Hospitals, "Magnet" Hospitals, Physicians and Nursing Homes Ratings on the Internet
(8/10/08)- Theo Francis wrote an excellent article entitled, "To Be Old, Frail and Evicted: Patients at Risk" in the August 7th edition of the Wall Street Journal. In the article the author states?
"No one counts evictions nationwide. But formal complaints about nursing home discharge practices have doubled over a decade to 8,500 nationally 2006, making it the second-biggest category tracked by the federal Administration on Aging, trailing only complaints about unanswered calls for assistance. ..
Federal law- enforced by the states-says residents can be discharged involuntarily for just six reasons: if they are well enough to go home; need care only available elsewhere; endanger the health of others; endanger the safety of others; fail to pay their bills; or if a facility closes its doors. Even so, nursing homes must give residents at least 30 days notice, explain their appeals rights, and put together a plan to make sure the move doesn't harm them."
(5/29/08)- The data that is available in www.hospitalcompare.hhs.gov continues to expand with the passage of time. This Website was created by the Federal Government's Centers for Medicare and Medicaid Services in collaboration with the Hospital Quality Alliance (HQA). The HQA represents associations for consumers, hospitals, doctors and nurses, employers, accrediting organizations and various other federal agencies
(4/27/07)- Patient satisfaction with U.S. hospitals rose slightly according to a recent survey conducted by Press Ganey Associates, a health-care quality firm. The survey involved 2.3 million patients at more than 1,700 hospitals throughout the country.
Hospitals averaged a rating of 84.2 on a 100-point scale, up 1.2 points from 5 years ago. Room conditions, food quality and the discharge process continued to draw the most complaints. Over one-half of the respondents had negative comments about the room conditions, with over one-third of the respondents complaining about the food and the discharge process.
Small hospitals scored better with patients than bigger ones, with small being defined as a hospital with 50-beds and large being a hospital with over 600 beds. Patients over 80 years of age were the least satisfied age group, with the most satisfied age group being those in the 65 to 79 age category.
Hospital obstetrics and gynecology services received the highest satisfaction scores, followed by anesthesiology and intensive-care units.
(11/18/06)- We at therubins received the
following e-mail from Mr. Earl Thurston[ "I run the site www.DoctorScorecard.com
which people use every day to rate doctors. The site is free for
everyone to use and will always remain that way. Would you kindly
consider adding a link to your site, letting people know that
this site exists for sharing information about specific doctors?
If you visit the site you will see how people are exercising
their freedom of speech to put the word out about good and bad
experiences with health professionals. I feel strongly about our
right to compare notes on doctors so I am trying to spread the
word to let people know the site exists.
(1/27/06)- The New York State Department of Health opened a Web site that allow people to check how their local hospitals perform on a number of surgical procedures and other treatments. The data will include ratings on the treatment of heart attacks and pneumonia, and the prevention of surgical infections. The information is available through the department's main Web site, www.health.state.ny.us.
(4/9/05)-The Medicare Modernization Act of 2003 included a 0.4% payment boost for hospitals that would participate in providing certain information that the government could use to create a site that would compare hospitals against each other. All but about 60 of the nations 4,200 general hospitals turned over the data that now appears on the site Hospital Compare( www.hospitalcompare.hhs.gov or www.medicare.gov ).The new Web site is free for usage. Please keep in mind that you can use the Medicare's Web site to locate a nursing home in your area, and to compare it with other nursing homes in regards to violations and complaints. It also contains key data as to the staffing and number of residents in the home you are looking at.
The site offers data on 17 widely accepted quality measures in treating heart attacks, heart failure and pneumonia. It shows how the hospitals compare with state and national averages, as well as against their peers. This site can be used in conjunction with the Leapfrog Group site that we referred to on 5/09/04 to help the consumer get a better picture as to which hospital is performing best in the area where you live.
(5/09/04)-The Leapfrog Group launched a site that has a set of ratings aimed at helping patients assess hospital safety in July 2004. The group will survey about 1,300 hospitals on 30 key safety practices, ranging from guidelines for preventing mistakes to general measure such as whether hospital managers are making safety a priority issue. The survey was designed at the nonprofit Texas Medical Institute of Technology under the leadership of Charles Denham, a physician and founder of the organization.
