How to choose a hospital

In the market for a new hospital?

This last week I’ve spent quite a bit of time researching hospitals online. Why?

First, I recently posted about the book, Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care, which questions the safety standards of American hospitals. The author, Dr. Marty Makary, writes about the difficulties both patients and patient safety advocates have in choosing and evaluating hospitals when the necessary information is not made public.

Second, my family is in the process of choosing both a new insurance plan and a new hospital and doctors. Our current health plan has been cancelled, and our current doctors/hospital will no longer be “in-network” with any of the new plans available to us.

Luckily, I still have several hospitals from which to choose, so I’ve decided to look for a hospital first, and then select doctors who use that hospital.

But, as Dr. Makary pointed out in his book, it’s not easy to determine which is the best/safest hospital in the community. I can get recommendations from friends and colleagues, of course, but I’m also interested in more objective data.

Ratings, rankings, grades and more

There are many websites and online tools that offer help. But each site is run by a different company with different motives. And each company uses different measuring criteria to evaluate different aspects of patient care.

With so much “different,” how do you know what should be measured and how?

Hospital ratings – Consumer Reports

I found Consumer Reports’ overview of hospital safety very helpful.  Last year they began publishing hospital ratings, just as they do for other consumer products. You have to be a subscriber to access their ratings list, but the overview explains the most common criteria used for judging a hospital–infection rate, readmission rate, quality of communication, and overuse of CT scans. It’s a good primer when starting your search.

Hospital Compare – Medicare

Most hospital ratings make use of Medicare data, the only publicly available statistics. Hopsital Compare is Medicare’s own website, and offers an easy-to-use tool to search for hospitals by name or location and compare them side-by-side.

In addition to such statistics as readmission and infection rates, death rates and use (or overuse) of medical imaging, Hospital Compare uses patient satisfaction surveys to report more subjective considerations such as cleanliness, pain control, patient education and communication.

Hospitals are also compared to state and national averages.

Why Not The Best?– The Commonwealth Fund (My pick!)

I really liked this website. The Commonwealth Fund is a private foundation that works to promote quality standards and measurements in health care.

Their Why Not The Best? online tool uses the Medicare data as well, but also utilizes a broad range of information from the American Hospital Association (AHA), the Centers for Disease Control CDC), the Agency for Healthcare Research and Quality (AHRQ), and county health rankings.

I was able to see not only the usual information about death rates and readmission rates, but also status of electronic health records, average costs for joint replacements or cardiac care and specific hospital and patient safety quality indicators.

The information can be filtered in multiple ways, depending on what is of most interest to you, and several hospitals can be compared at once. You can also save reports to look at another time.

Hospital Safety Score – The Leapfrog Group

The Leapfrog Group is well known in patient safety circles. It’s an organization founded by a group of business leaders who were concerned about the impact of skyrocketing health care costs on their companies. They have focused on patient safety, the prevention of costly medical errors, and hospital transparency.

The Hospital Safety Score is an A to F grade that is based on the Medicare data (again!) and Leapfrog’s own patient safety questionnaire.

Unfortunately, you can only see details on one hospital at a time, rather than being able to make side-by-side comparisons.

Quality Check – The Joint Commission on the Accreditation of Hospitals

The Joint Commission has been around forever and its job is to, well, accredit hospitals. Hospitals must meet certain standards and criteria to be accredited, or they cannot treat Medicare patients and take Medicare money (and they all want Medicare money!).

Quality Check tells you the hospital’s accreditation status and whether it has the Joint Commission’s “Gold Seal of Approval”. The seal is “an indicator that the organization has proven its commitment to high quality patient care and its willingness to be measured against the highest and most rigorous standards of performance.”

Whatever that means.

Two other popular rating websites are Healthgrades and the annual US News & World Report Best Hospitals.

I found Healthgrades difficult to navigate and understand the information presented. The US News rankings I consider more of a marketing tool for hospitals than a useful tool for consumers.

Nothing’s perfect

Naturally no one website can give me or you all the information we would want before making such an important choice.

But the sites I have highlighted are maintained by organizations that are committed to improving hospital quality and patient safety, and I would recommend all of them.

In fact, use all of them when comparing hospitals in your area. A good hospital should score high across all the different measurements used by these websites.

And depending on your health needs and what you value in a hospital, you might choose differently from someone else.

I have an enormous deductible, so I am most interested in information about the average costs for specific conditions and the average number of CT scans ordered (the fewer, the better). Someone else might be more interested in cleanliness and infection rates.

I know I’m fortunate to live in an urban area with several large medical centers. Rural locations, especially when combined with a narrow-network health plan, can severely limit hospital choice.

Sláinte!

Frugal Nurse

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