Hospital of Miami
203
350
4.6 days
3.3%
★★
0.2%
★★
Baptist Medical Center - Beaches
47
81
4.8 days
10.3%
0.0%
★★
Baptist Medical Center Downtown
204
301
4.2 days
3.1%
★★
0.0%
★★
Baptist Medical Center South
N/A
76
5.9 days
8.3%
★★
N/A
N/A
Bartow Regional Medical Center
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Bay Medical Center Sacred Heart Health System
35
108
4.9 days
7.3%
★★
0.0%
★★
Bayfront Medical Center
154
244
4.0 days
4.9%
★★
0.0%
★★
Bert Fish Medical Center
34
88
4.4 days
5.3%
★★
0.0%
★★
Bethesda Hospital
N/A
46
6.3 days
2.7%
★★
N/A
★★
Blake Medical Center
214
339
4.5 days
3.7%
★★
0.0%
★★
Boca Raton Regional Hospital
189
312
4.0 days
5.9%
★★
0.0%
★★
Brandon Regional Hospital
69
130
5.4 days
7.9%
★★
0.0%
★★
Brooksville Regional Hospital
35
60
4.3 days
8.2%
★★
0.0%
★★
Broward Health Coral Springs
46
78
4.4 days
8.7%
★★
0.0%
★★
Broward Health Imperial Point
31
68
4.9 days
10.3%
★★
1.3%
Broward Health Medical Center
269
364
3.0 days
4.4%
★★
0.0%
★★
Broward Health North
490
571
3.5 days
1.7%
★★★
0.1%
★★
Cape Canaveral Hospital
63
121
5.0 days
8.1%
★★
0.0%
★★
Cape Coral Hospital
122
217
4.6 days
5.1%
★★
0.0%
★★
Capital Regional Medical Center
42
88
4.9 days
6.4%
★★
0.0%
★★
Central Florida Regional Hospital
81
124
4.5 days
3.4%
★★
0.0%
★★
Charlotte Regional Medical Center
49
84
4.4 days
8.8%
★★
0.0%
★★
Citrus Memorial Hospital
95
218
4.4 days
4.4%
★★
0.0%
★★
Cleveland Clinic Hospital
209
297
3.5 days
6.4%
★★
0.0%
★★
Coral Gables Hospital
N/A
52
6.5 days
9.7%
★★
N/A
N/A
Delray Medical Center
223
375
4.1 days
5.5%
★★
0.0%
★★
Desoto Memorial Hospital
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Doctors Hospital
53
96
7.7 days
9.5%
★★
0.0%
★★
Doctors Hospital of Sarasota
398
514
3.5 days
4.0%
★★
0.0%
★★
Doctors' Memorial Hospital
N/A
N/A
N/A
N/A
N/A
N/A
★★
Dr. P. Phillips Hospital
185
243
3.8 days
7.1%
★★
0.0%
★★
Englewood Community Hospital
45
83
5.1 days
9.4%
★★
0.0%
★★
Englewood Community Hospital
N/A
56
4.2 days
3.5%
★★
N/A
★★
Fawsett Memorial Hospital
132
213
4.4 days
4.2%
★★
0.3%
★★
Fishermen's Hospital
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Flagler Hospital
123
221
4.8 days
4.5%
★★
0.0%
★★
Florida Hospital
91
326
5.8 days
9.0%
0.0%
★★
Florida Hospital Altamonte
71
131
4.5 days
5.1%
★★
0.0%
★★
Florida Hospital Caroollwood
89
127
3.8 days
4.6%
★★
0.0%
★★
Florida Hospital Celebration Health
151
200
3.5 days
2.0%
★★
0.0%
★★
Florida Hospital Deland
77
132
4.2 days
6.7%
★★
0.0%
★★
Florida Hospital East Orlando
N/A
32
5.4 days
N/A
N/A
N/A
N/A
Florida Hospital Fish Memorial
31
76
4.4 days
11.8%
0.0%
★★
Florida Hospital Flagler
63
111
4.8 days
4.7%
★★
0.0%
★★
Florida Hospital Heartland Medical Center
67
133
4.5 days
8.7%
★★
0.0%
★★
Florida Hospital Heartland Medical Center Lake Placid
 
