Finding the Best Healthcare You Can Afford is designed to assist healthcare consumers in making three important, inter-related choices:

  • Choosing a Doctor,
    Choosing a Hospital and Choosing a Health Plan

  • What Every Healthcare Consumer Should Know

“Consumers simply don’t have the information they need to pick a doctor
 based on measurable quality or the expected cost of care.”
– Pacific Business Group on Health –

Sources such as Consumer Reports, US News and McKinsey & Company, make clear that healthcare consumers need better information and better methods for choosing better quality, safer healthcare at an affordable price.  As the above quotation from the  Pacific Business Group on Health implies, most currently available internet tools don’t cut it.  Here’s why:

  • Using the best hospitals can reduce the risk of death or complications by 2/3.

  • Hospital safety ratings don’t identify the hospitals with the lowest death rates.

  • Many consumers are unaware of their local hospital choices.

“More than half of [those] hospitalized in the previous 3 years said
there was only one local hospital when, in fact, there were … three”
– McKinsey & Company –

  • Few consumers consider hospital admitting privileges when choosing a physician.

  • Most doctor selection services don’t let you screen for hospital and group affiliation, two of the most important criteria.
  • Patient surveys don’t tell you which doctors provide the best quality of care.

“sites like Healthgrades, RateMDs, Vital, and Yelp [are] riddled with limitations”   “In ten years, none of them have amassed enough [patient] reviews to be useful.”
– Consumer Reports –

  • Future Editions

Nationwide Focus on Hospital Outcomes

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.  The latter has become central focus of our current efforts because:

  • Choosing a hospital narrows your choice of doctors, especially helpful in metropolitan areas with thousands of primary care doctors to choose from; and
  • Because hospital quality is much more measurable than doctor quality, admitting privileges provide a key criterion for estimating quality of doctors and physician groups.

This focus and our related work have given rise to two new initiatives:

  1. Hospital Outcomes Scores (HOS) developed by Amory Associates, described below and in more detail in the section on Hospital Safety.
  2. Custom Provider Profiles using Hospital Outcomes Scores and a variety of other tools to help consumers with make more informed local healthcare choices.

Custom Provider Profiles is a new service designed to address the unique healthcare needs of groups and individuals in their local markets (see cover images below for examples).  To learn more, click here or contact us.

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 admitting privileges and group affiliation are perhaps the most useful guides to doctor quality.

For more on this subject see our section on How to Choose a Doctor.

Choosing a Hospital

Hospital outcomes are (literally) vital to the patient’s survival.  Hospital Outcomes Scores (HOS) were developed to meet a need that was not being addressed by various hospital safety ratings.  HOS enables consumers to find the hospital(s) with the lowest death and complication rates, i.e. the safest by virtue of outcomes, in their service area.

  1. Deaths are the most important outcome to avoid during a hospital stay.
  2. Death rates are generally much higher than complications rates.
  3. Existing hospital ratings are a blend of deaths, complications, procedures and other factors.
  4. Existing hospital ratings are not good predictors of death rates.
  5. HOS differentiates better among hospitals using a scale of 0% to 100% than by ranking them from A to F or 1 to 5.

For more on this go to the section on Hospital Safety on this website.

Choosing a Health Plan

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.  Yet 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. 

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Hospital Safety

Do you know how safe your hospital is?  Death and complications rates vary widely among hospitals, even in the same city.

“Go to the Wrong Hospital and You’re 3 Times More Likely to Die”
“…researchers found that patients at the worst American hospitals were
three times more likely to die and 13 times more likely to have medical complications
than if they visited one of the best hospitals.”
NY Times Dec. 14, 2016

Hospitals are the Key to determining Healthcare Quality

Since publishing Finding the Best Healthcare You Can Afford  last spring, we have focused on hospitals because.

  1. Choosing a hospital makes finding a doctor much easier, especially if you live in a metropolitan area where there may be literally thousands of doctors from which to choose.
  2. Hospital quality is measurable, whereas individual doctors can be judged only by indirect measures, such as board certification, group practice and hospital affiliation.
  3. There are numerous organizations that rate hospital safety and quality, including Leapfrog, US News, Consumer Reports and various health plans that tend to favor their network providers. which may be chosen based on cost or other factors rather than safety.
  4. While most of hospital rating organizations include CMS outcomes (deaths and complications), they combine them with many other inputs that dilute the results and make it difficult to identify low death rate hospitals.

We think it is important for the consumer to have direct access to hospital outcomes, as measures by deaths and complications.  As a result, we have take a deep dive into the data and developed a national rating system by comparing rates of death and complications for almost 4,000 hospitals.  We are developing a more comprehensive database that includes safety ratings from various sources, such as Medicare and the Leapfrog Group.

Why Hospital Outcomes Scores?

While researching Finding the Best Healthcare You Can Afford, we found it difficult, even with the best of hospital rating services, for the consumer to find and use CMS (Centers for Medicare & Medicaid Services) hospital outcomes (deaths and complications) as a basis for choosing a safe hospital.  As a result, Amory Associates has created a new hospital rating system – Hospital Outcomes Scores (HOS) – based on death and complication rates compiled by CMS.

