Become An Informed Consumer
For Yourself, For Your Family
TABLE OF CONTENTS
Letter
To Err is Human…and Sometimes Fatal
We Measure What We Care About...How Much Do We Care?
What You Can Do
Prescription Drug Information
Hospital Information
State-Specific Hospital Information
Nursing Home Information
Physician Information
Letter
Most of us have little choice but to hope for the best when we see a doctor or undergo a medical procedure. We have few tools to assess the quality and safety of the care we receive, so we trust in the system and put our faith in those providing our care. And we cross our fingers and hope that we get optimal care.
But more often than we might expect, patients in this country don’t get the best possible health care. Some of the medical tests we take are unnecessary. Some of the medications we are prescribed aren’t right. Some of the surgeries we undergo could – and should – be avoided. Sometimes not getting the right care to the right person at the right time is relatively harmless; sometimes it isn’t.
Medical errors and poor quality take an enormous toll on our health and our lives. And they are one reason the cost of health care is out of control in America today.
The National Partnership for Women & Families is leading a drive to improve the quality of the health care Americans receive by making more information available for consumers about hospitals, doctors, and other health care providers (like nursing homes and home health agencies). We invite you to join us in helping realize this vision. Reading this booklet is an important first step. You can do even more by acting on its recommendations and turning yourself into an educated health care consumer – and a force for change.
You study all your options when you buy a house, a car or even a refrigerator. Do the same with your health care. Your life may depend on it.
Debra L. Ness, President
National Partnership for Women & Families
"If we work together, we can strengthen our health care system."
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To Err is Human. . . And Sometimes Fatal
Breast cancer claims a lot of lives. Medical errors claim even more.
The wrong diagnosis. The wrong medication – or the right medication, in the wrong dose. The wrong operation. Preventable medicalerrors kill an estimated 100,000 Americans eachyear; it’s the eighth leading cause of death inthis country.
Two million of us pick up infections each year at the hospitals that are supposed to make uswell. Some 90,000 die from those infections. Many more suffer needlessly, are incapacitated or worse.
Research has found that Americans today have a 50/50 chance of getting the right care at the right time. That’s no better than a toss of the coin. And for women and minorities, the chance of getting poor care is even greater.
And errors can be costly. Infections, unnecessary or duplicate tests and wrong medications increase our health care costs. And more and more, these costs are being passed on in the form of higher premiums and patient charges. With health care costs outpacing inflation, health care is taking up a bigger part of employer costs, government costs, and our own household budget every year. We need to make sure our health care dollars are paying for the right care, at the right time, for the right reason. We need to make sure we’re getting real “value” for our health care dollars!
Improving the quality of our care requires that we pay more attention and demand solutions. It starts with eliminating the inconsistencies in treatment that should not exist.
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Why do 70 percent of children in one part of Vermont have their tonsils taken out, while just eight percent of children have tonsillectomies in another part of the state?
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Why, in one part of Maine, have seven in ten 70-year-old women had hysterectomies while, in another part of Maine, that number is just two in ten?
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Why is an elderly man in Binghamton nine times more likely to have his prostate removed than an elderly man in Baton Rouge?
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Why aren’t we all getting appropriate care? We need answers – answers that will help doctors, hospitals and other health care professionals give all patients the best possible care all the time.
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We Measure What We Care About . . .How Much Do We Care?
It is a national tragedy that there are few reliable measures of quality care, few places to go for information, few standardized databases that give patients apples-to-apples comparisons of hospitals, doctors, and other health care providers.
You can learn more about the performance of a company’s stock than the performance of a surgeon.
You can learn more about the safety record of a car than the safety record of a hospital. That needs to change.
You need to be able to choose the best surgeon for your bypass surgery. The safest hospital for giving birth. The physician who will do the best job of helping you keep your diabetes under control. The pediatrician who will treat your child’s asthma best so that you don’t have to go to the Emergency Room.
Measuring works
In 1996, only about 62 percent of eligible heart attack patients got prescriptions for betablockers (a life-saving drug). Then health plans began to measure how well they were doing in making sure their members who needed beta-blockers got the prescription. By 2003, the rate was 95 percent. Shrinking the gap between poor care and high quality care meant that thousands of lives were saved and thousands of heart attacks were prevented. Over and over again we’ve learned that what gets measured gets improved!