N/A
N/A
N/A
N/A
 
 
Florida Hospital Kissimmee
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Florida Hospital Memorial Medical Center
126
198
4.0 days
2.2%
★★
0.0%
★★
Florida Hospital North Pinellas
49
85
3.9 days
1.5%
★★
0.0%
★★
Florida Hospital Tampa
157
361
3.7 days
4.2%
★★
0.2%
★★
Florida Hospital Waterman
134
227
4.7 days
5.9%
★★
0.0%
★★
Florida Hospital Zephyrhills
N/A
56
5.0 days
7.5%
★★
N/A
N/A
Fort Walton Beach Medical Center
51
99
4.7 days
3.6%
★★
0.0%
★★
Good Samaritan Medical Center
59
121
4.2 days
4.7%
★★
0.0%
★★
Gulf Breeze Hospital
69
105
4.1 days
7.4%
★★
0.0%
★★
Gulf Coast Medical Center
120
185
3.9 days
3.3%
★★
0.0%
★★
Gulf Coast Medical Center Lee Memorial Health System
220
387
5.0 days
6.5%
★★
0.0%
★★
H. Lee Moffitt Cancer Center & Research Institute Hospital
N/A
43
6.2 days
N/A
N/A
N/A
N/A
Halifax Health Medical Center
239
378
4.0 days
4.0%
★★
0.0%
★★
Health Central
87
129
4.0 days
7.9%
★★
0.0%
★★
Healthpark Medical Center
 
N/A
N/A
N/A
N/A
 
 
Heart of Florida Regional Medical Center
150
180
4.1 days
2.5%
★★
0.0%
★★
Hialeah Hospital
N/A
32
6.6 days
N/A
N/A
N/A
N/A
Highlands Regional Medical Center
N/A
46
5.3 days
7.1%
★★
N/A
N/A
Holmes Regional Medical Center
288
448
4.1 days
5.0%
★★
0.0%
★★
Holy Cross Hospital Inc.
359
548
3.7 days
2.8%
★★★
0.0%
★★
Homestead Hospital
N/A
39
7.1 days
8.3%
★★
N/A
N/A
Indian River Medical Center
274
432
3.8 days
5.3%
★★
0.1%
★★
Jackson Hospital
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Jackson Memorial Hospital
N/A
64
6.4 days
2.3%
★★
N/A
N/A
Jackson North Medical Center
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Jackson South Community Hospital
N/A
N/A
N/A
N/A
N/A
N/A
N/A
JFK Medical Center
295
446
4.1 days
7.2%
0.0%
★★
Jupiter Medical Center
159
264
4.2 days
3.1%
★★
0.0%
★★
Kendall Regional Medical Center
159
242
5.3 days
7.7%
★★
0.2%
★★
Lake City Medical Center
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Lake Wales Medical Center
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Landland Regional Medical Center
199
324
4.7 days
4.1%
★★
0.0%
★★
Lakewood Ranch Medical Center
41
73
4.1 days
1.7%
★★
0.0%
★★
Largo Medical Center
160
285
4.7 days
5.5%
★★
0.0%
★★
Largo Medical Center - Indian Rocks
 
