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How Hospitals Can Be Nice to Patients
Tweet Share on Facebook December 26, 2008 Comment (7)My wife has gone to a particular hospital, which I see no point in naming, three times since June for outpatient surgery. She was treated so differently each time prior to surgery that I found myself wondering whether hospitals comprehend how easily patients' confidence can be undermined and their anxiety raised hours or days before they are wheeled into the OR. If patients believe their medical care will be superb, that initial worry can shake their trust: If a hospital can't do the simple things right, how do I know it'll get the hard stuff right?
I have yet to run across a hospital that doesn't formally pledge somewhere—in a mission statement, on a Web page, on posters in the corridors—to be considerate and humane and to see each patient as an individual. At the hospital my wife visited, the oath was this: "At [name withheld] Hospital, our goal is to treat every patient and visitor with compassion and respect. That is why we practice the philosophy of 'I C.A.R.E.,' which means we strive to be Courteous, Attentive, Responsive, and Engaged in everything we do."
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How to Choose a Nursing Home: Count the Stars
Tweet Share on Facebook December 18, 2008 Comment (2)As I wrote this morning, the main selling point of the federal government's revamped Nursing Home Compare tool is "to provide families with a straightforward assessment of nursing-home quality, with meaningful distinctions between high- and low-performing homes" (lifted from today's press release). Then wouldn't you think that one of those meaningful distinctions would be between homes with the highest (five stars) and those with the lowest (one star) rating overall? Why would anyone even consider a one-star nursing home?
So at this morning's press conference announcing the rollout of the new five-star rating system, I asked Kerry Weems, acting administrator of the Centers for Medicare and Medicaid Services, whether a family looking for a nursing home should automatically eliminate one-star, and perhaps two-star, homes right away. It seemed like a logical conclusion. "Not automatically," he answered. "I would recommend that they think carefully before choosing a one-star home. They should try to understand why that home has one star. A couple of bad health inspections, bad staffing levels—that could be the explanation." But how can you be sure that a home has cleaned up its act?
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Is Simpler Better in Rating a Nursing Home?
Tweet Share on Facebook December 18, 2008 Comment (4)For many years, the Centers for Medicare and Medicaid Services has posted data on its Nursing Home Compare site on quality of care, health-inspection results, and staffing, giving families something more to consider when choosing a nursing home than brochures, promises, and impressions from a visit. Working with this complex information can be challenging.
So today, CMS rolled out a revamped approach to make things easier. Like the system CMS uses to rate Medicare health and drug plans, it gives nursing homes from one to five stars in each of three key areas—10 quality measures, such as the percentage of residents with urinary tract infections; performance in the three most recent health inspections; and adequacy of staffing. Each facility also gets from one to five stars overall.
It's easy to understand, as CMS says. A glance is all that's needed for "making meaningful distinctions between high-performing and low-performing nursing homes." More than 15,500 nursing homes got overall ratings in the initial launch. In states with 25 or more nursing homes, Delaware had the highest proportion of five-star homes (30.2 percent) and Louisiana the lowest (2.8 percent). How they broke down:
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A New Tool Appears for Rating Hospitals
Tweet Share on Facebook December 17, 2008 Comment (2)Today a new hospital-rating tool, WhyNotTheBest.org, was launched by the Commonwealth Fund, a New York-based foundation that underwrites research in healthcare reform. It's aimed at hospital physicians, quality managers, and other hospital professionals and not, as opposed to America's Best Hospitals, at consumers. But anyone can access it, and the data come from public sources, so I think it is fair to offer a review.
The site shows how each of more than 4,500 U.S. hospitals performed in 24 different measures tracked by the federal government—how diligently a hospital gets heart-attack patients into the cath lab within 90 minutes after they arrive in the ER, for instance. Patient-satisfaction information collected by the government also is displayed, as are responses to survey questions on topics such as the quality of doctor-patient communication and the cleanliness of the room. All of this is posted already on the federal government's Hospital Compare page, maintained by the Centers for Medicare and Medicaid Services (CMS).
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Alternative Medicine's Rapid Spread? Nonsense
Tweet Share on Facebook December 12, 2008 Comment (27)I don't want to provoke the ire of the pros or the antis (I managed to anger both after doing a story about alternative medicine in January), so please heed: This post is not about the clincial merits of herbals, acupuncture, homeopathy, and other forms of complementary and alternative medicine. It's about the intellectual dishonesty of the surveys that appear every few years purporting to show CAM use. Invariably, very, very large numbers of Americans say they use CAM, and this year's report is no exception. Released earlier this week by the National Center for Complementary and Alternative Medicine (part of the National Institutes of Health) and the National Center for Health Statistics, it shows that almost 40 percent of all American adults used some form of CAM in 2007.
Spin, folks. The kind that would do a political consultant proud. It started almost 20 years ago with the first large survey in 1990. That one found 34 percent of U.S. adults used alternative medicine (as it was then called). "Used" was defined so generously, however, that it's hard to understand how almost every person surveyed didn't qualify. You were a user if one time in the previous year you used one of the 16 listed therapies, which included such marginal entries as "self-help group," "commercial diet," and "lifestyle diet." The 1997 survey was the same except more so; usage was up to 42 percent.
