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Trying to find the right doctor, hospital, skilled nursing facility, or home health service can be a tricky task.  While the physician-patient relationship is critical, it’s only one piece of the puzzle when someone with a significant condition is trying to navigate the healthcare system.  In many cases, especially if hospitalization is involved or it’s a chronic condition, a patient will end up with services from a multitude of different providers.  One illness can result in receiving care from the following types of healthcare providers: 

  1. Hospital care for the immediate illness
  2. Multiple physician specialists involved in your care
  3. Skilled nursing facility to care for you after your discharged from the hospital (Doctors are still involved)
  4. Home Health services to care for you when you’re able to go home
  5. More outpatient services including therapy, diagnostics, and visits to your doctor even months after your initial illness

When you are in the middle of getting treated for your condition, it can be overwhelming at a time when you’re focused on getting better.  So how can you as a consumer of healthcare services be certain you’re going to the providers that can serve you best?  Fortunately, the healthcare industry and various rating agencies are working to make their quality data available to the public.  However, finding these and being able to make sense of the data can be a challenge, especially when there are multiple agencies providing various ratings for healthcare providers.

A recent MedPAC report found that Medicare beneficiaries seldom chose the highest quality rated provider after a hospitalization.  The report focused on home health and skilled nursing facility selections:

  • Skilled Nursing Facilities:  84.3 percent of patients selected a facility with lower quality scores than at least one other facility available to them.  And 46.8 percent had 5 or more facilities available with higher quality scores.
  • Home Health:  95 percent of patients selected a home health provider that had lower quality scores than at lease one other provider available to them.  And 69.5 percent had 5 or more providers available with higher quality scores.

There are many rating agencies for each type of facility that can give you information on healthcare providers.  With that being said, the difficult part is knowing what’s available and which one to use. 

Hospital Rating Reports

  • The Centers for Medicare and Medicaid Services developed a comprehensive rating system for hospitals.  The website is https://www.medicare.gov/hospitalcompare/search.html.  This website compares quality, cost of care, and patient experience between all Medicare certified hospitals.  The Web site also shows hospital payments for heart attack patients, heart failure patients, and pneumonia patients compared to the national average.
  • The Joint Commission is the largest accrediting agency for hospitals and has a comparative report.  It can be found at http://www.qualitycheck.org.  This report compares patient safety goals, performance improvement initiatives, quality scores, and patient experience scores for the hospitals.
  • The Leapfrog Group is a well-known rating agency that compares quality and patient experience scores of more than 2,500 hospitals.  These scores are released to the public and can be found at http://www.leapfroggroup.org/ratings-reports.  This rating system is based on 30 national performance measures to keep patients safe and gives a letter grade of A, B, C, D, or F.

Skilled Nursing Facility Rating Reports

  • The Centers for Medicare and Medicaid Services has developed a comprehensive rating system for skilled nursing facilities.  This comparative rating report presents information on more than 15,000 Medicare and Medicaid participating hospitals, and can be found at https://www.medicare.gov/nursinghomecompare/search.html.  This web site includes five-star quality ratings of overall and individual performance on health inspections, quality measures, health and fire-safety, and number of staff in the nursing home.  The Web site also has information on any penalties against the nursing home.
  • Care Pathways has a tool called Nursing Home Inspector that reports the performance of every Medicare/Medicaid certified nursing home in the United States.  The report can be found at http://www.carepathways.com/NHx1.cfm.  Information reported includes quality measures, number of beds, and average worked hours by the staff per resident day.  This report uses star ratings to show the overall performance of nursing homes, with one star as the lowest score and five stars as the highest, comparing county and state averages.

Home Health Rating Reports

  • The Centers for Medicare and Medicaid Services has created a Home Health Compare Web site, comparing information on the quality of care provided by Medicare-certified home health agencies.  This website can be found at https://www.medicare.gov/homehealthcompare/.  This Web site shows how often each home health agency used recommended practices when caring for its patients, patient experience, and if patients had improvements in their overall care.

Physician Rating Reports

  • The Centers for Medicare and Medicaid Services has also created a comparative report for physicians, titled Physician Compare.  It can be found at https://www.medicare.gov/physiciancompare/.  This report compares quality of physicians that are enrolled in Medicare.  It includes performance on areas such as preventive care, care for chronic conditions, and patient safety.  Patient experience scores are also reported for some physician groups.

These rating agencies and healthcare providers have all made progress on capturing and presenting to the public the quality and satisfaction healthcare entities are providing to their patients.  Transparency is a hot topic and the industry is continuously striving to get the right information to the consumers of healthcare.  However, there is still a lot of controversy with the quality comparisons, with many saying it doesn’t truly capture the quality of care provided to patients, and there should be more meaningful quality goals identified.  These quality comparisons will continue to evolve, and consumers will play a vital role in this as they continue to demand higher quality and transparency.

On top of the controversy, understanding what the reports say can be overwhelming for someone that doesn’t have a background in healthcare.  That’s why it’s important to ask those healthcare workers specific questions when choosing a provider.  Case Managers and Independent Health or Patient Advocates can be extremely valuable to you if you find yourself in this situation.  They are knowledgeable and will be able to assist you to make sure you’re getting the right care by the right providers for your condition. 

If you need further assistance, the expert health advocates at Visium HealthLink, LLC can assist you when faced with the challenge of choosing the right providers.  Visit the website at www.visiumhealthlink.com for more information.

Reference:

https://www.ahrq.gov/talkingquality/resources/comparative-reports

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