“You can learn more about the safety record of a car than the safety record of a hospital. That needs to change.”
Measuring plus reporting works even better
Since 1989, the New York State Department of Health has published data on deaths following coronary artery bypass grafts, by hospital and by surgeon. From 1989 to 1992, mortality following bypass surgeries fell by 41 percent in the state. Why? Because public reporting spurred hospitals with poor records to make changes in the way they provided care. It encouraged them to improve health outcomes.
At the National Partnership for Women & Families, we want to improve the quality of care and make sure that consumers have the information they need to make the best possible health care decisions. We know that measuring and publicly reporting performance will result in consumers getting the information they need to make informed health care decisions and drive improvements to our health care system.
Consumers . . . A Powerful Force for Change
We know that measuring and reporting information can improve health care, but why aren’t we doing it? Why don’t we publicly track and report the kind of data that would help patients choose a doctor, hospital, or nursing home?
Unfortunately, many health care providers have never had to report information that consumers can use to make these decisions. After all:
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What hospital would want the public to know if they have a high infection rate?
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What surgeon would want prospective patients to know if his or her patients don’t fare well?
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What medical community would want to be exposed for performing unnecessary surgeries?
But patients – consumers – need to know. Consumers are expected to take greater control of their health care, but they do not have the tools they need to make informed decisions.
Consumers can be a powerful force for improving the quality of health care in this country. By asking the right questions and demanding more information, consumers can help make the health care system more accountable and its performance more transparent.
The National Partnership for Women & Families is working to make sure that consumers have the health care information they need. Learn more about what you can do to get better health care for yourself and your loved ones.
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What You Can Do
You can help us make our nation’s doctors, hospitals, health plans, and nursing homes more accountable to the patients and communities they serve. Let’s work together! There are three important steps you can take:
1. Become an informed consumer
Ask questions about the track record of your health care providers. Start using the information that is already available about the quality of hospitals, physicians, and nursing homes to guide your decisions. At the end of this document, there is a list of national and state-based websites that provide comparative information about health care providers’ performance.
2. Become an informed patient1
Once you’ve researched and selected a health care provider, here are some things you can do to help increase your chances of receiving high quality care:
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Speak up and ask questions! Make a list of your questions and concerns before you visit the doctor.
Never be afraid to ask. You have a right to question anyone involved in your care and get an explanation in terms you understand.
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Make sure your doctor knows about every medication you are taking – both prescription and over-the-counter drugs.
Make a list of all your medications before you go to the doctor or take them all with you to show the doctor.
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Make sure your doctor knows about any allergies or adverse reactions you have had to medications.
Keep a list that you can take with you whenever you go to the doctor.
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Remember that “more” isn’t always better. It is a good idea to find out why a test or treatment is needed and how it can help you. You could be better off without it.
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If you have a test, don’t assume that no news is good news. Follow up! Make sure you get the results.
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Learn about your condition and treatment by asking your doctor or nurse and by using other reliable sources. For example, treatment recommendations based on the latest scientific evidence are available from the National Guidelines Clearinghouse at
www.guideline.gov
If your doctor gives you a prescription, make sure that you can read it and that you understand what it is for and how to take it.
Is this medicine safe to take with other medicines you are taking?
How are you supposed to take it, and for how long?
What side effects are likely?
What do you do if they occur?
What food, drink or activities should you avoid while taking this medicine?
When you are being discharged from the hospital, ask your doctor to explain the treatment plan you will use at home and take notes. Understand how you will take your medications and find out when you can get back to your regular activities. Ask a family member or friend to be there with you and to be your advocate. Often doctors overestimate how much their patients understand about what they should or should not do when they return home.
3. Add your voice
The National Partnership is working to improve our nation’s health care system – to achieve safe, betterquality and more affordable care for all Americans. To achieve that goal we are urging providers of health care to measure the quality of the services they provide and to publicly report that information.
We believe that all patients should have quality and safety information when they choose a doctor, hospital, health plan or nursing home. We believe all consumers have a “right to know” about the valuethey are getting for their health care dollars.
You can help us achieve these goals by adding your voice to the Americans for Quality Health Care project. Visit our website: www.nationalpartnership.org to learn more about how you can help yourself and others get better information about your health care.