Leapfrog started evaluating hospitals four years ago by three "leaps," or measures of hospital quality: investment in computerized prescription systems, the use of specialized doctors in intensive-care units, and higher volumes of certain medical procedures. The safety survey will become the fourth "leap". Leapfrog will score hospitals progress on 27 new measures.
Rankings will be posted by state on the site in July www.leapfrog.com and hospitals can update the data monthly.
Two separate studies throw doubt about the theory of using volume as the sole determinant in evaluating the best hospital to get treatment for a particular ailment. The relationship between the number of procedures done in a particular hospital and their successes has become a widely recognized measurement of the hospital quality.
In the case of heart bypass surgery, a study done at the Duke University in Durham, N.C. in which 267,089 artery bypass graft procedures done at 439 U.S. hospitals during 2000 and 2001 seemed to prove this point. Eric D. Peterson, the principal investigator on the study and a professor of medicine at the University it is individual patient risk and other characteristics that have to be looked at that are more important than just looking at the number of procedures that were done at a particular hospital. The results of the study were published in the Journal of the American Medical Association.
According to a representative from the Leapfrog Group, a coalition of large employers and insurance companies that seeks to help patients chose the best hospitals, they were not surprised by the results of the study. R. Adam Dudley, a Leapfrog national advisory member and associate professor of medicine and health policy at the University of California at San Francisco stated: "Volume is a weak indicator, but it's better than nothing. Until hospitals and surgeons are willing to five up the data that is needed to get risk-adjusted outcomes, you shouldn't by surprised if people use volume in the meantime".
Volume also turned out to be a poor indicator of quality care for babies who weigh under about 3 1/2 pounds at birth according to a study headed by researchers at Rand Corp., a non-profit research organization. This study analyzed mortality among very low-birth-weight infants born over a five year period in hospitals in the Vermont Oxford Network, a voluntary collaboration of hospitals with neonatal intensive-care units.
Health-mart net provides hospital comparative pricing and quality data by disease. Since the information is based on Medicare patients, senior citizens and their families can draw some general idea of how hospitals differ within their communities.
Health-mart is a web site that contains hospital pricing and outcome data by disease for virtually every hospital in the U.S.. Users of the site can compare how long a hospital stay may last for a particular condition, as well as the expected cost. A hospital report card identifies the top hospitals for any given disease based on length of stay, pricing and mortality that occurs during hospital treatment.
Additionally, Health-mart.net provides Medicare price schedules for durable medical equipment. The prices can be viewed by state.
From a public policy perspective, Health-mart.net can be a tool to direct healthcare consumers to the highest quality hospitals. Quite often, these institutions are also the ones that are excellent healthcare values in terms of their charges"
If you are interested in finding out how your local hospital compares with others in your area, there is a web site with this information. You can find data on the clinical outcome & diagnosis at 5000 US hospitals involving 36 million Medicare patients from 1997 to 1999. The site now includes a database for ratings of physicians, health plans and over 17,000 nursing homes.
The web address is: http://www.health-mart.net
To view the Centers for Medicare and Medicaid Services site see: www.cms.hhs.gov/quality/hospital
Another good site to use in connection with this type of research is: http://www.healthgrades.com
The Alliance for Quality Health Care/Niagra Health Quality Coalition , an organization that is sponsored by 3,600 employers and 31 insurance companies is sponsoring a free site that will provide information on more than 200 hospitals in New York State. The site is located at http://www.myHealthFinder.com The site gives a scorecard to rate and compare every hospitals in the state in connection with life-threatening illnesses. The information covers the treatment for strokes, heart attacks, congestive heart failure, gastrointestinal hemorrhage, pneumonia and hip fractures. The data-base is risk adjusted for mortality and volume for specific procedures.
Empire Blue Cross & Blue Shield has a site where you can compare data about New York state hospitals. Its Web address is www.hospitaliq.net. For California hospitals Health-Scope.org has the data that you may be looking for.
Once you have the results of how your local hospital did with the three cardiac procedures, the question now becomes what do you do with such data. You may know that U.S. News & World Report in its July 27, 1998 issue published a list of "Americas best hospitals: where to find top medical care in 16 specialties." This could help you compare the clinical outcome hospital statistics published by the government and the "best hospitals" list and come up with a good choice of hospital to enter for treatment. But wait, there may be more to this "choice" then you think.
