By Eleanor Laise, Kiplinger Retirement Report
Choosing a good hospital shouldn’t seem all that difficult. If you’re facing surgery or another procedure, you can seek the advice of your doctor, family and friends. But consumers who want to dig deeper — delving into hospitals’ quality, safety and affordability — can quickly become confused and concerned.
You can consult an ever-growing array of hospital “report cards” that grade facilities based on patient satisfaction, infection rates, surgical outcomes and other factors. But these reports often offer conflicting scores, and a hospital highly rated by one system may fare poorly on another.
Even hospitals with good scores on surgical outcomes could fail the safety test. There are special concerns for older people. For example, more than 80 percent of deaths associated with Clostridium difficile, a common hospital-acquired infection, occur among people 65 and older, according to the U.S. Centers for Disease Control and Prevention.
Add in financial considerations — such as whether a hospital participates in your health plan’s network — and the process of choosing a facility becomes even more complex.
“Both prices and quality vary immensely from hospital to hospital,” says Chris Duke, director of the Center for Consumer Choice in Health Care at Altarum Institute, a nonprofit research and consulting group.
Although many organizations are racing to grade hospitals, Duke says, “no one has solved the puzzle” of producing a comprehensive, consumer-friendly assessment of hospital safety and cost. What’s more, a recent study comparing four major hospital-rating systems found that no hospitals rated highly on all four.
That makes it essential for consumers to look beyond lists of “best hospitals.” Overall hospital ratings “may not give patients a set of information that is most relevant to their reasons for seeking care,” says Akin Demehin, senior associate director of policy at the American Hospital Association. Consumers need to seek out the information that’s most meaningful to them — whether it’s a hospital’s infection rates, outcomes on particular procedures such as knee replacements, or the availability of financial assistance.
Even if you really don’t have a choice of hospitals — perhaps because there’s only one local hospital in your plan’s network where your procedure can be performed — it’s still vital to do your homework. If you look at the facility’s quality and safety data before you’re hospitalized, “it arms you and your family to be on the lookout for potential problems when you’re in the hospital,” says Carol Cronin, executive director of the Informed Patient Institute, a nonprofit organization that analyzes consumer health care information.
More hospital ratings are on the way. The Centers for Medicare and Medicaid Services (CMS), which offers data on more than 4,000 hospitals on its Hospital Compare tool, plans to start issuing overall hospital star ratings next year.
While ratings can play an important role in helping consumers make decisions, “one does need to have a buyer-beware attitude,” says Matt Austin, an assistant professor at Johns Hopkins Armstrong Institute for Patient Safety and Quality and lead author of the study comparing hospital report cards. “Dig into it. Don’t accept it at face value,” Austin stresses.
The patient experience
If your primary concern is a complex surgical procedure, looking at patients’ own assessments of their stays at a particular hospital may not seem a top priority. After all, if patients’ health outcomes are good, does it really matter if they felt respectfully treated by the hospital staff or if their room was quiet at night?
Recent research suggests the answer is “yes.”
“There’s a “striking link between respectful treatment and patient safety,” says Lisa McGiffert, director of the Safe Patient Project at Consumers Union. In a recent Consumer Reports survey of hospitalized patients, those who said they were rarely treated respectfully by hospital staff were 2.5 times more likely to suffer a hospital infection, wrong diagnosis or other medical error than those who said they were generally treated well.
You can compare the patient experience at various hospitals using the CMS Hospital Compare tool. Enter your city or state, select up to three hospitals to compare, and click the “survey of patients’ experiences” tab. In April, CMS added star ratings to the site to help consumers understand its extensive patient-survey data.
Now, each hospital has an overall patient experience rating of one to five stars as well as star ratings on specific measures such as how often patients’ rooms were kept clean and how often staff explained medicines before giving them to patients.
Safety
While patients’ experience with a hospital can be an important starting point for consumers, hospitals “can really focus on making people happy while still harming them,” Cronin says. Preventable hospital errors cause more than 400,000 deaths per year, according to a 2013 study in the Journal of Patient Safety.
To safeguard your health, investigate a hospital’s ability to prevent medical errors, accidents and infections. Go to www.qualitycheck.org to see whether the hospital has Joint Commission accreditation — an indication that it has a basic commitment to meeting quality and safety standards. The Joint Commission is a not-for-profit group that accredits more than 20,000 health care organizations in the U.S.
The Leapfrog Group, a nonprofit founded by large employers and other health care purchasers, assigns an A-through-F safety grade to more than 2,500 hospitals. Enter your location at www.hospitalsafetyscore.org to see local hospitals’ overall safety grade, as well as scores on measures such as patient falls, dangerous objects left in patients’ bodies, bed sores and hand-washing.
Infections related to hospital care affect about one in every 25 hospital inpatients. To delve into a hospital’s track record on infections, go to Hospital Compare and click the “readmissions, complications and deaths” tab, then scroll down to “healthcare-associated infections” and click “view more details.”
There, you’ll see the “standardized infection ratio,” which helps to make apples-to-apples comparisons among different hospitals. If the standardized infection ratio is above 1, the hospital is “going in the wrong direction,” McGiffert says. “The closer it is to zero, the better.”
You can also call the hospital and ask what it’s doing to prevent infections, such as performing routine MRSA swab tests on patients admitted for surgery, says Karen Curtiss, founder of patient safety group CampaignZERO and author of Safe and Sound in the Hospital (PartnerHealth, $20). MRSA is a bacteria that can cause life-threatening infections.
