Hospital Cost Transparency

Finding out about the quality of your health care provider can be a difficult task. However, it is in your best interest to find the best provider.

#1 Acute Care Hospitals: In Kentucky, patients can obtain very little information on hospital quality. One of the most important factors in hospital quality is the number of registered nurses it has taking care of patients. The only reason hospitals exist is to provide nursing care.

Meaningful measurements would include: The incidence of development of bedsores and ulcers, the incidence of patient falls, infection rates and the number of nurses staffing the patient floors. Kentucky does report hospital mortality rates and the volume of procedures. These measurements are also affected by the skill and quality of the physicians who practice at the hospital.

The US Department of Health Human Services does post data on hospital implementation of treatment protocols for most adult patients with heart attack, heart failure, pneumonia, and surgery. In addition, patient survey data on cleanliness and treatment is now available.

View US DHHS Hospital Compare: US Treatment Protocols, Outcomes and Patient Survey Data

AHRQ has posted an overview of how well your state is doing can be found at: http://statesnapshots.ahrq.gov/snaps10/index.jsp
The Leap Frog Group strives to trigger giant leaps forward in the safety, quality and affordability of health care. They have an extensive survey and ranking of participating hospitals.

View Hospital Comparisons on "Overall Patient Safety Ratings" and on the "Safety of Selected Procedures" . http://www.leapfroggroup.org/cp

Consumer Reports compares hospitals on the aggressiveness of hospital therapy. It looks at the average length of stay and the average number of doctor visits to hospitalized patients. Those hospitals with longer lengths of stay and more doctors visits are considered to give more aggressive therapy. There is also data on the average cost per doctor visit.

Use Consumer Reports Comparison Tool.

Commonwealth fund State Scorecard and Rankings

http://www.commonwealthfund.org/Maps-and-Data/State-Data-Center/State-Scorecard.aspx

The Joint Commission accredits hospitals and has summary data and accreditation status of facilities posted on their website. http://www.qualitycheck.org/consumer/searchQCR.aspx
Dartmouth Atlas of Health Care: For over 20 years this Atlas has used Medicare data to document variations, quality and cost in regions of the United States. View Dartmouth Atlas

Kentucky Specific Websites: Kentucky quality data can also be found on the KY CHFS website and as posted by the KY Hosp Association.

View KY CHFS: Link to Kentucky Risk Adjustd Mortality Reports, and Volume Data & Measurement of the Quality of Prevention Services.
View KY Hospital Association Website: View Quality - Risk Adjusted Mortality Reports

Other State Public Posting Sites

Florida Health Finder http://www.floridahealthfinder.gov/

The State of Florida has a data which it posts on the internet to allow consumers to readily compare hospitals. Information includes mortality rates, infections and complications. Median high and low prices for procedures are also available Link to Flordia Health Finder
Ohio Hospital Compare: http://ohiohospitalcompare.ohio.gov/
Illinois hospital Report Card and Consumer Guide to Health Care : http://www.healthcarereportcard.illinois.gov/glossaries/index/
Pennsylvania Health Care Cost Containment Council. Information on Hospital Performance, Financials, Healthcare -associated Infections,, Hip and Knee Replacements. http://www.phc4.org/default.htm
Indiana Medical Error Reporting System http://www.in.gov/isdh/23433.htm

One safety check a patient should do is to ask the nurse taking care of you how many patients he/she is taking care of and if he/she is overworked. According to span> Aiken, L.H., et. al. (JAMA, 2002), if the nurse is taking care of 8 or more patients a dangerous situation may be present.

#2. Quality of Nursing Homes: The US Department of Health and Human Services has an extensive website on quality measurements of nursing homes. This data includes the frequency of developing weight loss, pressure sores and ulcers, incidence of depression, anxiety and delirium, along with other measurements.

View US DHHS Nursing Home Compare: Nursing Home Resident Care
Ratings of Nursing Homes - Member of the Family dot Net
For Information on Kentucky Nursing Homes Click Here

In 2002, the US DHHS Nursing Home Compare website was criticized for having short-comings in a report prepared for Senator's Grassley and Waxman. Download Report

A guide for documenting and reporting patient abuse and neglect in nursing homes (but is also applicable to other healthcare facilities) is available from the Kentucky Attorney General's Office. Download "A Guide For Taking Action Against Abuse and Neglect".

#3. Quality of Physicians: The public is starting to expect that their doctors meet minimum quality standards and follow "evidence based medicine". Several reports have heightened this awareness. In a massive study involving twelve metropolitan areas, McGynn et. al. (NEJM 2003) reported that recommended medical protocols for the prevention and treatment of medical conditions were only followed on average 55% of the time. In addition, Boden et. al. (NEJM 2007) reported that as an initial management strategy in patients with stable coronary artery disease, the placement of coronary artery heart stents did not reduce the risk of death, heart attack, or other major cardiovascular events compared to just taking medical therapy. The vast majority of coronary artery stents are placed in patients with stable coronary artery disease to prevent future illness. However, the effectiveness of this expensive invasive procedure is now coming into question.

Industry payments to doctors can be found at ProPublica: http://projects.propublica.org/docdollars/payments

Medical quality parameters for primary care physicians are available in a few areas of the nation through pilot projects of the Ambulatory Care Quality Alliance (AQA). The states where data is available are listed below:

Other useful screening tools for selecting a physician are as follows:

Find out if your physician is board certified by the American Board of Medical Specialists.
Visit your State Medical Board website. Many states, including Kentucky post investigation reports, disciplinary actions and restrictions on a physician's medical license.
Perform a Google Search, this will often pull up severe infractions which make the news media.