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Can You Really Choose the Best Hospital?
| August 28, 2012
As a longtime consumer reporter, I've always thought the best way to see how the marketplace works is to put yourself in the shoes of someone buying the product or service you're investigating.' ' After learning recently that I may need cataract surgery, it was time for me to check out the hospitals where that procedure might take place.
To begin my quest for the best, I searched for ratings for four New York City hospitals:' New York Presbyterian, Lenox Hill, Manhattan Eye, Ear & Throat Hospital, and the New York Eye and Ear Infirmary. I examined three ratings schemes readily available to the public on the sponsors' websites and that did not require payment or subscriptions to obtain the evaluations. My sample included US News & World Report, which has been publishing ratings of 'America's Best Hospitals' for over 20 years; the federal government's Hospital Compare, and The Leapfrog Group, an organization of public and private employers with a mission to improve medical quality.
US News & World Report picks the best hospitals nationally, the best regional hospitals, and this year it labeled some 'high-performing' facilities. It rates hospitals according to their performance on16 medical procedures, and its methodology looks at survival rates, reputation among doctors in each specialty, and patient safety'how hard it works to prevent errors. For four specialties, including ophthalmology, hospitals are ranked only on their reputation among specialists.
Preferences can mean a lot of things not all related to quality of care, and experts have told me some hospitals directly aim their marketing at doctors hoping that they will think positively about their facilities when they fill out ratings surveys. How well a hospital makes its doctors happy makes for ratings with limited value to me.
The ratings for these New York City hospitals were hardly comprehensive enough for a judgment. I learned that USNews ranked New York Presbyterian as high performing in ophthalmology and the New York Eye and Ear Infirmary was ranked number 10 nationally in ophthalmology. Lenox Hill did not receive a ranking for eye care. Manhattan Eye and Ear was not listed at all, but perhaps the magazine considered it part of Lenox Hill because they are in the same hospital system.
Hospital Compare is the federal government's contribution to the consumer ratings game.' On this site you'll find all kinds of information about hospitals, some of it probably not relevant to your situation.' ' That was the case for me.' I found data for all but Manhattan Eye and Ear, but I wasn't interested in stuff about heart attack or pneumonia care or death rates for patients with those problems--- given my immediate concern is about cataract surgery.
I did, however, find the patient satisfaction data potentially useful. Two dimensions of care stand out.' The percentage of patients that said staff always explained their medications before giving them. None of the three hospitals got above 59 percent, and New York Eye and Ear had only about half saying they knew enough about their medicines.' ' When it came to reporting whether pain was always well controlled, only about two-thirds of the patients said it was.' While those numbers don't tell me which hospital is best, they did signal I need to ask about any medicines I am given, including those for pain.
The Leapfrog Group gives hospitals a letter grade, which indicates how well it keeps patients safe.' That sounded useful. I may not die from cataract surgery, but medical accidents do happen more often than we think.' The Leapfrog website was hard to navigate, but finally I learned New York Presbyterian and Lenox Hill got a not-very-reassuring gentleman's C for keeping patients safe. But then almost all of the New York City hospitals listed were given C's.
Leapfrog also tries to assess hospital performance on standardized quality measures' by comparing their answers to a survey.' When I looked further, I learned that only one hospital in New York City (Harlem Hospital Center) voluntarily reports to Leapfrog any of this data on 11 common procedures. But regardless eye surgery wasn't among them. Relying on self-reported data is a shortcoming of many rating schemes.
No rating system is best; all have strengths and weaknesses. And no one system can guide people for every possible health need that arises. The bits and pieces of data I gleaned from the three sites did not provide a clear winner for me.' So like most patients, I will go where my doctor tells me to go and that is New York Eye and Ear.' Why, I asked him, do you go there? ' 'They are eye care specialists and know exactly what I need doing surgery.' Differences among hospitals may be subtle, he added, and that's what the doctor knows.'
For more on hospital ratings, in next week's post I will look into getting state and federal inspection reports and the survey report from the Joint Commission, the private accrediting body that supposedly scrutinizes hospitals to make them safe.
More Blog Posts by Trudy Lieberman
Trudy Lieberman, a journalist for more than 40 years, is an adjunct associate professor of public health at Hunter College in New York City. She had a long career at Consumer Reports specializing in insurance, health care, health care financing and long-term care. She is a longtime contributor to the Columbia Journalism Review and blogs for its website, CJR.org, about media coverage of health care, Social Security and retirement. As a William Ziff Fellow at the Center for Advancing Health, she contributes regularly to the Prepared Patient Blog. Follow her on twitter @Trudy_Lieberman.
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|Jim Jaffe says|
August 29, 2012 at 5:45 PM
the rating systems are as flawed as those for colleges and for the same reason (which isn't the pioneering work of USNews) -- because there's no agreement on what the metric should be. in any event, seems to me the right question is competence rather than the best. by definition, most people won't have access to the best, but all should be guaranteed adequacy. there's a real need to cull out providers where inadequate or incompetent care is the norm. and there's a natural tendency go to wherever your doc recommends, which isn't necessarily a bad idea. whether it is a good investment to come up with a more comprehensive and reliable rating system is an open question. I'm not particularly interested in having my health dollars invested there.
August 31, 2012 at 9:50 AM
This is helpful feedback on the Leapfrog Group website (www.leapfroggroup.org) and our other initiative, the Hospital Safety Score (www.hospitalsafetyscore.org). Our goal is to make navigation smooth so we'll be in touch to understand more of the troubles you encountered.
Many hospitals in the five boroughs report voluntarily to Leapfrog, and many do well despite serving very challenged populations. (For instance, Montefiore). Nonetheless, New York City has one of Leapfrog's poorest response rates among hospitals. People in other major cities from Boston to LA have access to much more Leapfrog data on safety and quality, because apparently hospitals there think their residents deserve to know how they are doing. As a former NYC resident myself, I'd like to see New Yorkers like you, Trudy, ask your hospitals to report to Leapfrog. What you will find when you complete your analysis is that Leapfrog information is the standard in transparency, there's nothing that shows variation among hospitals on issues that matter to consumers more than Leapfrog. Others that report on hospital performance use CMS and Leapfrog data. Frankly, that's not a good thing, we need much more transparency among hospitals.
I wrote an editorial in the NY Daily News about the need for New Yorkers to apply their renouned ability to demand good service to the hospital industry. It is linked on the news section on the front page of the Leapfrog website: http://www.nydailynews.com/opinion/stop-medical-errors-transparency-shame-article-1.1131819?localLinksEnabled=false
Thanks again for the feedback. I hope you don't stop with your shopping: help us get more transparency.
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