A controversial report being released today by the Department of Health and Human Services identifies 269 hospitals nationwide -- including Georgetown University and Sibley Memorial hospitals in this area -- that have overall death rates for Medicare patients significantly higher or lower than expected.

It is the first time that such information is being made made public by the department. A copy of the report was obtained yesterday by The Washington Post.

The report, whose expected release brought angry criticism from the American Hospital Association and some hospital and medical groups fearful that publication of the raw statistics could mislead the public, also identifies hundreds of hospitals whose death rate for one of several specific conditions deviates from expected figures.

Both Georgetown and Sibley had overall death rates lower than had been anticipated, after taking into account their mix of cases. At Georgetown, the predicted death rate for Medicare patients as a proportion of their hospital discharges was 5.4 percent, but the actual rate was 1.9 percent. At Sibley, the anticipated rate was 4.8 percent, but the actual rate was 2.9 percent.

The lists were compiled by the Health Care Financing Administration, which runs the Medicare program, from a computer model and will be sent to Peer Review Organizations (PROs) with instructions that they find out why a hospital's death rate deviates from the norm. PROs are medical groups that review hospital practices under contracts with Health and Human Services to make sure that proper care and standards and efficient operations are being observed in the federally financed Medicare health insurance program for 30 million aged and disabled Social Security beneficiaries.

In a statement to be issued with the report, acting Medicare administrator Henry Desmarais warned that "the presence of a hospital on these lists does not mean that the hospital is a poor quality provider." He said that an above-average death rate could mean that the hospital usually takes only the severest cases, that it has an unusual population mix such as many very old people, and so forth. The idea is for the Peer Review Organization to find the reason.

Similarly, other authorities said that a below-expected death rate might not necessarily mean higher quality care.

When asked for comment, American Hospital Association executive vice president Jack Owen said: "We see no legitimate use for these data. They will cause confusion and apprehension among Medicare beneficiaries, rather than convey meaningful information. The model used to generate these data appears to be seriously flawed."

He predicted that the numbers would be found to be "meaningless and misleading."

Michael Bromberg, director of the Federation of American Health Services, which includes 1,200 for-profit hospitals, said: "Disclosure for consumer-information purposes is fine, but in this case it can only mislead until the experts can interpret the data."

Local hospitals listed as deviating from the expected norm on death rates for specific conditions include the National Hospital for Orthopaedics and Rehabilitation (congestive heart failure), D.C. General (joint procedures), Sibley (acute myocardial infarction, or heart attack) and Greater Southeast Community Hospital (gastrointestinal hemorrhage).