Finding the Best Healthcare You Can Afford was designed to assist people in making three inter-related choices:
- Choosing a Doctor
- Choosing a Hospital
- Choosing a Health Plan
Since publishing the 2017 Massachusetts Edition of Finding the Best Healthcare You Can Afford, we have focused on expanding coverage to all 50 states and DC and on making it easier to choose a hospital. Hospitals have become central to our focus because:
- Choosing a hospital narrows your choice of doctors, especially helpful in metropolitan areas with thousands of primary care doctors to choose from; and
- Since hospital quality is measurable, it provides a means of finding better doctors.
This focus and our related work have given rise to two new initiatives:
- Hospital Outcomes Scores (HOS) developed by Amory Associates, described below and in more detail in the section on Hospital Safety.
- Custom Provider Profiles using Hospital Outcomes Scores and a variety of other tools to help consumers with make more informed local healthcare choices.
Choosing a Doctor
Choosing a doctor can be a daunting task, especially in a large metropolitan area where there can be literally thousands to choose from and because it is difficult to determine the quality of care provided by an individual doctor.
Choosing doctors typically involves relying on indirect measures of quality such as medical education, board certification, group and hospital affiliation and recommendations from friends. We have come to believe that hospital and group affiliation are perhaps the most useful of those, especially the former because of the many ways that hospital quality is measured.
For more on this subject see our section on How to Choose a Doctor.
Choosing a Hospital: Outcome Scores
As noted above, there are many resources for choosing hospitals, but hospital outcomes (deaths and complications) rather than secondary characteristics, such as procedures and amenities, are perhaps the most important determinant of hospital quality. Put another way, death is the hospital outcome we most want to avoid.
The New York Times reported, for example, that the likelihood of dying is three times as great at the worst hospital as at the best hospital. Yet we found hospital outcomes information hard for consumers to use as a basis for choosing a hospital. Researchers have found hospital safety ratings to be an unreliable indicator of outcomes. While other rating services include outcomes, they bury them in the details of their hospital ratings.
We developed HOS to focus squarely on death and complications and because:
- Deaths are the most important outcome to avoid during a hospital stay.
- Death rates are generally much higher than complications rates.
- Existing hospital ratings are a blend of deaths, complications, procedures and other factors.
- Existing hospital ratings are not good predictors of death rates.
- HOS differentiates better among hospitals using a scale of 0% to 100% than by ranking them from A to F or 1 to 5.
Choosing a hospital based on result – death and complication rates – will result in safer choices.
Choosing a Health Plan
Unlike choosing a doctor, there are many useful tools available to choose a health plan ranging from clearing houses to rating services to cost comparisons based on specific health needs. Nevertheless, choosing a plan can be one of the most perplexing and challenging tasks that a consumer can face. For more on choosing a health plan, visit the section on How to Choose a Health Plan.
It should be noted that while recent congressional legislation has changed some of the running rules for the Affordable Care Act (known as “ACA” or “Obamacare”), that program is still alive and well as of January, 2018.
Are Boston Hospitals safer than New York Hospitals?
Prior to developing HOS, Amory Associates found that, on average, Boston hospitals outperformed New York and Long Island hospitals in several different measures of safety, including safety assessments by Medicare and the Leapfrog Group.
However, Hospital Outcomes Scoring revealed that the best performing New York and Long Island teaching hospitals have lower Death Scores than their Massachusetts counterparts.
Comparison of Boston & NY Hospitals prior to developing HOS