Q&A: HEALTH CARE INFORMATION
JANICE McCOY, MSN, MSHSA, RN, CNAA. Her education includes: RN, BS in Health Arts, MS in Health Services Administration, and MS in Nursing.
SCM&HL welcomes Jan McCoy, MSN, MSHSA, RN, CNAA, to answer some of the burning questions related to healthcare information sources and help our readers sort out the sometime confusing sites out there on the web. Ms. McCoy, in her capacity as a long time nursing executive, has a keen interest in educating the healthcare consumer on hospital quality, safety and service.
SCM&HL: Can you give some examples of some of the more credible web sites and describe their primary focus?
MS. McCOY: There are three websites that are non-proprietary and represent accrediting and regulatory quality improvement organizations for Florida hospitals and other providers.
• Florida Health Finder: www.FloridaHealthFinder.gov/CompareCare
This is a relatively new site mandated by the state of Florida to connect Florida health care consumers with health care information, including health outcomes, drug prices, and a health encyclopedia. You can view performance and outcome data and information on selected medical conditions and procedures in health care facilities throughout Florida. It also reports the number of admissions, average length of hospital stays, charges, readmsission and mortality rates, and complication/infection rates. The web site is user friendly and easy to navigate.
There is a data disclaimer that states, “This information is not designed to offer medical advice, and is only one avenue to assist you in making well-informed health care decisions….the data contained in this website must be used cautiously, and the Agency for Health Care Administration strongly recommends that consumers discuss this information with their physicians.”
• Hospital Compare: www.HospitalCompare.hhs.gov
Medicare is one of the primary payers for health care services in the US. They continue to define care expectations based on research to improve patient outcomes, and they base their payments more and more on how well hospitals perform on certain “core measures”, including myocardial infarction (heart attack), congestive heart failure, pneumonia, and the prevention of surgical infections. Compliance with these core measures is measured by manual chart reviews utilizing a rigid set of rules of abstraction, data entry, and reporting, and the data is validated by on-site reviewers. This intense process ensures that the data reported on core measure performance is accurate and truly reflects the quality of care provided by the institution.
Hospital Compare was developed through the joint efforts of the Centers for Medicare & Medicaid Services (CMS), the Department of Health and Human Services, and other members of the Hospital Quality Alliance: Improving Care Through Information (HQA). The information on the website has been submitted by hospitals who have agreed to allow their quality information to be reported in this public forum.
The web site tracks and reports results for core measure compliance. The web site is very user friendly and easy to navigate. A step by step process is provided to help the user identify specific hospitals by name, city, zip code, state, and/or county. Specific medical conditions and surgical procedures can be selected for comparison with up to three hospitals within a geographical area.
Comparison information includes process measures, outcome measures, patient experience, average Medicare payment, and the number of Medicare patients treated for the specific diagnosis. Graphs are available which compare specific indicator results for each hospital and with state and national averages. The current data displayed is for a running 12 months through January of 2008 with an update due in October. Unfortunately, information on any of these healthcare consumer websites is 6-9 months old.
• Joint Commission Quality Check: www.JointCommission.org/GeneralPublic
The Joint Commission has been accrediting hospitals for over 50 years. Its accreditation is a national seal of approval that indicates a hospital meets high performance standards. The Joint Commission website contains numerous pages of information for the consumer which can be helpful when selecting a health care provider, including a list of publications, patient safety videos, and access to the standards against which hospitals and health care providers are measured.
There is a General Public section with a specific link to a site called Quality Check in which you can search for a specific facility by organizational name, zip code, or state. Current data that is posted includes the 1/08 – 12/08 time frame, so the information does not reflect current outcomes. The facility information includes a list of its accreditations and certifications and also includes a “report card” of results for the National Patient Safety Goals and National Quality Improvement Goals. If there are multiple hospitals in a given area, all of the reports can be accessed for comparison.
SCM&HL: We’ve recently heard about some new information which originates from healthcare consumer surveys called “HCAHPS” (pronounced “H-Caps”). Exactly what are “H-Caps” and what is the value to the consumer?
MS. McCOY: HCAHPS (Hospital Consumer Assessment of Healthcare Providers) is a standardized survey instrument and data collection methodology for measuring patients’ perspectives of hospital care. This new tool developed by the Centers for Medicare & Medicaid Services (CMS) standardizes patient satisfaction survey questions nationwide to be used as another source of publicly reported information to assist the consumer with uniform comparison of hospitals. It is for inpatients only who meet specific eligibility requirements.
Patient surveys measure how well hospitals are meeting their patients’ and families’ needs and expectations. The information may be of greater interest and more easily understood than other, more technical web sites, which can be confusing and may not give an accurate picture of the actual patient experience.
Data collection began in October of 2006, and the first results were published in March of 2008. A minimum of 300 surveys must be received in a twelve month period for a facility to receive a report. The results measure the percentage of “always” answers, which can be compared to other facilities, as well as state and national averages. Data is updated quarterly on a rolling twelve month basis. CMS believes that “public reporting of patient satisfaction information supports consumer choice and promotes hospital quality of care and service.” The HCAHPS results can also be found on the CMS Hospital Compare web site www.hospitalcompare.hhs.gov
SCM&HL: What does it mean to be “accredited” or to have an accredited program (i.e. stroke program)?
MS. McCOY: Accreditation is a process. There are a number of accrediting bodies whose primary purpose is to survey health care facilities to ensure that they are meeting defined standards to protect the health and welfare of the public. These standards are published in manuals as references for the institutions to educate them on the expectations and rules and to define the items against which they will be measured. Each accrediting body has a regular schedule of surveys, some annually and others every two or three years, depending on the findings.
Each facility is surveyed by a team of trained professionals in the industry, including physicians, nurses, administrators, and engineers who survey for life safety issues. The surveys usually take several days, depending on the size of the facility, the number of beds, and other defining factors. The surveyors identify a score based on the level of compliance with each standard, and a final score determines if the facility will receive full, partial or no accreditation. Two of the most familiar accrediting bodies in the state of Florida are The Joint Commission and the Agency for Health Care Administration (ACHA). Det Norske Veritas, or DNV Healthcare Inc., is a US healthcare accrediting organization, which is a new alternative to the Joint Commission and has been accrediting some hospitals in the United States for the past two years.
SCM&HL: What does accreditation mean to the consumer?
MS. McCOY: If a facility is accredited by one of these agencies, they have validated that it meets the expectations for safety and quality of care and that it provides good care and services for its patients.
SCM&HL: Can you sum up the most important things to look for when deciding on which hospital to choose for health care services?
MS. McCOY: Ask yourself these questions:
• Is the hospital and/or some of its disease-specific programs accredited by the Joint Commission?
• Is it certified by the Centers for Medicare & Medicaid Services (CMS)?
• Is it rated highly by the state and consumer groups?
• Does your physician have privileges to practice at your hospital of choice, and is your physician confident that the hospital is focused on and delivers uncompromised safety and superior quality and service?
• Is the hospital a provider for your insurance plan?
• Does the hospital have experience and successful outcomes for your condition or the procedure/surgery that you need?
• Is the hospital recommended by your family and friends?
SCM&HL: Any final words of wisdom?
MS. McCOY: Do your homework, but be cautious. Evaluate the information on each web site for:
• Inclusive dates for the information reported – how current is the data?
• Source of the data
• Explanation of the data – hospitals offer different levels of service and programs, so be sure to clarify what all is included in the information (be sure you are comparing apples to apples)
• Review all information and clarify questions and confusion with your physician. Do not make assumptions or try to self-diagnose or treat based on information found on any specific web site.
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