N/A
N/A
N/A
N/A
 
 
Larkin Community Hospital
 
N/A
N/A
N/A
N/A
 
 
Lawnwood Regional Medical Center & Heart Institute
46
97
5.8 days
11.8%
0.0%
★★
Lee Memorial Hospital
480
653
3.4 days
5.0%
★★
0.0%
★★
Leesburg Regional Medical Center
188
286
4.3 days
7.9%
0.0%
★★
Lehigh Regional Medical Center
30
58
4.5 days
1.7%
★★
0.0%
★★
Lower Keys Medical Center
37
56
5.7 days
9.4%
★★
0.0%
★★
Manatee Memorial Hospital
75
145
4.6 days
4.6%
★★
0.0%
★★
Mariners Hospital
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Martin Medical Center
N/A
68
5.3 days
5.4%
★★
N/A
N/A
Martin Memorial Hospital South
170
250
4.5 days
5.2%
★★
0.0%
★★
Mayo Clinic
232
351
3.5 days
4.0%
★★
0.0%
★★
Mease Countryside Hospital
88
178
5.0 days
6.9%
★★
0.0%
★★
Mease Dunedin Hospital
39
64
4.3 days
7.5%
★★
0.0%
★★
Medical Center of Trinity
100
195
4.7 days
5.0%
★★
0.0%
★★
Memorial Hospital Jacksonville
77
164
6.0 days
7.5%
★★
0.0%
★★
Memorial Hospital Miramar
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Memorial Hospital of Tampa
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Memorial Hospital Pembroke
31
64
4.7 days
11.3%
0.0%
★★
Memorial Hospital West
N/A
70
4.9 days
4.9%
★★
N/A
N/A
Memorial Regional Hospital
32
97
5.0 days
6.2%
★★
0.0%
★★
Memorial Regional Hospital South
N/A
41
4.0 days
10.1%
★★
N/A
N/A
Mercy Hospital, A Campus of Plantation General Hospital
124
196
5.3 days
4.6%
★★
0.0%
★★
Metropolitan Hospital of Miami
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Morton Plant Hospital
448
667
4.0 days
3.7%
★★
0.0%
★★
Morton Plant North Bay Hospital
N/A
48
4.3 days
4.7%
★★
N/A
N/A
Mount Sinai Medical Center
75
136
4.4 days
5.0%
★★
0.5%
★★
Munroe Regional Medical Center
102
201
4.7 days
6.2%
★★
0.0%
★★
Naples Community Hospital
376
546
3.8 days
5.2%
★★
0.0%
★★
NCH Healthcare System North Naples Hospital Campus
72
148
4.4 days
5.2%
★★
0.0%
★★
North Florida Regional Medical Center
233
369
4.8 days
6.8%
★★
0.0%
★★
North Okaloosa Medical Center
 
N/A
N/A
N/A
N/A
 
 
North Shore Medical Center
N/A
N/A
N/A
N/A
N/A
N/A
N/A
North Shore Medical Center - FMC Campus
N/A
45
6.1 days
7.7%
★★
N/A
N/A
Northside Hospital
N/A
71
6.9 days
11.8%
N/A
N/A
Northwest Medical Center
N/A
61
5.4 days
3.2%
★★
N/A
N/A
Oak Hill Hospital
144
208
4.7 days
5.4%
★★
0.2%
★★
Ocala Regional Medical Center
88
162
4.4 days
4.1%
★★
0.0%
★★
Orange Park Medical Center
45
127
4.6 days
6.4%
★★
0.8%
Orlando Regional Medical Center
217
357
4.4 days
5.7%
★★
0.2%
★★
Osceola Regional Medical Center
56
114
4.2 days
5.1%
★★
0.0%
★★
Palm Bay Hospital
47
85
4.4 days
2.3%
★★
0.0%
★★
Palm Beach Gardens Medical Center
99
168
4.6 days
7.1%
★★
0.0%
★★
Palm Springs General Hospital
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Palmetto General Hospital
32
72
6.2 days
7.6%
★★
0.0%
★★
Palms of Pasadena Hospital
82
156
4.1 days
5.6%
★★
0.0%
★★
Palms West Hospital
33
61
5.5 days
8.0%
★★
0.0%
★★
Parris Medical Center
32
82
4.5 days
3.8%
★★
0.0%
★★
Pasco Regional Medical Center
N/A
32
5.5 days
7.8%
★★
N/A
N/A
Peace River Regional Medical Center
117
185
4.2 days
3.8%
★★
0.0%
★★
Physicians Regional Medical Center - Collier Boulevard
 
