Consumers in the past often picked a doctor or hospital based on word of mouth, on proximity to their home, even on a facility’s curb appeal.
But the world of consumer health care information is rapidly expanding, driven in large part by the Internet and demand from patients, employers and government. Now a person can go online and make a more informed choice among his or her area’s medical providers, finding data on their pricing and quality.
It’s called the transparency movement.
Two new tools have surfaced this week to help patients on this information hunt.
First, the Leapfrog Group, a Washington-based nonprofit organization, has rated 2,651 hospitals, including 78 in Georgia, on their patient safety records, giving them a single letter grade. The rating is based on 26 different measures collected by Leapfrog or by Medicare officials.
The second consumer tool comes from UnitedHealthcare, which has introduced an online service for 14 million members in its health plans to compare medical providers’ quality of care and estimate the cost of more than 100 common treatments and procedures.
The Leapfrog Group analyzed hospitals’ adherence to safe practices, such as entering physicians’ orders into computer records, and removing catheters promptly to minimize the risk of infections, Kaiser Health News reported. The grade was also based on hospitals’ records of problems such as bed sores and infections.
Among Georgia hospitals, 13 received an “A’’ grade, 27 a “B’’ and 35 a “C.’’ Three hospitals were rated with “Grade Pending,’’ which KHN said was Leapfrog’s euphemism for below a “C.” They were Grady Memorial Hospital in Atlanta, Phoebe Putney Memorial Hospital in Albany, and Stephens County Hospital in Toccoa.
Compared with other states, Georgia hospitals were largely in the middle of the pack.
Massachusetts, Maine and Vermont were the only three states where half of the hospitals or more got a grade of “A.” Seventeen percent of Georgia’s hospitals received an “A,’’ versus 27 percent nationally. Here’s the link to the Georgia scoreboard, which allows a consumer to find out how a hospital received its grade.
In 24 states and the District of Columbia, half or more of the hospitals got a “C” or “Grade Pending,” Kaiser Health News reported. The worst performers were D.C., Alabama, New York, Oregon, South Dakota, New Mexico, Hawaii, Arizona and Arkansas, where at least two-thirds of the hospitals got a “C” or lower.
In Georgia, 49 percent of the hospitals rated a “C’’ or lower.
A controversial system
Not surprisingly, the Leapfrog Group’s hospital rankings have gotten a mixed reception in the health care industry.
The American Hospital Association said in a statement to KHN that it “has supported several good quality measures but many of the measures Leapfrog uses to grade hospitals are flawed, and they do not accurately portray a picture of the safety efforts made by hospitals.”
Dr. Michael Henderson, chief quality officer at the renowned Ohio-based Cleveland Clinic – whose hospital received a C grade – told KHN that much of the data was a year or two old, and many hospitals have made significant strides since then. “The question the public needs to be asking is, ‘Are you working on this? Are you getting better?’ ” he said.
Leapfrog’s information comes from its own surveys of hospitals that agree to participate, and data that the Centers for Medicare and Medicaid Services post on their Hospital Compare website.
Kevin Bloye, a Georgia Hospital Association vice president, told Georgia Health News on Wednesday that his organization agreed with criticism of the Leapfrog rankings, including the fact that the data were a couple of years old. “We have made serious strides since then,’’ he said.
Hospitals that didn’t fill out the Leapfrog Survey appear to be at a disadvantage in the rankings, Bloye said.
But Leah Binder, CEO of the Leapfrog Group, told KHN that the way the scores were calculated would not disadvantage hospitals that didn’t participate in Leapfrog’s survey.
Bloye said boiling down 26 measures into a single letter grade is no simple matter. The difference between an A and a C can be small, he said.
He acknowledged that employers have helped push for more transparency. “The business community is very frustrated by the growing health care cost burden,’’ he said. “They’re looking for more accountability. Georgia hospitals are working to become more transparent.’’
Bloye said the Leapfrog information is another tool that consumers can use to pick a facility. “Nothing can take the place of [patients] consulting with their physician,’’ he added.
Binder said Leapfrog was inspired to issue letter grades after seeing how effective and consumer-friendly such ratings have been for restaurant health inspections, reported the Los Angeles Times.
David Hopkins of the Pacific Business Group on Health, a coalition in San Francisco that works with employers, told the L.A. Times that health plans should be providing these safety scores to all of their customers when they’re choosing a hospital.
“I think this is a huge breakthrough for consumers,” he said.
Practical cost estimates
Meanwhile, the UnitedHealthCare tool, the subject of a large marketing campaign, provides cost estimates for treatments and procedures such as surgeries, lab tests, radiology tests and office visits.
United members will be able to compare quality and cost information for 240,000 different physicians and hospitals. And they will be able to identify the out-of-pocket costs that they will owe for a medical service.
Most of the people in Georgia’s biggest health benefits plan – the state employees plan – are United members, and those seeking care in the Atlanta market will be helped by the tool, called myHealthcare Cost Estimator.
The Department of Community Health, which runs the State Health Benefit Plan, said in a statement that the United tool “helps consumers be more engaged in their health care decisions; makes them more aware of actual costs for services, treatment and procedures; and provides them with a realistic picture of what will be owed out-of-pocket, what their employer will pay and the real-time account balance in their eligible health care account.’’
The United move follows consumer tools introduced by other health insurers.
Georgia’s largest health insurer, Blue Cross and Blue Shield of Georgia, has begun providing information to help its members compare the price and quality of medical imaging services in the Atlanta, Savannah, Macon, Augusta, Athens, Rome and Columbus areas.
And Aetna has been giving its Georgia members information about price and performance of local physicians for the last five years.
Price information is important when many consumers have a health insurance policy with potentially high out-of-pocket costs.
“Health care should have full transparency,’’ Mike Cadger, CEO of Monocle Health Data, told GHN recently. Monocle is an Atlanta firm that sells independent information about health care price and quality to employers and to disease management companies.
The trend in medical insurance is for more consumers to have higher out-of-pocket payments, with some deductibles reaching several thousands of dollars per year, Cadger said.
He added that 34 states require some form of mandatory price and quality transparency. Georgia is not one of them.