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For Better CT Scan Readings, Add Patient’s Photo
Tweet Share on Facebook December 2, 2008 Comment (1)If the study I read this morning holds up, maybe you and I and everybody else should start carrying a wallet-sized photo of ourselves. Make it one that's cute or fun or expressive. Maybe call attention to it with a big bright smiley on the front. And attach this note: IF YOU ARE READING THIS IN THE EMERGENCY ROOM AND I AM GETTING A CT SCAN, PLEASE PLEASE PLEASE GIVE MY PICTURE TO THE RADIOLOGIST.
Why? Because when faces of patients who got a diagnostic CT scan were put on the screen along with the CT images, radiologists did a more thorough job of interpreting the results. The study, presented today at the radiologists' annual scrum, hosted in Chicago by the Radiological Society of North America, was small, but its findings were clear, significant, and either intriguing or scary, depending whether you're Pollyannaish or a skeptical reporter. My reaction was alarm at what is now being missed rather than elation at the additional information that might be unearthed.
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Is Robotic Surgery Better? Or Just Marketing?
Tweet Share on Facebook November 25, 2008 Comment (2)Why the U.S. healthcare system (if you want to call it a system, which it isn't) is a mess is obvious. It's mostly because of bureaucratic, inefficient, denial-fixated health insurers—chop out the waste, and escalating costs will come back into line. Considering this albatross as well as various other handicaps, it's amazing that the quality of our healthcare is really good.
Myths, both. Administrative expenses are a relatively small driver of healthcare costs. And the quality of U.S. care not only fails in many respects to measure up to the care delivered in other countries but swings between extremes depending on where you live, the caregiver you see, and the hospital you use. Shannon Brownlee, a visiting scholar at the National Institutes of Health Clinical Center (and a former U.S. News colleague), and oncologist Ezekiel Emanuel, chairman of the center's bioethics department, busted those two myths and three other widespread misconceptions in a well-argued piece in Sunday's Washington Post that is well worth reading.
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Medical Tourism to India, All Expenses Paid
Tweet Share on Facebook November 21, 2008 Comment (15)Lots of talk, not much action—until now. In January, Serigraph Inc., a West Bend, Wis., manufacturer, will become the first U.S. company of any size to embrace medical travel or medical tourism, offering employees the option of having certain nonemergency operations, such as joint replacement, in India. The company will pay all expenses, including travel and lodging for a companion. The incentive for employees is that they don't have to pay a deductible—typically $1,000 to $5,000—or the hospital copay, which would be 10 percent to 20 percent of the charges.
Last May, I went to India and Singapore to explore the trend of growing numbers of under- and uninsured Americans heading to both places and other foreign climes to take advantage of package prices for hip replacement, heart valve repair, spinal surgery, and other elective procedures that can be 80 percent less than the sums charged by U.S. hospitals. To cite one expensive example, heart bypass surgery can easily run up a $70,000 to $133,000 bill at a U.S. center, compared with an average of $7,000 at Indian hospitals catering to westerners. An uninsured patient I interviewed extensively in India paid a total of about $25,000 to have both hips and one knee replaced, including airfare and incidentals. He easily could have paid more than $125,000 at a U.S. hospital. And there are plenty of similar cases of huge price differences.
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Are Hospital Ratings a Mess, a Message, or Both?
Tweet Share on Facebook November 18, 2008 Comment (5)Last Friday, I criticized a report in the public policy journal Health Affairs arguing that consumers' relatively restrained use of hospital ratings and data (such as America's Best Hospitals) can be blamed on confusion: The ratings and rankings measure different aspects of care, cannot be compared, and often contradict each other. I wrote that consumers can wade through the information, just as families sift through facts and numbers in America's Best Colleges and other college guides of more than 1,500 pages and cobble together custom lists online by sorting and clicking. I charged the study authors with underestimating consumers and condescending to their capabilities to do the same with hospital data.
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U.S. News's 'Best Hospitals' Clashes With Other Ratings. Is That Bad?
Tweet Share on Facebook November 14, 2008 Comment (5)U.S. News, publisher of the annual "Americas Best Hospitals" rankings, isn't the only hospital-rating game in town. Corporate-backed groups such as Leapfrog and the federal government's Medicare arm, through its Hospital Compare page on the Web, are other examples of public reporting of hospital data and ratings, each with its own unique approach. A new study in Health Affairs , a public-policy journal, concludes that because the ratings measure different qualities and disagree with one another, consumers are confused rather than enlightened. As Health Affairs puts it, sometimes more is less.
I see the point, but I think motivated consumers—as I would call anyone looking for information about particular hospitals—can sort things out better and be smarter than the authors seem to believe they can. And the pot of gold the authors are seeking at rainbow's end—broad-based information that is useful, accurate, and consistent across different reporting platforms—is wishful, almost delusional thinking. Developing a consensus among clinicians, analysts of data quality, and occupants of hospital executive suites about how to define, collect, measure, and report data that is meaningful is far more difficult than herding cats or whatever comparison you want to make.
Comarow On Quality
U.S. News's Avery Comarow has been editor of the America's Best Hospitals annual rankings since they first appeared in 1990. His reporting on clinical medicine, from the latest cholesterol guidelines to robotic surgery, has been driven by the question: What does this mean to patients? And that is the perspective he brings to his observations and commentaries on the increasing number of programs by hospitals and other healthcare providers to improve care and patient safety.
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