How To Determine Healthcare Provider Quality

Introduction

Healthcare Consumers should know that understanding the delivery of Healthcare Quality by healthcare providers is very important to their overall wellbeing and medical outcomes.  Simply put, if hospitals, doctors, etc… have medical outcomes below certain standards, the healthcare consumer could be exposed to medical treatments that are subpar.   Quality Indicators are the standards most healthcare organizations are rated.  Examples of quality indicators are; infection rates, readmission rates, falls, patient safety, bed ulcers, medication errors, etc.  The Institute of Medicine defines health care quality as “the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”. With that said, healthcare consumers should take the time to research the facilities, doctors, and related organizations to determine if they meeting or exceeding the basic quality standards.  The following survey results indicate the opposite:

A recent survey indicated that over 60% of the respondents were somewhat confident in understanding the quality differences among healthcare providers.  In the same survey, 44% of the respondents indicated that they valued a doctor’s education and experience in making decisions. Absent were quality indicators.  And lastly, respondents spent more time researching a vacation than doctors. The survey results indicate that the average healthcare consumer does not think healthcare quality is important.  Healthcare quality should be the first search consumers complete.

Determining quality for a hospital, doctor or other healthcare organization can be very difficult to understand and navigate.   Healthcare Consumer Navigator Center has researched web sites and reference documents available for the healthcare consumer to navigate and utilize.

The following sections will provide the healthcare consumer with web sites and reference documents to locate quality ratings for hospitals and doctors.

 Section I:  Web Sites

Section I is designed to guide the healthcare consumer to web sites that will provide quality ratings.  The following grid has three columns; Web Site Designation, What the Web Site Provides the Consumer and How it can Help the Consumer.

What this means to the Healthcare Consumer

The following web sites were developed by independent healthcare companies to help the consumer.  They contain very valuable quality rating data.  The healthcare consumer should use these tools prior to treatment at the healthcare facility or doctor if possible.  If the treatment was an emergency, use the tools during or after the treatment. The consumer now knows the rating of the facility and can manage their care appropriate to the ratings.  Asking questions and monitoring the care provided is always important regardless of the ratings.

Recommendation: As stated above use the tools at the appropriate time of the treatment.

 

WEB Site Designation

 

What the Web Site Provides

 

How the Web Site Helps the Consumer
http://www.leapfroggroup.org/compare-hospitals Choosing a hospital doesn’t have to be a daunting task—as long as you have the right tools. The Leapfrog Hospital Survey results can tell you a lot about a hospital, and if it provides safe, high-quality care.

Nearly half of all U.S. hospitals voluntarily provide data to our annual survey, and we put the data at your fingertips. Whether you want to know about a hospital’s C-section rate, safety protocols, or how frequently patients must be readmitted, you’ll find it all here. Look for hospitals with four green bars on the issues that matter to you. These hospitals have fully met the most rigorous standards set by our volunteer health care safety and quality experts.

 A very powerful tool for the healthcare consumer to use.
https://www.healthgrades.com/find-a-hospital Your risk of complications and death can be many times higher at one hospital than at another just down the road.

Here’s what you need to know to find the right hospital:

Doctors and Hospitals are Linked: Doctors have admitting privileges at only certain hospitals — so when you choose a doctor, you are choosing a hospital.

Care Quality Varies. A Lot: Some hospitals deliver significantly better care than others when it comes to specific conditions and procedures.

You Can Minimize Risk: If you need hospital care, use our industry-leading ratings to make sure your doctor can treat you at a hospital rated at least three stars in your area of care. The difference to your health can be dramatic.

A very powerful tool for the healthcare consumer to use that links Hospitals and Doctors
http://www.hospitalsafetygrade.org/your-hospitals-safety-grade Whether you simply want to know about the hospitals in your area, or you need to choose a hospital for surgery or other procedure, the Leapfrog Hospital Safety Grade should be your first stop for finding the best hospital for you and your family.

The Safety Grade can tell you more about things like:

·       How well does my hospital prevent infections and encourage hand washing?

·       Does my hospital value patient safety by supporting strong health care teams?

·       Are there protocols and standards in place for preventing errors at my hospital?