N/A
N/A
N/A
N/A
 
 
Physicians Regional Medical Center - Pine Ridge
270
325
3.1 days
4.3%
★★
0.1%
★★
Plantation General Hospital
 
N/A
N/A
N/A
N/A
 
 
Putnam Community Medical Center
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Raulerson Hospital
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Regional Medical Center Bayonet Point
90
156
4.5 days
6.9%
★★
0.4%
★★
Sacred Heart Hospital
167
298
3.7 days
4.0%
★★
0.0%
★★
Sacred Heart Hospital on the Emerald Coast
65
90
3.3 days
4.0%
★★
0.0%
★★
St. Vincent's Medical Center Riverside
370
502
3.6 days
9.4%
0.0%
★★
Santa Rosa Medical Center
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Sarasota Memorial Hospital
337
540
3.7 days
3.7%
★★
0.0%
★★
Sebastian River Medical Center
40
71
4.5 days
5.6%
★★
0.0%
★★
Seven Rivers Regional Medical Center
147
189
3.6 days
3.3%
★★
0.0%
★★
Shands Hospital at the University of Florida
187
312
4.4 days
8.0%
0.2%
★★
Shands Jacksonville Medical Center
56
107
5.1 days
4.9%
★★
0.0%
★★
Shands Lake Shore Regional Medical Center
 
N/A
N/A
N/A
N/A
 
 
South Bay Hospital
74
148
5.1 days
7.4%
★★
0.0%
★★
South Florida Baptist Hospital
53
85
4.3 days
3.2%
★★
0.0%
★★
South Lake Hospital
100
148
4.8 days
5.0%
★★
0.0%
★★
South Miami Hospital
39
74
4.8 days
9.5%
★★
0.0%
★★
South Seminole Hospital
38
69
4.6 days
11.9%
0.0%
★★
Spring Hill Regional Hospital
N/A
34
5.5 days
N/A
N/A
N/A
N/A
St. Anthony's Hospital
93
208
4.8 days
7.0%
★★
0.0%
★★
St. Cloud Regional Medical Center
N/A
N/A
N/A
N/A
N/A
N/A
N/A
St. Joseph's Hospital
129
286
5.0 days
4.8%
★★
0.0%
★★
St. Joseph's Hospital North
67
169
3.3 days
4.1%
★★
0.0%
★★
St. Lucie Medical Center
208
310
4.4 days
8.3%
0.0%
★★
St. Mary's Medical Center
39
90
4.8 days
6.3%
★★
0.9%
St. Petersburg General Hospital
N/A
87
5.2 days
3.8%
★★
N/A
N/A
St. Vincent's Medical Center Southside
236
298
3.3 days
4.5%
★★
0.0%
★★
Tallahassee Memorial Hospital
237
396
4.3 days
2.7%
★★
0.2%
★★
Tampa General Hospital
389
539
4.3 days
4.0%
★★
0.0%
★★
Town & Country Hospital
N/A
35
4.9 days
0.0%
★★
N/A
N/A
Twin Cities Hospital
38
53
3.5 days
5.2%
★★
0.0%
★★
University Hospital and Medical Center
130
213
4.6 days
4.0%
★★
0.3%
★★
University of Miami Hospital
74
155
5.4 days
9.9%
0.6%
★★
Venice Regional Medical Center
168
292
3.9 days
3.7%
★★
0.0%
★★
Viera Hospital
37
67
3.8 days
9.8%
★★
0.0%
★★
The Villages Regional Hospital
59
133
4.9 days
11.6%
0.0%
★★
Wellington Regional Medical Center
74
149
5.0 days
9.4%
0.0%
★★
West Boca Medical Center
N/A
70
5.7 days
10.1%
N/A
N/A
West Florida Hospital
74
130
4.7 days
4.0%
★★
0.0%
★★
West Kendall Baptist Hospital
N/A
N/A
N/A
N/A
N/A
N/A
N/A
West Marion Community Hospital
423
483
3.0 days
1.0%
★★★
0.0%
★★
West Palm Hospital
N/A
49
4.3 days
8.4%
★★
N/A
N/A
Westchester General Hospital
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Westside Regional Medical Center
64
139
5.5 days
5.1%
★★
0.0%
★★
Winter Haven Hospital
42
119
5.1 days
2.8%
★★
0.9%
Winter Park Memorial Hospital
357
496
3.9 days
3.7%
★★
0.0%
★★
Wuesthoff Medical Center - Melbourne
N/A
44
6.7 days
13.8%
N/A
N/A
Wuesthoff Medical Center - Rockledge
54
90
5.1 days
4.1%
★★
0.0%
★★

