Photo (cc) by Fotos Gov/Ba
The best health care is just what the doctor ordered – but it’s not always what the patient gets. Hospitals are not all the same, and knowing the differences can save not only money but maybe your life.
According to a report out in February [PDF] from HealthGrades.com, “Patients have, on average, a 28.59-percent lower chance of dying at America’s 50 Best Hospitals compared to all other hospitals across 17 procedures and conditions,” including heart attack, stroke, and respiratory failure.
Improving your odds by more than a quarter isn’t necessarily a matter of “good” or “bad” hospitals – those judgments vary depending on many criteria, including the friendliness of the staff, the quality of the food, and the level of attention and service. The most important factor when it comes to high-quality medical service is experience. Some hospitals specialize in specific procedures or build a network of doctors who have expertise in a certain area.
The Cleveland Clinic in Ohio, for example, is known for its cardiac care. It’s been ranked number one for heart procedures by U.S. News & World Report for more than 15 years.
When Dr. Jonathan Berman needed heart surgery, that’s where his father – also a doctor – suggested he go. But he didn’t. Although he personally knew surgeons at the Cleveland Clinic and could easily have gone there, this plastic surgeon from Boca Raton, Fla., instead went to a local hospital for his procedure. We asked him why: Hear what he said in the video below, and read on for more advice about finding the best place for your own care.
It’s actually not surprising that Dr. Berman would stay local – West Palm Beach is home to six of Health Grades’ list of 50 Best Hospitals. Chicago and Cleveland each have four of the best. But not everybody lives near these cities, so here’s some advice:
1. Research local hospitals online. If you don’t have the time or money to fly out to the country’s premier health care centers, check out the expertise in your area. As health care reform moves forward nationally, transparency and accountability will become more important than ever, and hopefully judgments will become easier. But here are some resources you can use now:
- U.S. News Health
- U.S. Department of Health and Human Services’ Hospital Compare
- Joint Commission on Accreditation of Healthcare Organizations
- Consumer Reports Health ($5/month or $19/year)
You can also check your state’s health department.
While many consumers rely on resources like the ones mentioned above, when we asked Dr. Berman about them, he was skeptical. He’s of the opinion that knowing the people who work there is more important than a top rating by an outside organization. “You hear the ‘Top 50 Best’ things, but who’s doing the rating, what’s the criteria, how much do you have to pay to get in that thing? I don’t really know the answer for that,” he says. “But I do know that university hospitals are [categorically] number one.”
Health Grades agrees that teaching, nonprofit, and government-run hospitals often rank among the best. They don’t charge hospitals for participating or accept money in exchange for favorable ratings. You can check out their methodology here. The U.S. News & World Report methodology [PDF] is available online too.
2. Ask questions. Practice makes perfect, so find out about the specific expertise of both your hospital and physician and how often they perform specific procedures that are relevant to you. “The more times you complete a procedure, the more accustomed you are not only to the routine of that procedure, but if you things don’t go well, being able to respond to that,” says Jerry Fedele, CEO of Boca Raton Regional Hospital.
Dr. Berman adds, “What I like to believe about surgeons, you know, we’re all trained really well, but you have to know what you shouldn’t be doing and if your comfort level is there. If they’re not comfortable with the procedure, go somewhere else.”
3. Compare costs. As Stacy mentioned in the video above, not all hospitals charge the same amount for identical procedures. If you have insurance, obviously you want to make sure the hospitals you’re considering will accept it, as well as determining what your out-of-pocket cost might be. And especially if you don’t have insurance, remember that there’s nothing wrong with a bit of negotiating. See our story Confessions of a Serial Haggler.
As for determining prices, Vimo.com has average national prices for health procedures, and from there you can search for local prices, but you definitely won’t see prices for every procedure at every hospital. Some hospitals also voluntarily report cost information to the U.S. Department of Health and Human Services, and if they do, you can find it by doing a search by procedure and then clicking on the “Medicare Payment and Volume Data” tab.
Sometimes state hospital associations also have pricing information, like the Washington State Hospital Association. Your state government website, or its health department, may have resources too: Oregon.gov compares hospital costs, for example.
But the simplest way to determine cost is by the most obvious: Talk to your doctor and the hospital.
4. Get referrals. You can’t judge a hospital just by its rankings, online data, or buildings. “Cornell University Medical Center, New York – big Ivy League, super place – the building’s built in the early 1920s, stuff is falling apart, they keep revising and adding wings,” says Berman. “You’d see the pipes in the room, and the cubicle is small, but what makes the hospital so spectacular is the people working in that structure. The people make the hospital.” And the doctors know the people. Doctors and nurses you trust can recommend the best places to go for specific care because, as Dr. Berman mentioned in the video above, they “live, eat and sleep in them. We’re here all the time and see the goods and the bads.” Ask about both.
5. Plan for emergencies. While you never know exactly what might happen, you hopefully do know the existing conditions and health risks for you and your family. You might think knowing your local options isn’t much help in a true emergency, but being prepared means knowing what to expect when the ambulance is on the way. If you live near multiple hospitals, you may be able to request where it takes you.
Even if an emergency happens you can’t predict, some options are still better than others. For example, if you’re in a crash, Dr. Berman says, “you’re probably going to get great care at a community hospital, but you’re better off going to a trauma center where they deal with it on a daily basis.”
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