Finding the Right HospitalSep 24, 2013
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Scot: There are a lot of different magazines and online resources to select the best hospital, but a lot of times these studies contradict each other. Recently, some of the highest-ranking hospitals in one magazine were the lowest in Consumer Reports. So as a health care consumer, whom can you believe? What can you do to ensure you get the best outcome? We've got Dr. Tom Miller, Chief Medical Officer for the University Utah hospitals and clinics here. And, first of all, why do we see so much variance in all these different rankings, from magazines to websites? What causes that?
Dr. Miller: There are different criteria that each of these groups use to define, in their opinion, what the best hospitals and clinics are. And that's the rub, Scot.
Scot: Yeah. So what are some of the criteria that they're using, and are some better than others?
Dr. Miller: Some are reputational, purely based on what certain physicians think are the best hospitals, so that's a reputational analysis. Some are based on certain data points, and input on outcomes. But there's not a lot of that going on. Some is based on consumer information that's out there. Some is based on government information that is available on the CMS websites. So it just kind of depends. And I think we have to remember that these rating systems are many times driven by the magazines and corporations that set them up as a way to sell copies. So we have to be aware of that a little bit.
Scot: Sure. Yeah, and we have no idea of knowing what kind of, what data, if it's good data that's going in. When somebody says, "We're the number one hospital." Based on what?
Dr. Miller: Yeah, you'd actually have to find out which group was rating them, and then read the report. They'll put the criteria in the report. But the problem is, right when you get down to the actual criteria, was that really valuable information? Hard to know. I still am struggling to figure out which one of those reports to believe myself. I don't know.
Scot: Really? You even don't know?
Dr. Miller: I struggle with that.
Scot: So, what's a consumer to do then? Well, first, before we do that, what's the controversy with the Consumer Reports rankings that just came out?
Dr. Miller: The controversy seems to be around the fact that it's not in line with some of the other major surveyors of hospital systems and healthcare. And there are many reasons they're pointing out that the Consumer Reports are different, and one of those seems to be that they're basing their analysis on billing data for length of stay. So a patient's length of stay in the hospital can be tracked based on the billings. And is that the best way to really know if a hospital is delivering quality care? Well, there are a lot of critics that say that's not the best way, and that when you look a billing data it's just that. Billing data. It doesn't really tell you much about the care, or the complexity of the care.
Scot: Sure. So they're basing it on, I come in, I should, according to national averages, stay after this surgery for two days. I've stayed for three, now there's a problem in the care.
Dr. Miller: You might think that, but it could have been that you were a more complicated patient, and you didn't have a bad outcome. It's just that you had to stay a couple days longer because you were at a bit of a higher risk to start out with. And that was accounted for by the physician that took care of you, but it wasn't reflected in the data.
Dr. Miller: And that seems to be one of the major complaints that I'm seeing as it relates to academic health centers, because many of them are saying, "We take care of sicker patients." Now we don't know that yet quite either. But we're trying to figure that out. So that's one of the reasons that some people are upset in our industry with the Consumer Reports.
Scot: Do you put any stock in the rankings of these various sources? Is there any valuable information for a consumer in any of it?
Dr. Miller: I think it's difficult because it's not granular enough information. Because I think what the consumer, what the patient and the patient's family seek is a sense of who's the best doctor for them? And does knowing that a hospital is the best hospital in the region answer that question? I think the answer is, maybe not. I think it's difficult to know.
And I think it's very difficult to get information at this point about who might be the best physician. My own family, I was trying to find a physician for one of my family members out of state, and I ran into the same problem. I went on the web, looked up names of local specialists in the city that my family member, my daughter, was in. And I really struggled to figure out who would be the best, except I would learn that they went to this medical school, they did a residency at another institution, and that just really isn't enough information to know if this would be the right person for my daughter.
It's hard to know. We just don't have data on outcomes, how well these physicians do, how well their patients think of them. We have a little bit of information, but it's nothing like you can find on other websites for other industries.
Scot: Yeah. So even for you, it was tough?
Dr. Miller: For me, it's tough.
Scot: So what is the best solution? I mean, how can we get good information?
Dr. Miller: I think as we go forward with electronic medical systems and with the pressure on hospitals and physicians to report their outcomes, their quality outcomes, we will see more and more information on how good physicians are. There will be report cards on physicians. Not only related to patient satisfaction, which is well underway, but on the way they deliver care, and how successful they are in delivering that care. I think it's all coming. But we're not there yet, so it's going to take a while.
Scot: What's the most important thing to take away from this conversation?
Dr. Miller: I think the best thing to take away from this conversation is when you do go to see a physician, you still have to ask questions that will help you feel comfortable with whether you've picked a physician that is most concerned about your care and will deliver a quality treatment. And those questions would be, "How well do you do with this particular problem? Have you done enough surgeries? Have you studied in this area?"
Now the problem is many patients are going to be a little reluctant to ask that of a professional who they regard with some revere. And I think a lot of patients are uncomfortable with that, but I would encourage them to continue to ask those questions so that they're satisfied that they're going to get the kind of treatment that they would hope for.
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