Make Informed Health Decisions, Part 1 – Quality

When it comes to your healthcare, you really can’t skimp on quality. So how is the informed health consumer to judge the quality of a prospective provider? Everybody – from payers to patients to providers – agrees that it’s hard to police quality in medicine. Researching quality care means weighing a lot of options, from specialists to alternative medicine to family doctors. The answers aren’t as easy as a Google search – finding the best quality care is the art of mixing trusted advice, quality data, and your own good judgment.

In Friends and Family We Trust

Are you looking for a specialist? Ask your primary care doctor who they would see if they were the patient. Do your friends and family have a doctor, dentist, or therapist they really love – or can’t stand at all? Find out why. Who better to tell you about the patient experience than fellow patients you know and trust, right?

If you have insurance, you can also reach out to your insurer and ask for quality data on a prospective physician. Insurance companies keep quality data on their contracted doctors, especially companies that “pay for performance,” who pay doctors based on their quality scores. As a member, you may have access to that kind of information.

• Strengths:

  Trusted advice, opportunity to ask questions

• Drawbacks:

  Possible biased opinions

The Dangers of Databases

Databases can be a great tool to track performance, but the numbers don’t always tell the whole story. For example, the most skilled doctors take the hardest cases, the ones that other doctors won’t touch. These doctors might have worse outcomes data than other doctors who may have less skill or experience, simply because they take the higher risk patients. Do your homework and don’t be afraid to ask questions like, “Do you take a lot of high-risk patients?” or “Do your patients often have complications with this procedure?”

Medicare Ratings: Physician Compare 

The Centers for Medicare and Medicaid Services, or CMS, maintain a searchable physician database of all providers who participate in Medicare. Some doctors and practices participate in quality programs and report on certain quality measures relevant to that specialty. You may have to do a bit of digging through multiple tabs to find quality star ratings, but they will show you how that provider scored in each category.

Keep in mind when using this database that not every physician has quality information listed, and not participating in the quality reporting shouldn’t be taken as a measure of quality in itself.

• Strengths:

  Lists providers participating in Medicare and federal quality programs

• Drawbacks:

  Many providers don’t have quality information listed

Medicare Ratings: Hospital Compare 

The CMS Hospital Compare database is a more robust version of its sister, Physician Compare. You search by your geographical area first, and can then choose to look up data for a specific hospital, or see a list of local hospitals which you can compare side by side. Hospital Compare explains the criteria used to measure the quality of care and what the numbers mean in a table that shows your selected hospitals compared to the state and national averages.

• Strengths:

  Side by side hospital comparison, explanations of quality measures

• Drawbacks:

  Updates periodically and may not include all hospitals

The Leapfrog Group: Compare Hospitals 

About half of all U.S. hospitals voluntarily participate in the Leapfrog Hospital Survey, and you can find all of that information in a simple, user-friendly format. You can search for a specific hospital, or geographically. Like Hospital Compare, you can choose which hospitals you want to see displayed together for an apples-to-apples comparison. Leapfrog also encourages patients to take part in the transparency movement, by helping patients send letters (under the How to Use this Information tab) to hospital administrators, urging them to report their quality measures in future surveys.

• Strengths:

  Side by side hospital comparison, engages patients in transparency efforts, on-site data verification programs

• Drawbacks:

  Some hospitals decline to respond to survey

Open Rating Systems

There are plenty of open rating websites that encourage patients to review their providers. Unfortunately, the very openness that makes them so easy to use makes them vulnerable to misinformation, so take these reviews with a grain of salt if you use them to choose a doctor. Competitors can post bad reviews posing as patients, actual patients may negatively review a doctor because of an unpleasant experience with the front desk staff or a long wait, and some patients can use the threat of a bad review to try and get something from the doctor. Use these sites with care.

• Strengths: 

  Easy access, open forum for feedback

• Drawbacks:

  Vulnerable to misinformation

Do Your Homework, but Trust Your Gut

Never discount the power of your own intuition! See if you can talk with a prospective provider before you make your appointment, or visit the hospital you’re considering for a procedure. Look at the office, the people in the waiting areas, and the staff. Are you comfortable there? Is the facility conducive to a low-stress patient experience? Most importantly, do you feel like you can trust this provider? Trust is something you can’t research beforehand. When it comes to something as personal as your health, there’s no substitute for good, old-fashioned human interaction. 

You know how to judge the quality of a provider. Now check out your healthcare facility options in Freedom to Choose: Make Informed Health Decisions, Part 2 – Access.