The New England Journal of Medicine, in its January 28, 1999 issue published the results of two studies that you will need to factor into your choice. One study originated in the Department of Medicine at Yale University School of Medicine, Section of Cardiovascular Medicine and Section of Chronic Disease Epidemiology Department and the other at The Center for Health Policy, Law and Management and The Department of Medicine, Division of Cardiology at Duke University. The credentials of these medical centers would seem impeccable.
Another critical factor in evaluating a hospital is the nurse to patient ratio. Certain hospitals are classified as "magnet" hospitals. For a hospital to qualify as a "magnet" hospital it must be certified by the American Nursing Association as meeting certain nursing standards. A list of 28 magnet hospitals can be found at http://www.ana.org/ancc/magnet.htm. A recent study headed by Linda Aiken, professor of nursing at the University of Pennsylvania School of Nursing, found that "magnet" hospitals reported five fewer deaths for every 1000 Medicare patients who were discharged.
The Yale University School of Medicine study, "Do Americas Best Hospital perform better for acute myocardial infarction (lead investigator, Jersey Chen), attempted to look at a rather elusive concept, comparing the quality of care in teaching hospitals with that in non-teaching hospitals. They compared the outcomes (30-day mortality rates) of about 150,000 Medicare patients with acute myocardial infarction treated at 60 top-ranked hospitals with outcomes of patients at 4612 other hospitals. They concluded "Admission to a top ranked hospital was associated with lower 30-day mortality after adjustment for differences in patients and hospital characteristics, but not after adjustment for the rates of use of aspirin and beta-blockers. These findings suggest that a substantial portion of the difference in mortality among patients with acute myocardial infarction that has been observed between top ranked hospitals and others was associated with the higher rates of aspirin and beta blockers." (Italics added.) Importantly, this result has nothing to do with any form of high technology. It just followed the American College of Cardiology/American Heart Association Task Force on practice guidelines published in 1996.
Now let us look at the second study in the same issue of the New England Journal of Medicine, the one done at Duke University (lead researcher Donald H. Taylor), entitled "Effects of admission to a teaching hospital on the cost and quality of care for Medicare beneficiaries". The results indicated "the only significant survival advantage associated with admission to major teaching hospitals was for hip fractures ." (Italics added.). Again a question arises as to the kind of setting a Medicare patient can get the best quality of care.
These two studies dealt with outcome criteria. Another survey study conducted at 48 Massachusetts hospital presents still another part to this developing picture. This time patients were asked about the quality of care received, i. e. how the hospital handled their emotional needs, treatment of their discomfort while in hospital, coordination and continuity of care and whether family was adequately involved in their care. "Americas best hospitals" (teaching hospitals) scored substantially lower than many hospitals with a non-teaching role (italics added.).
Thus non-teaching hospitals seem to have an edge in many of the human dimensions of patient care, while teaching hospitals success may be in very specific disease areas rather than an overwhelming advantage as reflected in surveys. Both types of hospitals need to incorporate the best features of each to ensure that Medicare patients get the quality of care that a society should be obligated to provide. Guidelines need to be followed in all types of centers and coordination of care needs to be assured even in the cases of the frail elderly with no social support system available to them.
If you are a hospitalized New York Medicare beneficiary and you have a quality of care complaint you may call 1-800-331-7767. If you feel you are being wrongfully discharged from a hospital you may call 1-800-446-2247 to have your discharge appealed.
New York State has just passed and Governor George E. Pataki has signed a law that requires the state to provide New Yorkers with extensive information about malpractice judgments and discipliniary actions against doctors practicing in the state. The site will include facts such as a doctor's education, hospital affiliations and professional awards. It will also include disciplinary actions against hospitals for violations such as harmful early dismissals of patients from their facilitiy.The measure is known as the Health Information and Quality Improvement Act and all hospitals and doctors will be required to post notices informing patients of the Web site address and the 800 phone number. the address and phone number is as follows:New York State Department of Health: http://www.health.state.ny.us or call 1-800-663-6114. This site shows you how to get birth, death, marriage and any other vital statistic records from the State of New York. You also can get the disciplinary record of any medical doctor in NY State.
Please see our other article: Ratings of Healthcare Organizations (HMOs)-Part II
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "HOW TO SELECT A NURSING HOME".
By Allan and Harold Rubin, MS, ABD, CRC, Guest Lecturer
Updated August 10, 2008
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