Bed scores: administrators use best-hospital rankings and ratings to win market share. But what's their real measure?

• Author: Martin, Edward
• Position: Cover Story

Ingeborg Benfield lies motionless. In her chest, blood surges through the mitral valve into the left ventricle, one of her heart's two primary pumping chambers. She is otherwise fit, but with each beat the valve leaks, allowing blood to flow back into her lungs. Tired and short of breath, Benfield is slowly dying.

Ten feet away, a surgeon faces a console slightly bigger than a kitchen range. Poked through small incisions in her chest, one spider-like metal arm holds a miniature camera and two others grasp scalpels. Peering at monitors in the console, it's as if he has been transported into the three-dimensional world of the 69-year-old woman's beating heart.

Using da Vinci, as the $1 million robotic system is called, he slices away the valve's scalloped edges, then stitches them together so they seal. The operation, the first of its kind in the United States, made history nearly three years ago. Once, surgeons would have had to saw open Benfield's sternum to reach her heart. With the robot: less pain, fewer complications and half the hospital stay -- less than four days.

Though many, even in North Carolina, might not know it, this hospital -- Pitt County Memorial, adjacent to East Carolina University's Brody School of Medicine in Greenville -- is one of the nation's best, according to Lakewood, Colo.-based Health Grades Inc. and Evanston, 111.-based Solucient Inc. They are hospital consultants that are among the handful of organizations that rate American hospitals.

Like most grades, these report cards are loved and loathed, reveled in and ridiculed. But they play a competitive role in the state's $40 billion health-care market: Employers and insurers increasingly rely on them to decide where to steer patients, who cost less the quicker they get well. And for them, many patients believe, that choice could be, quite literally, a life-or-death decision.

"I can tell you, it feels really good if they pick you in the ratings," says physician Jeffrey Houpt, chief executive of Chapel Hill-based UNC Health Care and dean of UNC School of Medicine. "But if you're not chosen, it can feel really bad." University of North Carolina Hospitals was the nation's 18th best -- and North Carolina's best -- in the latest rankings by Modern Maturity, the magazine of the former American Association of Retired Persons. It based an ad campaign on it: "AARP makes us feel 18 again." UNC Hospitals also rates highly in U.S. News & World Report magazine's annual ranking for specialties.

"Everybody honestly wants to be at the top of the lists because they give people at least a rough cut of excellence," says cardiologist Gary Stiles, chief medical officer of Duke University Medical Center in Durham, the state's highest-rated in U.S. News' hospital issue. He laughs. "Of course, if you're not on that particular list, it isn't worth a thing." Duke also ranks high in most of the magazine's 17 specialty ratings.

Twenty-four Tar Heel hospitals show up on four of the most widely followed national lists -- U.S. News & World Report, Modern Maturity, Solucient, which analyzes more than 20 million hospital cases a year for about 5,500 clients, and Health Grades. BUSINESS NORTH CAROLINA asked Health Grades to dig deeper and come up with the state's 10 best hospitals for cardiac, vascular and orthopedic procedures. Heart disease is the leading cause of death -- and the most lucrative practice for many hospitals, generating up to 40% of revenue. Vascular surgery is closely related. Orthopedic surgery represents a substantially different set of risks.

FirstHealth Moore Regional Hospital in Pinehurst, a 400-bed hospital about a third Duke's size, was rated best in heart procedures such as bypass surgery and angioplasty, followed by WakeMed, a 746-bed Raleigh hospital. The 803-bed Mission St. Joseph's Hospital in Asheville was rated as the top hospital in vascular surgery -- the repair of arteries and vessels outside of the heart -- and 156-bed Presbyterian Orthopaedic Hospital in Charlotte, part of Winston-Salem-based Novant Health System, was ranked No. 1 for joint operations such as hip and knee replacements.

Why did those smaller hospitals fare so well? Health experts aren't sure, but their speculation suggests a pattern: Repetition is important. Most cite a study two years ago in The New England Journal of Medicine that found the death rate for certain operations at hospitals that perform them infrequently was as high as 16%, compared with 4% at hospitals that performed them daily.

"We've only got about 10,000 people in Pinehurst, but years ago some key medical practices here decided to focus on specialty care," says Charles Frock, president and CEO of FirstHealth of the Carolinas, a system that covers 16 counties and includes Moore Regional. "Most practices in rural areas deal with primary care and family care. Here, we focus on specialty care such as cardiology. In...