UK HealthCare again best Ky. hospital in U.S. News & World Report rankings; Baptist Health has two of seven on state list

By Melissa Patrick

Kentucky Health News

Seven Kentucky hospitals are included in the nation's "Best Regional Hospitals" in the latest annual rankings by the magazine U.S. News & World Report. 

They are, in order: the University of Kentucky hospital; in a tie for second, Baptist Health Louisville and St. Elizabeth Healthcare Edgewood-Covington Hospitals, Louisville's Norton Hospital and Baptist Health Lexington; and in sixth, the University of Louisville's Jewish Hospital and Saint Joseph Hospital-Lexington. 

To make the list, a hospital must offer a full range of services; either be ranked nationally in one of 12 measured specialties or have three or more high-performance rankings for procedures and conditions; and have at least two more high-performing than below-average rankings for procedures and conditions. The last criterion is new.

The report offers an overview of 122 Kentucky hospitals with a breakdown of each of the measured categories, as relevant to the services the hospital provides. 

UK HealthCare, for the fifth consecutive year, claimed the No. 1 ranking with its Albert B. Chandler Hospital. The hospital also ranked in the top 50 for cancer care for the fourth straight year, and moved up to its highest ranking yet in that specialty, 29th. The hospital's Markey Cancer Center is the state's only National Cancer Institute-sponsored center, one of 71 in the nation. 

Dr. Mark F. Newman, UK executive vice president for health affairs, said in a news release, “This has been a challenging year, to put it mildly. But in these times, it’s more important than ever that Kentuckians with complex health problems have a medical center they can come to for best treatment options possible.”

UK also ranked as high-performing in these specialties: gastroenterology and gastrointestinal surgery, geriatrics, nephrology (kidneys), orthopedics and urology.

The 31st annual rankings compared more than 4,500 hospitals in 26 specialties, procedures and conditions. A release said 134 were nationally ranked in at least one specialty, and 563 were ranked among the Best Regional Hospitals in a state or metro area. Data used for the rankings predate the covid-19 pandemic.

Baptist Health had two of the state's top seven hospitals. Baptist Health Paducah fell off the Best Regional Hospital list this year, after being added last year for the first time ever, but it continued to be rated high-performing in heart failure and COPD.

Baptist Health CEO Gerard Colman said in a news release, “Baptist Health has long been known for its compassionate clinical care, and the U.S. News & World Report Best Hospitals rankings validate the high quality care provided by our physicians, nurses and staff as they live out our mission of leading in clinical excellence, compassionate care and growth to meet the needs of our communities.”

The report recognizes hospitals that are "high-performing" for 10 common adult procedures and conditions, including repair of abdominal aortic aneurysms, aortic valve surgery, trans-catheter aortic valve replacement (added this year) chronic obstructive pulmonary disease, colon-cancer surgery, heart-bypass surgery, lung-cancer surgery, hip replacement, knee replacement and congestive heart failure.

UK Healthcare ranked high-performing in all those categories except abdominal aortic aneurysms and trans-catheter aortic valve replacement, both dealing with the body's main artery, and knee replacement. It ranked average in those three categories. 

Baptist Health Louisville ranked high-performing for all procedures and conditions except trans-catheter aortic valve replacement and lung-cancer surgery. It ranked average in both.

St. Elizabeth Healthcare ranked high-performing in all the categories except aortic valve surgery, trans-catheter aortic valve replacement and heart-bypass surgery, in which it ranked average. It ranked high-performing in one specialty, orthopedics.

Baptist Health Lexington ranked high-performing in all but four categories, in which it ranked average: aortic valve surgery, trans-catheter aortic valve replacement, colon-cancer surgery and hip replacement.

Norton Hospital ranked high-performing for four procedures and conditions: heart failure, hip replacement, knee replacement and COPD. It ranked average for the other seven. 

Saint Joseph Hospital-Lexington ranked high-performing for colon-cancer surgery, heart failure and COPD, and average for the rest.

UofL Health-Jewish Hospital ranked high-performing for lung cancer surgery, heart failure and COPD. It ranked average for the remaining categories. 

Click here for information about how the magazine ranks the hospitals, including details on this year's methodology changes. 

Nationally, the Mayo Clinic in Rochester, Minn., claimed the No. 1 spot, followed by Cleveland Clinic and Johns Hopkins Hospital in Baltimore, according to a news release. 

Small, rural hospitals doing more orthopedic surgeries, but their 30-day death rate is one-third higher than that of larger hospitals

Critical-access hospitals, a linchpin of health care in rural areas, are performing many more orthopedic surgeries. But the Medicare patients who get the five most common orthopedic procedures at such hospitals are one-third more likely to die within 30 days than those who get them at larger, general hospitals.

That's what The Wall Street Journal found by reviewing Medicare billing data from 2008 to 2013, which showed a 43 percent increase in surgeries at critical-access hospitals, "far outpacing the growth of those services at general hospitals" and raising "troubling implications for patient safety," says the Christmas Day story by Christopher Weaver, Anna Wilde Mathews and Tom McGinty. From 2010 to 2013, the death rate at such hospitals was 34 percent higher than at the larger facilities.

“Patients are getting bad outcomes, probably because they are getting procedures at hospitals without the experience to do it well,” Ashish Jha, a Harvard University public-health professor who has studied critical-access hospitals, told the Journal. He and his colleagues reviewed the Journal's data and concluded that "the 30-day mortality rate for inpatient joint replacements was about 9 per 1,000 at critical-access hospitals in 2013, compared with around 5 in 1,000 at general hospitals," the newspaper reports.

