When you want to buy a car, you can test-drive a variety of vehicles before you make your choice. When you need a new pair of jeans, you can try on styles by various designers in pursuit of that perfect fit. But when you have a health problem that cannot be ignored, you can’t give hospitals or doctors a similar trial run. How do you choose which is best to treat your specific ailment?
The answer, of course, is complex. Once you’ve found out which professionals and institutions are covered by your healthcare plan, it’s not uncommon to ask friends or family members for referrals. But while word of mouth is undeniably valuable, more comprehensive “referral” resources do exist—and may make all the difference in your quality of treatment.
Say you live in the Chicago metropolitan area, and traveling for the best locally available care is not an issue. Hospital Compare (hospitalcompare.hhs.gov) was created through the efforts of the Centers for Medicare and Medicaid Services (CMS), the United States Department of Health & Human Services and other members of the Hospital Quality Alliance (HQA). Here, users will find a wealth of information submitted by hospitals—cold, hard facts on hospital quality, procedure by procedure and hospital by hospital. The site presents accumulated data from hospitals on an aggregate of procedures and allows users to view side-by-side comparisons of hospitals.
In addition to such objective data, the CMS site (cms.hhs.gov) also includes the Hospital Consumer Assessment of Health Providers and Systems (HCAHPS), a national, standardized survey of hospital patients. The survey covers 18 substantive items that encompass critical aspects of the hospital experience including communication with doctors, communication with nurses, responsiveness of hospital staff, cleanliness and quietness of hospital environment, pain management, communication about medicines, discharge information, overall rating of hospital and recommendation of hospital. While many medical institutions already collect such information on their own patients’ satisfaction, the HCAHPS offers reliable standards and procedures for collecting and publicly reporting that information, thereby allowing users to make methodical and dependable comparisons across hospitals.
Once you have a short-list of quality hospitals in hand, find out whether any of the institutions employ someone who is responsible for the quality of services they provide. At the University of Chicago Medical Center, Dr. Bruce Minsky has held the title of chief quality officer since the position was created in January 2007. Cynthia Barnard leads a similar effort at Northwestern Memorial Hospital as the hospital’s director of quality strategies and chair of the Quality Measurement Advisory Task Force of the Illinois Hospital Association. “Historically, chief quality officers were very low in the leadership hierarchy, but now they have been brought to a level where they have top priority,” says Dr. Minsky, who is also an associate dean. “This is a growing trend.”
Dr. Minsky recommends the CMS website, pointing to some particularly useful data points. For example, one of the measures, called door-to-balloon time, indicates how long it takes for an emergency heart attack patient to be catheterized. “There are very clear data showing that the shorter the time between presentation in the [emergency room] and the moment when the catheterization is done, the better the outcome,” Dr. Minsky says. “In order to score well, the hospital has to do that within 90 minutes.”
For its part, Northwestern Memorial has gathered information from more than a dozen resources, including CMS and HCAHPS, to develop a Quality Report Card, which was made available on its website (nmh.org) last year. Readable and easy to understand, it offers data about the quality and safety of the hospital’s performance in a wide variety of fields including cancer, cardiovascular disease and stroke as well as pregnancy and newborn care. “We wanted to provide information for consumers that was useful, comprehensive, reliable, valid and honest on measures that are nationally accepted,” Barnard says. “If we don’t look great on some measures, that’s okay, because we’ll be working to improve them.”
Another useful resource, recommended by Dr. Minsky, is the “Best Hospitals” issue of U.S. News and World Report. More than 4,800 hospitals were evaluated for the survey published in 2009, and 174 were chosen for the list. In that report, 11 specialties of both the University of Chicago Medical Center and Northwestern Memorial were ranked among the top in the country. “The majority of the information is subjective and based on the opinions of individual physicians, but there are more objective measures as well, such as the nurse-to-patient ratio,” Dr. Minsky explains.
With all of these available resources, choosing a hospital known for the quality of its care and its safety record is no longer such a guessing game. But what about the best doctor to treat your back pain, your migraines, your sleepless nights, your risky pregnancy or your hip replacement surgery? Many hospitals, including the University of Chicago Medical Center and Northwestern Memorial, offer profiles of affiliated doctors that will give you a wealth of information. You can find specialists considered leaders in their field, along with the number of years they have been in practice, the research they have done and the awards they have received. And most doctors have their own websites featuring applicable qualifications and professional experience.
Of course, biographical information doesn’t tell the whole story. When evaluating possible physicians, it’s important to ask how many cases of a particular disease he or she has seen.
“In the field of oncology, for example, there are very clear data showing that for complex surgical operations, the outcome depends on the number of procedures a doctor has performed,” Dr. Minsky says. He nevertheless points out that selecting a doctor is not an easy process. “Rating doctors is very difficult, because part of a physician’s rating can be based on technical expertise, but there is no measurement for his or her communication skills.” Fortunately, Minsky says that communication skills are now often being taught in medical schools.
Clearly, technical achievement is not the only factor to consider—one of the reasons why Barnard still recommends old-fashioned, word-of-mouth referrals from current and previous patients or from other trusted physicians. There are also environmental elements to consider: You might decide that you want a doctor in a large practice, because you have a better chance of seeing a physician in an emergency, or you might prefer a small institution, because you can get to know the doctors better. Soon, Barnard plans to post on the hospital’s website a comprehensive list of questions to ask when choosing a doctor. For example, you might like to find out if a doctor always has same-day appointments available for urgent cases.
In addition to U.S. News and World Report, a number of other publications offer some guidance in selecting a physician. Nonprofit organization Consumers’ Checkbook asked some 340,000 physicians around the country for the names of specialists they would trust to treat a loved one. The results are published in Consumers’ Guide to Top Doctors ($25, checkbook.org), which lists more than 23,000 doctors in a wide range of specialties. Castle Connolly Medical Ltd. publishes America’s Top Doctors® ($79.95 hard cover, $34.95 soft cover, castleconnolly.com), which is based on mail and online surveys of physicians and healthcare specialists.
Still, readers should be cautious. “I wouldn’t put a lot of emphasis on these kinds of guides because some of them are based on popularity,” Dr. Minsky says. “Just because doctors are not in the directory doesn’t mean they are not outstanding physicians.”
According to Barnard, “The rankings are limited by the nature of the measurements, so it’s important for people to take a look to see how the data was collected and what the survey measures. This only highlights the fact that it is very important for the industry and researchers to come up with better ways to measure the performance of doctors, [in a way] that will be meaningful to patients.”
For additional information on these and other resources, please read “Online Resources for Choosing a Hospital or Doctor”.
Originally published in Chicago Health Spring 2010