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Use The Information That Is Available To You2
You know that not all doctors or hospitals are created equal so it’s important to do your research when it comes to choosing your health care provider. Don’t simply go to the closest doctor or the "biggest and best" hospital in your community. It's up to you to make sure that the hospital or physician you choose meets your needs and provides high quality care for the services you or your family will need.
Prescription Drug Information
Information on Prescription Drug Effectiveness, Safety and Cost
Consumer Reports Best Buy Drugs
http://www.crbestbuydrugs.org
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Hospital Information
Centers for Medicare & Medicaid Services
877-267-2323 (toll-free)
410-786-3000 (local)
http://www.cms.hhs.gov/quality/Hospital
Health Care Choices
212-724-9395
Email:
info@healthcarechoices.org
http://www.healthcarechoices.org
Joint Commission on Accreditation of HealthCare Organizations
630-792-5000
http://www.jcaho.org/quality+check/
The Leapfrog Group for Public Safety
202-292-6713
http://leapfroggroup.org/for_consumers
U.S. News and World Report
202-955-2000
http://www.usnews.com/usnews/health/hosptl/tophosp.htm
Hospital Infection Reporting
http://www.consumerunion.org/campaigns/stophospitalinfections/learn.html
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State-Specific Hospital Information
California
California Health Care Foundation/California Institute for Health Systems Performance
888-430-2423
http://www.calhospitals.org
The Office of Statewide Health Planning and Development
916-654-1499
http://www.oshpd.ca.gov
The Orange County Register
877-469-7344
http://www.ocregister.com/news/2003/hospitals/reportcards.shtml
PacifiCare Health Systems Inc.
866-863-9776
http://www.pacificare.com
Pacific Business Group on Health
415-281-8660
http://www.healthscope.org
Pacific Business Group on Health/Office of Statewide Health Planning and Development
415-281-8660
http://www.pbgh.org
& 916-654-1499
http://www.oshpd.state.ca.us
Connecticut
The Connecticut Department of Public Health
860-509-8000
http://www.dph.state.ct.us/hcquality/ hcquality.htm
Connecticut Hospital Association
203-265-7611
http://www.cthosp.org/ChimeData/ ChimeData.asp
Florida
FloridaHealthStat
http://FloridaCompareCare.gov
Georgia
Partnership for Health & Accountability Consumer Hospital Report
770-249-4500
http://www.gha.org/pha/insights/2006/index.asp
Illinois
Blue Cross Blue Shield of Illinois
http://www.bcbsil.com/employer/resources/hospitalreport.htm
Kansas
Healthy Kansas City & Kansas City Metropolitan Healthcare Council
http://www.healthykansascity.org
Maine
Maine Health Management Coalition
www.mhmc.info/
Maryland
Maryland Health Care Commission/Health Services Cost Review Commission
410-764-3460
http://hospitalguide.mhcc.state.md.us
Massachusetts
Massachusetts Health Quality Partnership
617-972-9079
http://www.mhqp.org/
Michigan
Michigan Health & Hospital Association
517-323-3443
http://www.michiganhospitalprofiles.org
Michigan Health & Safety Coalition
248-448-6266
http://www.michiganhospitalprofiles.org
Greater Detroit Area Health Council
313-963-4990
http://www.gdahc.org/save_report.asp
Minnesota
Minnesota Department of Health
651-201-5000
http://www.health.state.mn.us/patientsafety/index.html#mn
Missouri
Missouri Department of Health & Senior Services
573-751-6400
http://www.dhss.state.mo.us/
Healthy Kansas City & Kansas City Metropolitan Healthcare Council
http://www.healthykansascity.org
New Jersey
New Jersey Department of Health & Senior Services
800-418-1397
http://www.nj.gov/health/hpr
http://www.state.nj.us/health/hcsa/cabgs01/cabg_consumer01.pdf
New Mexico
New Mexico Health Policy Commission
505-424-3200, ext. 117
http://www.healthlinknm.org/guide
New York
Center for Medical Consumers
212-674-7105
http://www.medicalconsumers.org
Excellus Blue Cross/Blue Shield
800-633-6066
https://www.excellusbcbs.com/
New York State Department of Health
800-663-6114
http://www.health.state.ny.us/nysdoh/heart/heart_disease.htm
Niagara Health Quality Coalition/Alliance for Quality Health Care
http://www.myhealthfinder.com
Ohio
The Cleveland Clinic & The Quality Institute of the Cleveland Clinic Health System
800-223-2273 (toll-free)
216-444-2200 (local)
http://www.clevelandclinic.org/quality
The Community Healthcare Coalition, Inc.