Hospital Outcomes Scores consist of Hospital Death Scores and Hospital Complications Scores, both derived from the same CMS outcomes data used by every major hospital rating service.  Each outcome is scaled from 0% (lowest rate) to 100% (highest rate) in a way that yields a median at 50%.  All 7 death outcomes for more than 4,000 hospitals are then averaged together, and the averages rescaled from 0% (lowest rate) to 100% (highest rate) in a way as above that yields a median at 50%.  Complications Scores are determined similarly.

HOS vs other Hospital Ratings

Unlike other rating systems, Hospital Outcomes Scores focus entirely on outcomes:

We compared Hospital Safety Grades and HOS Death Scores for the hospitals with the 20 lowest Death Scores in the country and found substantial variations in their Hospital Safety Grades.

We also compared Hospital Outcomes scores and Hospital Safety Grades for a sample of 200 hospitals from six states, which were selected based solely on geographic considerations, i.e. no bias.  The chart below shows variations in outcomes within a Hospital Safety Grade that far exceed the variations from one Grade to another.

A review of Medicare hospital ratings shows similar results:

These findings are corroborated by research at the University of Michigan, which concluded Hospital Safety Grades don’t reflect comparative death and complication rates (outcomes).

“ there was negligible difference in mortality or complication rates among hospitals receiving A, B, or C grades. There were no statistically significant differences across grades for readmission rates” (emphasis added) from “Hospital Safety Scores: Do Grades Really Matter?”
by Andrew A. Gonzalez, MD, JD, MPH and Amir A. Ghaferi, MD ) 

State Hospital Outcomes Scores

For more about HOS go to Hospital Outcomes Scoring System.  To be notified when details about the safest hospitals in your area become available, add your name to our mailing list.

Individual Hospital Outcomes Scores

We are currently beta testing online Hospital Outcomes Scores for the following areas:

  • San Francisco Bay Area   45 hospitals
  • Southeast Florida               42 hospitals
  • Massachusetts                    44 hospitals
  • New York Metro & LI        59 hospitals
  • Maricopa County, AZ       26 hospitals
  • Philadelphia, PA                  10 hospitals

We have included, where available, Hospital Safety Grades, Medicare Hospital Ratings and Medicare Safety Penalty, the latter focused on hospital acquired infections.   If you are interested in learning more, please email us at PAW@AmoryAssociates.com.

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[1] Medical Errors Are No. 3 Cause Of U.S Deaths, Researchers Say, May 3, 2016 NPR.org

Custom Provider Profiles

Custom Provider Profiles are designed to provide the most relevant information to assist households and groups in choosing their doctors, hospitals and health plans.  Each profile is tailored to the unique healthcare needs, preferences and financial resources of the individual, family unit or group.

Sample Content

Contents will vary from one report to another. The sample images below are taken from various profiles illustrate some of the possibilities.

Introduction to 2017 Massachusetts Report

Finding the Best Healthcare You Can Afford:  Massachusetts Edition 2017 was published in March.  The purpose of this report is to help healthcare consumers obtain the highest quality healthcare they can afford through careful selection of health plans and healthcare providers, which choices are inter-dependent.  Nearly all health plans limit provider choices to some extent.  Not all doctors accept all health insurance plans.  Not all doctors have admitting privileges to the best or most conveniently located hospitals.  And not all primary care physicians have relationships with the specialists you would choose for yourself and your family.  This report, while focused on Massachusetts, recommends a consumer oriented approach that is applicable anywhere in the U.S.

A majority of people now rely on the internet to choose a doctor…Choosing a physician in a metropolitan area can be overwhelming…

Finding the Best Healthcare You Can Afford  has been written to help the healthcare consumer choose a doctor, a hospital and a health plan.  It highlights the best of breed and analyzes hospital outcomes data to give the consumer a fresh perspective on hospitals.  To peek inside the report, look at the Excerpts from Report, which includes the Introduction to the report and to each of the three sections:

I. How to Choose a Doctor

A well chosen website can quickly narrow down the choices…

II. How to Choose a Hospital

The chart below compares general acute care in the Boston, New York and Long Island.

Boston Hospitals safer than New York/Long Island Hospitals?

A study by Amory Associates found that Boston are hospital outperform New York and Long Island hospitals in safety assessments by  Medicare and the Leapfrog Group.  However, Hospital Outcomes Scores tell a different story.  While the average Massachusetts hospital outperforms the average New York hospital, New York’s top hospitals report lower death rates, as compiled and disseminated by the Center for Medicare and Medicaid Services (CMS).

Finding the Best Healthcare You Can Afford also devotes chapters to specialties such as cancer, cardiology, maternity, pediatrics, orthopedics and emergency care and a chapter on surgical outcomes organized by doctor.

III. How to Choose a Health Plan.

The purpose of this section is to provide you with the knowledge, terminology and resources to choose a health plan that is most suited to the readers’ needs and those of his or her family.

 

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“This is a remarkable exploration of the topic.
Detailed, yet comprehensible, it is such a time and anxiety saver!
 Have you tried to research this issue yourself, without a guide? DON’T…
Mr. Wadsworth has done the heavy lifting for you!
Highly recommend!” – Amazon –

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