*One star, higher than expected; two stars, as expected; three stars, lower than expected.

Statewide, 29,210 Florida residents were hospitalized for hip replacement surgery in 2011. They were in the hospital for an average of 4.3 days. Just under 5 percent were readmitted within 15 days of surgery. Nineteen patients died, an overall death rate of .06 percent. The state does not report rates of side effects, such as joint failure, blood clots, or infection.

But hospitalizations, length of stay, and readmissions begin to provide a picture of a hospital's efficiency and effectiveness. The state also reports hip-replacement mortality, which is so rare—most hospitals reported zero deaths—that the main value of the data lies in spotlighting the few exceptions.

Florida risk-adjusts its data sets in different ways. For readmission data, a proprietary approach from 3M is utilized; for mortality, a blend of ICD-9 codes and 3M APR-DRGs developed by the federal Agency for Healthcare Research and Quality is employed.

AHCA doesn't display all hip-replacement data together. Billed charges, length of stay, and readmissions are in one place; mortality data are separate, to rescue consumers from data overload. Each hospital gets two ratings: 1 to 3 stars for readmissions and 1 to 3 stars for mortality, with 1 star denoting the worst performers and 3 the best.

Only three of the state's 184 hospitals received the best-possible 3 stars for readmissions: West Marion Community Hospital in Ocala with a rate of 1.0 percent, Broward Health North in Pompano Beach with 1.7 percent, and Holy Cross Hospital in Fort Lauderdale with 2.8 percent. All three hospitals replaced lots of hips in 2011, ranging from 483 at West Marion to 571 at Broward Health North.

At the other end of the spectrum, 17 hospitals performed poorly, with risk-adjusted readmissions ranging from 7.2 percent at JFK Medical Center in Atlantis, where doctors performed 446 hip replacements in 2011, to 13.8 percent in Wuesthoff Medical Center in Melbourne, where doctors did just 44. No official body has established a recommended minimum for the number of annual hip replacements a hospital should perform, but nine of the 17 poor performers did 100 or more procedures in 2011. Hip replacement volume at Florida hospitals varied dramatically, from 32 procedures at Pasco Regional Medical Center in Dade City, with a rate of 7.7 percent, to 667 at Morton Plant Hospital in Clearwater, with a rate of 3.7 percent.

None of the hospitals had significantly fewer deaths than expected. That is no surprise, since most of them had no deaths at all. Four hospitals, however, got a single star for a higher death rate than expected: Orange Park Medical Center in Orange Park, Winter Haven Medical Center in Winter Haven, St. Mary's Medical Center in West Palm Beach, and Broward Health Imperial Point in Fort Lauderdale. None of the hospitals had more than a single death, but their patients presented such low risk that one death was enough to significantly boost the risk-adjusted mortality. Interestingly, all of these hospitals got two stars for readmissions, within the expected range for the state.

For U.S. News, two separate star ratings for one procedure may be too many. It asks a lot of prospective patients to consider the merits of two ratings, each with its own methodology. Our inclination favors a composite score. But would that unfairly penalize a hospital that performs well overall but reports a death? Are these datapoints sufficient, moreover, to draw conclusions about hospital performance? Shouldn't patients be informed about complications and patient safety issues, from infections to blood clots to hip failure?