330-305-6565
http://www.ehpco.com/images/guide.pdf
A new law will require the Ohio Department of Health to create a website that will report the information on quality measures developed by nationally recognized health care organizations. The site is expected to launch in mid-2007. Hospitals also will be required to report the costs of the top 60 inpatient and outpatient procedures they perform.
Pennsylvania
Pennsylvania Health Care Cost Containment Council
717-232-6787
http://www.phc4.org
Rhode Island
Rhode Island Department of Health
401-222-2231
http://www.health.state.ri.us/
Tennessee
Blue Cross Blue Shield of Tennessee
http://bcbst.com/health/hospital_quality.shtm
Texas
Texas Business Group on Health/Dallas-Fort Worth Business Group on Health
214-382-3037
http://tbgh.org/checkup
Texas Health Care Information Council
512-458-7261
http://www.dshs.state.tx.us/thcic/
Virginia
Virginia Health Information
877-844-4636 (toll-free)
804-643-5573 (local)
http://www.vhi.org
Wisconsin
The Alliance: Employer Health Care Alliance Cooperative
608-276-6620
http://www.qualitycounts.org/
Wisconsin Collaborative for Healthcare Quality
414-456-5261
http://www.wiqualitycollaborative.org
Wisconsin Hospital Association
608-274-1820
http://www.wicheckpoint.org
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Nursing Home Information
Centers for Medicare & Medicaid Services Nursing Home Compare includes information only on nursing homes that are Medicare or Medicaid certified. These nursing homes provide skilled nursing care, however, there are many other types of facilities that provide various levels of health care and assistance with activities of daily living.
www.medicare.gov/NHcompare/
1-800-633-4227
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PHYSICIAN INFORMATION
Unfortunately, there is very little information publicly available about the comparative quality of doctors; however, we’ve listed some of the best resources for you to begin your research.
Your health plan directory can be a good source for information about the physicians in your network. You’ll most likely find a list of physicians’ names, their gender, clinical specialty, languages spoken, and whether or not they are accepting new patients. Ideally you might find a link to quality performance information on individual physicians or medical groups if it is available in your state.
Licensing
State boards of medical examiners are the legal authority that license physicians to practice medicine. Physicians MUST have a medical license from each state in which they practice medicine. Information on doctors in some states is available on the Internet at http://www.docboard.org
This site contains the licensing background and disciplinary information of physicians and other health care practitioners and is run by Administrators in Medicine, a group of state medical board directors.
Board Certification
The American Board of Medical Specialties (800-733-2267) or http://www.certifacts.org can tell you if a doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam (board) to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty, such as internal medicine or geriatrics.
What you can do:
1. Become an informed consumer
2. Become an informed patient
3. Add your voice
NCQA Physician Recognition Program
Diabetes, Heart/Stroke
Patients can search for physicians in their state who have achieved special recognition by submitting data that demonstrates they are providing high quality care for diabetic patients or those that have suffered from a stroke or heart disease.
http://www.ncqa.org/PhysicianQualityReports.htm
State-specific information about medical group performance:
California
More than 50,000 patients rated California physician groups on how well treatments and specialty care were delivered, doctor communications, and if coordinated, timely care and services were provided.
http://www.healthscope.org
Massachusetts – Massachusetts Health Quality Partners (MHQP)
The quality information in MHQP's Physician Network Quality Report is based on the performance of Massachusetts' primary care physicians. It measures the delivery of certain preventive and chronic care services and compares the care received by patients through nine
different large physician networks. It also compares the quality of care delivered in these networks to state and national benchmarks.
http://www.mhqp.org/physicianquality/
Minnesota
Minnesota Community Measurement
651-209-0390
http://www.mnhealthcare.org/
Washington
Puget Sound Health Alliance
206-448-2570
http://www.pugetsoundhealthalliance.org
1Adapted from What Can You Do? Be Involved in Your Health Care. Agency for Health Care Research and Quality
(www.ahrq.gov/consumer/20tips.htm).
2Information available at no cost
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