A very powerful tool for the healthcare consumer to use
https://www.qualitycheck.org/ The purpose of Quality Check is to list Joint Commission accreditation status. Organizations listed on Quality Check that are not accredited by The Joint Commission are for comparison purposes only and not to be considered an endorsement by The Joint Commission. Consumers should not rely on this information for choosing a provider without verifying its accuracy. A very powerful tool for the healthcare consumer to use
http://www.whynotthebest.org WhyNotTheBest.org was created by The Commonwealth Fund, and in January 2015, was transferred to IPRO, a national organization providing a full spectrum of healthcare assessment and improvement services. It is a free resource for health care professionals and consumers interested in tracking performance on various measures of health care quality. A very powerful tool for the healthcare consumer to use

 

Section II: Government Sponsored Web Sites and Reference Document

Reference Document:  Hospital-Acquired Condition Reduction Program Fiscal Year 2017 Fact Sheet

WEB SITE:  https://kaiserhealthnews.files.wordpress.com/…/hac-penalty-chart-for-2016_1210201…

 

What this means to the Healthcare Consumer

The healthcare consumer needs to know which hospitals are failing to manage Acquired Conditions. Acquired Conditions are potentially avoidable events that occurred to patients while they were patients in the hospital.  Examples of Acquired Conditions are; infections and complications such as blood clots, bed sores and falls. Hospital that failed are financially penalized.

RECOMMENDATION:  The Healthcare Consumer should review the published list of hospitals that have failed in their locale.  The list can be accessed by using the web site listed above. If a consumer or family member is admitted to a hospital that failed, the consumer can aggressively manage the care and treatment to avoid any issues.

The following is an overview of the program.

Program Overview

Section 3008 of the Patient Protection and Affordable Care Act (ACA) established the Hospital Acquired Condition (HAC) Reduction Program to incentive eligible hospitals to reduce HACs. Beginning in Fiscal Year (FY) 2015 (discharges beginning on October 1, 2014), the HAC Reduction Program requires the Secretary of the Department of Health and Human Services to adjust payments to hospitals that rank in the worst-performing quartile of all subsection (d) non Maryland hospitals with respect to risk-adjusted HAC quality measures. CMS will reduce payments to 99 percent of what hospitals would otherwise be paid for such discharges.

FY 2017 Results

In FY 2017, 769 of 3,203 hospitals ranked in the worst performing quartile, compared to 751 hospitals out of 3,211 hospitals in FY 2016. Across FY 2015, FY 2016, and FY 2017, the average performance across eligible hospitals improved for the mean Catheter-Associated Urinary Tract Infection (CAUTI) standardized infection ratio (SIR). The mean SIR decreased from 1.12 in FY 2015 and 1.17 in FY 2016 to 0.91 in FY 2017.

Hospital-Acquired Condition Penalties, Year 3

Medicare is reducing payments to 769 hospitals with high rates of potentially avoidable infections and complications such as blood clots, bed sores and falls. This is the third year of the Hospital-Acquired Conditions Reduction Program, which was mandated by the federal health law to reduce patient injuries. Hospitals will lose 1 percent of each Medicare payment during the 12 months that began last October. This chart indicates which years’ hospitals were penalized under the program.

Hospital Government Ratings; The Five Rating System

WEB SITE:

https://www.medicare.gov/hospitalcompare/search.htm


What this means to the Healthcare Consumer

This is a very powerful tool the Government has developed and made available to the Healthcare Consumer.  The web site above will direct the consumer to hospital compare. You can enter the hospital name or city/state to search for the hospital you are researching.

RECOMMENDATION:  The Healthcare Consumer should review the web site to determine the star rating of hospitals in their locale. If a consumer or family member is admitted to a hospital with a small number of stars, the consumer can aggressively manage the care and treatment to avoid any issues.

The following is an overview of the program.

What is the Hospital Compare overall rating?

The overall rating summarizes up to 57 quality measures- Opens in a new window on Hospital Compare reflecting common conditions that hospitals treat, such as heart attacks or pneumonia. Hospitals may perform more complex services or procedures not reflected in the measures on Hospital Compare. The overall rating shows how well each hospital performed, on average, compared to other hospitals in the U.S.

The overall rating ranges from one to five stars. The more stars, the better a hospital performed on the available quality measures. The most common overall rating is 3 stars.

 

How can I use the Hospital Compare overall rating?

In an emergency, you should go to the nearest hospital. When you can plan ahead, the Hospital Compare overall rating can provide a starting point for comparing a hospital to others locally and nationwide. Along with the overall rating, Hospital Compare includes information on many important aspects of quality, such as rates of infection and complications and patients’ experiences, based on survey results.

Choosing a hospital is a complex and personal decision that reflects individual needs and preferences. You should consider a variety of factors when choosing a hospital, such as physician guidance about your care plan and other sources of information about hospitals in your area.

Discuss the information you find on Hospital Compare with your physician or health care provider to decide which hospital best meets your health care needs.

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