It's not easy to find good Chinese food in Florida. I've checked out several places since moving recently, but something always puts me off -- the cleanliness of the place, the service or the food itself. After asking around, I finally found a restaurant I like near my son's school. Clean, good service, tasty food and only moderately higher prices.All this time and effort for a decent plate of chicken cashew and an egg roll. I doubt many people do this much research when they, or someone in their family, are having a procedure done at a hospital. But you probably should. After all, wouldn't you want to know whether a hospital has low rates of infection, sufficient nursing staff, is patient focused and has performed the procedure many times with good rates of success? And while you may not be very sensitive to the cost of a bowl of fried rice, you might want to know how much a hospital visit would set you back. I wish I could tell you finding this information was easier. I've been following the so-called trend toward "greater transparency" about the cost and quality of medical care for years, and while there have been many advances, they are still not very transparent to you or me. Your choice of hospital will most likely rest on your physician, your insurance company and perhaps advice from friends and family. But if you are willing to do a little homework you can find a few good nuggets of information out there.
Information on hospital costs is very limited; most of the Web sites below only provide data about the quality of select procedures offered at various institutions. There are basically three kinds of resources: those provided by state or federal governments, private consortiums and insurers. You will need to check out all three to get the best picture possible of a particular hospital. Government Sites The most often cited government source is the Hospital Compare
tool offered through the Centers for Medicare & Medicaid Services. This Web site shows how often a provider gives recommended care for a limited number of procedures at hospitals nationwide: heart attacks, heart failure, pneumonia and surgery care/infection prevention. You can search by the name of the hospital or by location. (Oddly enough, you can't sort results for the best hospitals, either on this site or any of the others that I reviewed.) I found the table view easier to read than the graph format. Look for a hospital with a large number of patients treated for the procedure with a high rate of providing the recommend care. My guess is that the information for pneumonia and surgery care will be the most useful, since you probably won't have time to check into hospital quality when you are having a heart attack.
There are also a number of states that offer some information on hospital quality but many of them, including New Jersey and Washington, simply use the Medicare data, presented in a different format. Others offer a lot more. California's
Web site supplements the Medicare data with feedback from patients about their experiences as well as data on patient safety for 210 hospitals in the state. The New York State Hospital Report Card provides indicators on mortality, patient safety and volume for a large number of procedures and conditions. You can either select hospitals based on region and procedure or you can view up to five facilities to compare on all procedures and conditions. The site also offers patient feedback on quality of care, but only on 14 participating hospitals. An added convenience is links to other sites including some mention here in this article. At New Hampshire's Web site you can find estimated costs based on claims data collected from insurance companies operating in the state. Select the tab for Health Costs by Procedure, scroll down and click on the middle button for Health Costs for Insured Patients. You can then narrow your search to preventative health procedures, emergency visits, radiology, surgical or maternity. Then you will be asked to enter your zip code, insurance carrier, plan type, deductible and co-insurance rate. Results include a list of area hospitals, the estimated cost to you, the amount the insurer pays, and an accuracy level of the figures. I was very impressed with the simplicity of this resource and its availability to the public. If more states followed this lead in collecting the data directly from the insurers, it would be a great service to us all.
Private Entities Topping the list of private entities offering information on hospital quality to the public is the Leapfrog Group. The organization assesses hospitals' use of computerized physician order entry systems, intensive care unit staffing levels, performance of several high-risk procedures, and progress on 27 safe practice guidelines. The group released its
list of the top 41 hospitals last month. The Joint Commission on Accreditation of Healthcare Organizations is well known within the provider industry. Hospitals work very hard to meet accreditation standards set by JCAHO that cover performance issues as they relate to medication, treatment of pain, staffing and infection control. While it may not be an organization you have heard of, JCAHO does provide quality information and reports to the public. I recommend you check out this Web site. You should first check the hospital's accreditation status, paying attention to what actual programs and services JCAHO has accredited. The company uses a check mark and plus/minus signs (which I found a little confusing at first, so I downloaded the user guide) to highlight a providers compliance with patient safety goals such as reducing the risk of infections and harm resulting from patient falls. Information on quality improvement goals relating to heart attack, heart failure and pneumonia care are culled from the Medicare dataset mentioned above, and then compared to other accredited organizations.
Unlike LeapFrog or JCAHO,
HealthGrades primarily aggregates information from both private entities and public sources to compile the Hospital Quality Report at a cost of $17.95. The report attempts to present the information in a consumer-friendly manner. However, if you are actively engaged in trying to assess a hospital you are probably in a position to visit the individual sites yourself and get the same information. Insurance Companies One of the best sources of information available to you will most likely be through your insurance company. A big advantage to using your insurer's Web-based tools is the ability to find cost data. That is if you are lucky enough to be a member of an insurer that makes this information available. Companies moving aggressively into health saving account products will need to provide this kind of information to customers in a user-friendly format if they want to make these products successful. Policyholders of HSA-linked products have a greater incentive to price shop due to the larger deductible on those plans. However, with increases in cost-sharing and out-patient procedures that may fall below your deductible, many more of us have an interest in the prices and quality of the services we are getting. Aetna ( AET) announced plans last month to expand its online tool to include cost comparison data for common medical procedures. This tool will initially be available to members in 11 states plus the Washington, D.C. area. Members will be able to find information based on location or facility name and then by procedure. Display results will include the range of the entire cost charged by both the physician and facility from admission through discharge on over 30 common procedures -- such as colonoscopies and hysterectomies. UnitedHealthcare's Web-based tool takes this process one step further, providing customized member spending estimates based on their plan design, the amount of deductible used to date and if the provider is in-network or not.