Well there are about 370 hospitals who agree to have patient outcomes on cardiac surgery published [1]. And there are 173 hospitals who agree to have patient outcomes on stem cell transplants published [2].
And if we keep the identity of the hospital confidential, the number of hospitals willing to provide data on patient outcome grows substantially. The study referenced by the New York Times article [3] had 22 million hospital admissions, and the Cystic Fibrosis Foundation has gathered detailed data from all US Cystic Fibrosis treatment centers for 50 years [4]. Although it would be better for all hospitals to be completely transparent, there are still significant benefits to judging hospitals in anonymous fashion, as described in [4] (which is a fascinating article in its own right).
As for statistically significant results, it's true that we will be unable to judge the effectiveness of smaller hospitals (unless they are extremely good or extremely bad). But for medium-sized and large hospitals this is not a problem - in the stem cell study [3] there were 43 out of 173 hospitals whose 2015 results were judged to be outside the 95% confidence interval (26 were better than predicted to a statistically significant degree, while 17 were worse). Of those 43 outliers, 26 were also outliers in 2014 which suggests this is not just a fluke.
Regarding your question: "Did the patient die because his heart bypass surgeon was incompetent, or because he went right back to eating Big Macs as soon as he was discharged from the hospital?": Keep in mind that we can control for body-mass index, so the question is whether people with similar BMI will be more likely to eat Big Macs after treatment at Hospital A, rather than Hospital B? Yes it's possible, but it seems to me more likely to be an effect of the hospital. Also note that it may not be down to the quality of the heart bypass surgeon - it may be simply that Hospital A is more effective at encouraging healthier eating after patients are discharged.
And if we keep the identity of the hospital confidential, the number of hospitals willing to provide data on patient outcome grows substantially. The study referenced by the New York Times article [3] had 22 million hospital admissions, and the Cystic Fibrosis Foundation has gathered detailed data from all US Cystic Fibrosis treatment centers for 50 years [4]. Although it would be better for all hospitals to be completely transparent, there are still significant benefits to judging hospitals in anonymous fashion, as described in [4] (which is a fascinating article in its own right).
As for statistically significant results, it's true that we will be unable to judge the effectiveness of smaller hospitals (unless they are extremely good or extremely bad). But for medium-sized and large hospitals this is not a problem - in the stem cell study [3] there were 43 out of 173 hospitals whose 2015 results were judged to be outside the 95% confidence interval (26 were better than predicted to a statistically significant degree, while 17 were worse). Of those 43 outliers, 26 were also outliers in 2014 which suggests this is not just a fluke.
Regarding your question: "Did the patient die because his heart bypass surgeon was incompetent, or because he went right back to eating Big Macs as soon as he was discharged from the hospital?": Keep in mind that we can control for body-mass index, so the question is whether people with similar BMI will be more likely to eat Big Macs after treatment at Hospital A, rather than Hospital B? Yes it's possible, but it seems to me more likely to be an effect of the hospital. Also note that it may not be down to the quality of the heart bypass surgeon - it may be simply that Hospital A is more effective at encouraging healthier eating after patients are discharged.
[1] http://www.sts.org/quality-research-patient-safety/sts-publi...
[2] https://www.seattlecca.org/sites/default/files/content_page/...
[3] http://journals.plos.org/plosone/article?id=10.1371/journal....
[4] http://www.newyorker.com/magazine/2004/12/06/the-bell-curve