Some state Web sites also offer detailed safety information. To find state-specific hospital Web sites, go to the Informed Patient Institute, select your state and choose “hospital report cards.”
Specific procedures
If you’re going into the hospital for a knee replacement or gallbladder surgery, you’ll want to check the hospital’s track record on that specific procedure.
Federal and state government Web sites offer some of this data. On the Hospital Compare site, for example, you can click the “readmissions, complications and deaths” tab to see a hospital’s rate of complications and unplanned readmissions for hip and knee surgery patients.
Also check your state health department’s Web site. The New York State Department of Health, for example, offers many years of hospital-specific data on cardiac surgery readmission rates.
Healthgrades analyzes patient outcomes for roughly 35 specific procedures and conditions, including hip replacement and abdominal aortic aneurysm repair. At Healthgrades.com, hospitals are awarded ratings of one, three or five stars for each procedure, based on patient complications and deaths.
Such data can reveal situations where a hospital that has a great overall reputation may not be the best choice for your specific needs, says Evan Marks, chief strategy officer at Healthgrades.
“The truth is, we may rate a hospital as one of America’s 50 best, but they may be rated one star, or ‘worse than expected,’ on knee replacement,” he says.
Also consider the volume of your particular surgery that each hospital performs.
“Practice makes perfect,” Cronin says. Unless the procedure is extremely specialized, she says, steer away from hospitals with very low volume, such as fewer than 10 procedures a year. The Leapfrog survey lists many hospitals’ volume data and survival odds for certain high-risk surgeries. (Click the question mark next to each hospital’s bar chart to get volume data.)
Staff and visitors
The quality of your — or your loved one’s — care will depend on the support staff as well as on the skills of physicians. You can ask about the staffing levels of nurses and other personnel, especially on weekends and holidays. Also find out about the availability of patient advocates, who may be able to intervene if you have complaints about your treatment, or social workers, who can help deal with special situations such as patients with dementia.
Sheila Sperber Haas, 72, a freelance writer in New York City, helped care for her father, who had Alzheimer’s, through several hospitalizations.
“When a person with dementia has to be hospitalized, the potential dangers are really intense,” Haas says. During the first hospitalization, her father suffered a significant increase in his dementia, including hallucinations, and Haas needed to hire nurse’s aides to stay with him around the clock. Faced with the same situation again, she says, “I’d want to have a relationship at the outset with either a patient advocate or a social worker” experienced with dementia.
Ask the hospital about accommodations for visitors — such as a pullout bed in your room where a friend can spend the night. Key times to have friends or family members with you in the hospital include nights as well as weekends and holidays — when staffing tends to be light — and when you’re being moved from one unit of the hospital to another. “That’s a prime time for errors to happen,” says McGiffert.
Also ask if the hospital has a “Condition Help” program. Condition Help, sometimes also called a “rapid-response team,” enables friends or family members to quickly call in a separate medical team if they feel a loved one is declining and not getting appropriate attention from the hospital staff.
Financial considerations
Determine whether the hospital is covered by your health-insurance plan and whether everyone involved in your care there is within your plan’s network.
“This is more difficult than it might sound,” says Mark Rukavina, principal at Community Health Advisors, in Boston.
Will Lameyer, 52, a retired bond trader in Portsmouth, N.H., knows that all too well. Last year, his wife was diagnosed with breast cancer and had a mastectomy and chemotherapy, as well as tests such as EKGs and MRIs.
Imaging done at their in-network hospital by providers who accept their health insurance was often sent off to another state for processing. But his insurer wouldn’t cover the bills because it wasn’t clear that the imaging was an in-network service. Lameyer spends 60 to 90 minutes on the phone each month trying to get such claims covered, he says. Some of the bills are “very scary,” he says. “It can be stressful.”
Often, people schedule surgery at an in-network hospital, only to be surprised by a big post-surgery bill from, say, an out-of-network anesthesiologist. In conversations with your doctor and the hospital, try to anticipate every type of provider that will be seeing you in the hospital and ask whether they’re covered by your plan.
“That will help eliminate unpleasant surprises,” Rukavina says.
Price comparisons among hospitals are a major challenge for consumers. Although online cost comparison tools abound, many are of little use to consumers because they don’t factor in the individual’s health coverage, experts say. You can call the hospital and ask for an estimate of your out-of-pocket costs.
Still, depending on your state and your insurer, you may have access to some useful cost-comparison tools. Michigan-based insurer Priority Health, for example, early this year launched an online “cost estimator” tool that gives members price estimates for specific procedures and facilities based on the individual’s plan information. And a Massachusetts law that took effect last year requires insurers to give consumers online access to estimates of how much they’ll pay for various health care services, including hospital procedures.
If you’re concerned about out-of-pocket costs for an upcoming hospital stay, check your prospective hospitals’ Web sites for their financial assistance policies. Nonprofit hospitals are required to have a financial assistance policy. Such policies, which are also often available at for-profit hospitals, may be offered to both insured and uninsured patients, Rukavina says.
“People shouldn’t be shy or reluctant to ask for it,” he notes.
Even if you don’t qualify for formal financial assistance, ask each hospital you’re considering whether they offer any sort of discount, such as a “prompt pay” discount for paying at or near the time of your hospital stay. If you’re facing a large bill, also ask about an extended payment plan, which may allow you to stretch payments over an extended period without owing interest.