"Many studies suggest that patients generally get better results when their procedures are done at hospitals that perform them frequently," the Journal reports. "The average critical-access hospital performing inpatient joint replacements in 2013 did about 26 that year, compared to about 132 at general hospitals. Hospitals doing more than 100 procedures a year have the lowest risks, said Nelson SooHoo, an orthopedic surgeon at UCLA’s David Geffen School of Medicine who has studied the issue."

Kentucky has 29 critical-access hospitals. In general, such hospitals must have no more than 25 beds and keep patients no more than 72 hours. In return, the federal government gives them a small bonus on their Medicare and Medicaid payments, part of a policy Congress enacted to maintain the viability of hospitals in rural areas.

"Financial incentives can make doing more surgeries appealing to critical-access hospitals, thanks to their special status with Medicare, especially as the rural hospitals merge with larger rivals," the newspaper notes. "The Journal’s analysis shows that the fastest-growing procedures at critical-access hospitals are often-elective orthopedic surgeries that could otherwise be scheduled at facilities with more experience. Experts say that as the hospitals’ experience grows, patients’ outcomes should improve. But so far, mortality rates have held fast, according to the analyses by the Journal and Harvard researchers."

U of L gets patents for new cancer treatments, spinal cord treatments and a new bone graft product

The University of Louisville Research Foundation has recently been awarded patents for improved cancer treatments, a new bone graft material, and therapies for spinal cord damage, and two of the inventions are already licensed and will soon be utilized by the health care system, according to a School of Medicine news release.

The patent for a new bone graft cement called Trabexus EB is one of the patent's that has been cleared by the Food and Drug Administration for use. This bone replacement cement will be used by orthopedic surgeons to repair bones damaged through injury, tumor or other defects, according to the release.

Another recently patented treatment involves a "revolutionary" new way to treat paralysis following spinal cord injury that incorporates epidural stimulation to activate the spinal cord. This treatment, along with physical training and medications, allows individuals with spinal cord injury to have voluntary control of body movements and improve heart, lung and other autonomic functions. Research participants for this treatment have been able to move and stand unassisted, with some improvements in heart, pulmonary and bladder function, according to the release.

The foundation has also received a patent for an improvement to a cancer therapy that enhances immunotherapies used for the treatment of cancer and chronic viral infections, like HIV. This new method of stimulating the immune system "has significant potential" to make immunotherapies more effective and help protect against recurrence of the disease, according to the release.

They have also received a patent for software that detects areas of depleted lung function during radiation treatment for lung cancer and other lung diseases. This new 4-D computed tomography (CT) image analysis software can be used with existing lung imaging during radiation therapy to detect early changes in lung elasticity, allowing the treatment to be adjusted to prevent permanent breathing problems, according to the release.

U of L also received a patent for a treatment that can repair the spinal cord by taking a tissue biopsy from a patient's nose, isolating the stem cells from it, and then using these stem cells to regenerate the spinal cord to repair an injury. This treatment can also be used in the treatment of Parkinson’s Disease, amyotrophic lateral sclerosis (ALS), multiple sclerosis and type 1 diabetes. This method of generating the stem cells has been licensed from UofL by RhinoCyte Inc. and is scheduled for a concept study at the University of Louisville Hospital with Phase I/II clinical trials beginning in 2016.

Partial knee replacement using a robotic arm used in Ky. for first time; offers hope of longer lasting knees that feel more natural

A partial knee replacement surgery that utilizes a robotic arm was performed for the first time in Kentucky in May, Mark Hansel reports for the Northern Kentucky Tribune.

RIO, Robotic Arm System
(Photo from NKYTribune)

Dr. Matthew Hummel of Commonwealth Orthopaedic Physicians, which serves the greater Cincinnati area, performed the Stryker MAKOplasty partial knee resurfacing procedure at St. Elizabeth Edgewood May 19.

Hummel said "benefits of the minimally invasive procedure are expected to include a more natural feeling post-surgery and improved recovery time," Hansel writes.

“Stryker MAKOplasty allows us to treat patients with knee osteoarthritis at earlier stages and with greater precision,” Hummel said. “Because it is less invasive and preserves more of the patient’s natural knee, the goal is for patients to have relief from their pain, gain back their knee motion, and return to their daily activities.”

Osteoarthritis is the most common form of arthritis and a leading cause of disability worldwide, according to the American Academy of Orthopaedic Surgeons.

Hummel said the procedure has been "around for several years," and that he has been tracking its progress, including recent results and upgrades in technology, before using it on his patients.

Hansel explains that the procedure is performed using RIO, a highly advanced, surgeon-controlled robotic arm system. The system correlates a pre-surgical plan that was created by using a CT scan of the patient's knee taken before the surgery with a three-dimensional, virtual view of the patient's bone surface during the procedure.

Hummel told Hansel that some patients are "apprehensive about having a robot perform the procedure," but assures them that "I am actually operating and doing all the work, but it is helping me apply the best laser lines and guiding techniques."

In addition to a more rapid recovery, the procedure is expected to result in reduced pain, a smaller scar, minimal hospitalization, less implant wear and loosening, and better motion that feels more natural, Hansel reports.

“If my implants completely match my plan CT scan, I’m hopeful that with today’s technology, we can have knees that last 25 and 30 years,” Hummel said

Hummel has since performed the procedure on at least one other patients at St. Elizabeth Edgewood. It is anticipated that this procedure will be expanded to total hip and total knee replacements, but these procedures have not yet gained the U.S. Food and Drug Administration's approval.

Arthroscopic knee surgery is no better than fake surgery for some people with torn meniscus cartilage, study suggests

http://www.nytimes.com/2013/12/26/health/common-knee-surgery-does-very-little-for-some-study-suggests.html