Thinking About Health: Patients grade their local hospitals
April 24, 2015
The government has just announced its first-ever star ratings http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-04-16.html of the country's hospitals based on patients' assessments of the care they received. Other organizations have dabbled in this ratings business, many of them to make a buck by selling their rankings. And it's not uncommon for some of these outfits to get licensing fees from hospitals that get glowing report cards they can then use to market themselves.
I've tended to view those ratings schemes with skepticism. The government's ratings, however, don't come with any of that baggage and don't appear to be sugarcoated for commercial purposes. Only 251 of the 3,500 or so hospitals that received a rating got the top score of five stars — about 7 percent of the total. It turns out many of them are small specialty hospitals like the Heart Hospital at Deaconess Gateway in Newburgh, Indiana.
I checked the http://kaiserhealthnews.org/news/only-251-hospitals-score-five-stars-in-medicares-new-ratings/ rankings for the seven states participating in the Rural Health News Service. Nebraska, South Dakota and Indiana scored in the top group with hospitals averaging the most stars. Colorado, Wyoming and Illinois ranked in the second highest group, and California was in the bottom tier where hospitals averaged the fewest number of stars.
The government gathers its data by randomly selecting both Medicare and non-Medicare patients and asking them to fill out a questionnaire about their experiences in the hospitals. They are asked if doctors and nurses always communicated well with them; if the area around their rooms was quiet at night and bathrooms were clean; whether the staff explained medications before administering them and patients' pain was controlled; whether they were given discharge instructions when they left the hospital and whether they understood them; whether they received help as soon as they wanted it and whether they definitely would recommend the hospital to others.
While there are many other components that measure differences between a really good hospital and one that's so-so such as infection control, patient safety and clinical outcomes, patient experiences are nothing to be sniffed at http://www.cjr.org/the_second_opinion/how_reporters_can_improve_coverage_of_medical_errors.php.
Why would any patient want to have an operation in a hospital where the bathrooms weren't clean and they'd always be yelling for pain relief? The problem is many patients have no choice when they need a hospital procedure. They go where their doctors go. Certainly they have no choice when an emergency arises. But in parts of the country where hospitals are competing for your business — and, yes, hospitals are now very big businesses — you might be able to use such http://cdn.kaiserhealthnews.org/attachments/HospitalStarsForPatientSatisfaction.pdf ratings when you choose your next health insurance policy.
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Increasingly, insurers are asking patients to pick policies that come with very narrow provider networks. Carriers are giving the lowest premiums to policyholders who pick networks where doctors and hospitals have agreed to the prices insurers want to pay. Often those low-cost networks exclude well-known, marquee hospitals that often come with high price tags like Cedars-Sinai Hospital in Los Angeles, Memorial Sloan Kettering in Manhattan and Chicago's Northwestern Memorial Hospital.
If you will be facing such a choice of networks and the premium trade-offs that come with them — wider networks usually mean higher premiums — the government's patient satisfaction ratings might tip the balance in favor of one network rather than another.
If your doctors want you to go to a facility that has gotten middling ratings or low scores with one or two stars that should spark a conversation about what the doctors actually know about the care their patients are getting and why they want you to use a particular hospital.
Now that there is a more objective way to measure hospital experience, beware of all that hospital advertising http://www.healthnewsreview.org/2015/03/dissecting-pr-puffery-trudy-lieberman-guest-post/ aimed to make you think well of the facility and build the brand. The government's ratings show that sometimes there is no correlation between patient satisfaction and a hospital's advertising to promote its lucrative services.
In New York City where I live, three hospitals, which received mediocre ratings, advertise widely on TV sometimes featuring over-the-top success stories of patients who have been miraculously cured. They also use subway advertising and banners hanging from street posts to help build their customer base. Clearly the message for patients and doctors is: Come to us.
As I've written many times, shopping for healthcare is not as easy or as much fun as buying a new computer or car, but this latest crop of government ratings offers good, straightforward data to help with that task.
We'd like to hear your experiences with hospital care. Write to Trudy at firstname.lastname@example.org.
Editor’s note: The Rural Health News Service is funded by a grant from The Commonwealth Fund and is distributed through the Nebraska Press Assn. Foundation, Colorado Press Assn., South Dakota Newspaper Assn., Hoosier (IN) State Press Assn., Illinois Press Assn., Wyoming Press Assn. and California Newspaper Publishers Assn.