A Patient’s Quest for Quality in Healthcare

October 5th, 2009 by DCPatient Leave a reply »

As part of an otherwise excellent presentation on the key drivers of rising healthcare costs, two slides purported to demonstrate that overbuilding of healthcare facilities was the result of inappropriate emphasis by patients on facilities’ cleanliness and convenience as measurements of quality.  The presenter’s point was that patients could not be trusted to assess healthcare quality since they chose such obviously silly metrics instead of judging and selecting hospitals or physician practices on the basis of cost, outcomes, or adherence to guidelines.

I had several thoughts in reaction, a few of which I can print – (1) With upwards of 2 million nosocomial (my favorite word) infections a year causing more that 100,000 deaths and complications, cleanliness is nothing to sneeze at; (2) in a past life I was taken to task by the HRSA administrator for making the point that there might be value in having the choice of  a transplant center close enough that families could support their loved one through a traumatic life event so I won’t comment here on the issue of proximity; but most importantly (3) patients judge what they can see.  If we make quality metrics such as cost, outcomes, and adherence to guidelines more accessible to patients then they will include those metrics in their decisionmaking.

And so I embarked on my own journey to see how readily available patient-friendly quality data is for patients.  First I looked for information on hospital information.  Hospital Compare http://www.hospitalcompare.hhs.gov/, an HHS website powered by Medicare data, allowed me to compare hospitals within a radius of my chosen zipcode on process of care (basically guidelines/evidence) adherence, outcomes like death, and patient satisfaction elements like physician communication or nurse responsiveness.  Interestingly, among the subset of local hospitals I chose, quality was similar but median Medicare payment ranged from a two to four fold difference.  Still a limited set of procedures and conditions are included, I have no idea how patients with my demographics and characteristics fared, and the Medicare cost data may bear little relation to what I might actually pay under my insurance let alone self-pay.

Physician information is available in a variety of formats for various fees, typically $9.95 to $24.95 on websites such as HealthGrades http://www.healthgrades.com and Physician Reports http://www.physicianreports.com or compiled in the Consumer’s Checkbook Guide to Top Doctors or Castle Connolly’s various city-specific  Top Doctors.  Plugging in one of my specialist’s name I was able to get disciplinary actions (luckily none), board certifications, years of education, hospital affiliations and even ease of scheduling, however I had no idea from the information provided if my doctor was any good.

Lastly my health insurer has a premium designation that awards stars for quality and cost-efficiency.  I could not find the basis for those designations and having been ill-served by one of their “centers of excellence” in a particular specialty, you can color me skeptical.

My takeaway is that even for a highly motivated, insured, internet savvy patient, with fair familiarity with health care and health care jargon, comprehensive actionable physician and facility information is limited, hard to find or non-existent.

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  1. Tom says:

    Great post, Donna. While the intention of quality-transparency sites like HospitalCompare are in the right place, much is needed to turn those intentions into useful information for consumers and other healthcare “stakeholders”. It is particularly interesting that there was so much variance in cost (assuming the quality metrics showed negligible differences) between comparable providers in your area. What do you think needs to happen to make the public reporting process more meaningful to us as consumers, and thus to the healthcare “system” in the U.S. as a whole?
    Please keep writing!

    • DCpatient says:

      Tom, I think physician level data outcomes data is as or more important than overall hospital outcomes data. Just as we are developing more risk assessment calculators where you plug in your personal factors such as BMI, smoking, family history, I’d love to see a physician selection calculator where I could enter race, gender, age, answer questions that determine disease state or severity (such as heartburn sufferer vs. IBD patient), type of insurance and get a recommendation such as here are 3 doctors in a 20 mile radius who have outcomes at or above the national average in treating patients like you, the cost will be in this range, and here are links to the factors we used in making this recommendation. Personalized and tiered information would be the ideal.
      Thanks for the comment.