Health Insurance - Choosing a Hospital

How can you choose the best quality hospital for the care you need? It is important to consider quality, because research shows that some hospitals simply do a better job than others. For example, we know that hospitals that do a greater number of the same surgeries have better outcomes for their patients.

Quick Check for Quality

Look for a hospital that:

Is accredited by the Joint Commission on Accreditation of Healthcare Organizations.
Is rated highly by State or consumer or other groups.
Is one where your doctor has privileges, if that is important to you.
Is covered by your health plan.
Has experience with your condition.
Has had success with your condition.
Checks and works to improve its own quality of care.

Choosing a Hospital Worksheet
The following questions can help you make the best choices. At the end you will be able to print out your results summary for the hospital you are considering.

You may not have a choice right now because of your health plan or doctor. But keep these questions in mind for when you might make a change.

Does the hospital meet national quality standards?

(_) Yes (_) No

Hospitals can choose to be surveyed by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to make sure they meet certain quality standards. The standards address the quality of staff and equipment, and—most recently—the hospital's success in treating and curing patients. If a hospital meets those standards, it becomes accredited (gets a "seal of approval"). Reviews are done at least every 3 years. Most hospitals participate in this program.

The JCAHO prepares a performance report on each hospital that it surveys. The report lists:

Accreditation status (six levels—from the lowest, "Not Accredited," to the highest, "Accredited with Commendation").
Date of the survey.
Evaluation of the key areas reviewed during the survey.
Results of any followup activity.
Areas needing improvement.
Comparison with national results.

You can order JCAHO's performance reports free of charge by calling 630-792-5800. Or, check the JCAHO's Web site at http://www.jcaho.org for a hospital's performance report or for its accreditation status.

How does the hospital compare with others in my area?

____________________________________________________________

One important way to learn about hospital quality is to look at hospital report cards developed by States and consumer groups. A recent study about such reports found that besides helping consumers make informed choices, they also encourage hospitals to improve their quality of care. This is a very good reason to look for and use consumer information about hospitals. Here are some ways to find such information:

Some States—for example, Pennsylvania, California, and Ohio—have laws that require hospitals to report data on the quality of their care. The information is then given to the public so consumers can compare hospitals.
Some groups gather information on how well hospitals perform and how satisfied their patients are. An example is the Cleveland Health Quality Choice Program, which is made up of businesses, doctors, and hospitals.
Consumer groups publish guides to hospitals and other health care choices in various cities. Find out what kind of information is available where you live by calling your State department of health, health care council, or hospital association. Also, ask your doctor what he or she thinks about the hospital.

Does my doctor have privileges at the hospital (is permitted to admit patients)?

(_) Yes (_) No

If not, you would need to be under the care of another doctor while at the hospital.

Does my health plan cover care at the hospital?

(_) Yes (_) No

If not, do you have another way to pay for your care?

If going to a certain hospital is important to you, keep that in mind when choosing a doctor and/or health plan. In general, you will go to the hospital where your doctor has "privileges."

Does the hospital have experience with my condition?

(_) Yes (_) No

For example, "general" hospitals handle a wide range of routine conditions, such as hernias and pneumonia. "Specialty" hospitals have a lot of experience with certain conditions (such as cancer) or certain groups (such as children). You may be able to choose General Hospital "X" for gallbladder surgery, Specialty Hospital "Y" if you need care for a heart condition, and Specialty Hospital "Z" for your children.

You also may want to find out if the hospital has a special team of health professionals that works with people with your condition or treatment.

Has the hospital had success with my condition?

(_) Yes (_) No

Research shows that hospitals that do many of the same types of procedures tend to have better success with them. In other words, "practice makes perfect." Ask your doctor or the hospital if there is information on:

How often the procedure is done there.
How often the doctor does the procedure.
The patient outcomes (how well the patients do).

Also, some health departments and others publish reports on "outcomes studies" about certain procedures. These studies show, for example, how well patients do after having heart bypass surgery. Such studies can help you compare which hospitals and surgeons have had the most success with a procedure.

How well does the hospital check and improve on its own quality of care?

____________________________________________________________

More and more hospitals are trying to improve the quality of their care. One way is to keep track of patient outcomes for certain procedures. Another way is to keep track of patient injuries and infections that occur in the hospital. By finding out what works and what doesn't, the hospital can improve the way it treats patients.

Ask the hospital quality management (or assurance) department how it monitors and improves the hospital's quality of care. Also, ask for any patient satisfaction surveys the hospital has done. These will tell you how other patients have rated the quality of their care.

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