Robert Besse's painful odyssey began when he checked himself into Good Samaritan Hospital in Cincinnati a year ago to get his right knee replaced. The 60-year-old retired pharmacist had worn down the joint skiing and hiking and working on his feet for years. After the surgery Besse recovered for four days in a room he shared with another gentleman who'd had stomach surgery. His roommate's four youngsters would visit for hours, creating a racket, while up to 20 hospital staff a day would come in the room to examine him, bring food or change a lightbulb. A student nurse would wake Besse up to ask if he needed a new pillow. The physical therapist would peel back a bit too far the blue brace on his knee and expose the bloody gauze.
Ten days after leaving the hospital his knee was still oozing lots of fluid. "The pain was off the scale," he says. One of his surgeons took a look and immediately had him admitted to a different hospital, where he declined rapidly. Twice during the first night he was given last rites. But he survived until the morning when the surgeon opened up his knee again and found a raging staph infection that took two rounds of surgery to clean up. "I wanted out of there. I couldn't stand it," he says. He spent the next several months on infused antibiotics and pain medication. He was barely able to celebrate his sixtieth birthday with his family in Breckenridge, Colo. He already has a strategy to celebrate future birthdays: "My plan is stay the hell out of the hospital, period," he says. (Good Samaritan can't comment on the case because of privacy laws but says it has a comprehensive infection-fighting program.)
Hospitals are still the heart of the health care industry, consuming a third of the $2 trillion U.S. health care bill. Some are very good. But many are not, brimming with infectious bugs, systemic error and negative hospitality. And because the hospital industry does all it can to thwart competition, many communities are stuck with the hospitals they have. One in 200 patients who spends a night or more in a hospital will die from medical error. One in 16 will pick up an infection. Deaths from preventable hospital infections each year exceed 100,000, more than those from AIDS, breast cancer and auto accidents combined. The presidential candidates are grappling over the plight of the uninsured, yet you're five times more likely to die from visiting a hospital than from not having health insurance, according to the not-for-profit Committee to Reduce Infection Deaths.
Patients have a choice, but it's not widespread yet. It's called the specialty hospital, a center that focuses on the care of a particular body part such as the heart, spine or joints, or on a specific disease such as cancer. There are 200 specialty hospitals in the U.S. (out of 6,000 hospitals overall), and they often deliver services better, more safely and at lower cost. A recent University of Iowa study of tens of thousands of Medicare patients found that complication rates (bleeding, infections or death) are 40% lower for hip and knee surgeries at specialty hospitals than at big community hospitals. A 2006 study funded by Medicare found that patients of all types are four times as likely to die in a full-service hospital after orthopedic surgery as they would after the same procedure in a specialty hospital.
HealthGrades is a quality review firm that ranks hospitals by their complication and mortality rates (adjusted for the health of the patient on admittance). According to HealthGrades, specialty hospitals don't always outpace traditional hospitals in quality of care, but they are overrepresented in the top tier. Three of the nation's top ten cardiac programs are at specialty hospitals in South Dakota, Indiana and Texas. Three of the top ten hospitals for total joint replacement surgery are specialty centers in Oklahoma, Ohio and Georgia.
"Specialization is a law of nature," says Robert Tibbs, a neurosurgeon and part-owner of the Oklahoma Spine Hospital. "Spine surgery is an elective procedure. One of the biggest risks to any surgery is infections. Here we don't have sick people." Last year, out of 1,773 patients who slept over at the hospital, only 7 got an infection. That's one-third to one-ninth the rate seen for similar patients at a big hospital. At Oklahoma Spine anesthesiologists are practiced in putting patients under in the prone position for back surgery. At a big hospital few anesthesiologists would be skilled in that particular task. "You don't take your Ford to the VW mechanic," says Tibbs' partner Stephen Cagle.
In most industries the lumbering, unresponsive incumbent gets wiped out by the nimble newcomer, or at least is spurred to improve its ways. The nation's public education system has the charter-school movement to keep it honest. Microsoft (nasdaq: MSFT - news - people ) has Google (nasdaq: GOOG - news - people ). But over the past several years the hospital industry, through legally questionable bullying tactics and arduous lobbying, has all but stamped out expansion of the specialty hospital sector, the only real competitive threat it has ever faced.
