What is health care quality?Back to top
Many consumers define health care quality as how well their doctor listens to them or the amount of parking available at the hospital, rather than the successful outcomes of their medical care. The health care industry and the Institute of Medicine define quality care as:
- “Doing the right thing (getting the medicines, tests, and care you need)
- At the right time (when you need them)
- In the right way (your doctor and/or hospital are using the best practices for treatment and death is prevented)
- For the right person (for you and not a different patient)
- Having the best possible outcome (end result of treatment), that is
- Free from accidental or preventable injuries as a result of the medical care.”
How good is the quality of health care?Back to top
Regrettably, the quality of health care in America is not what it could be. We spend at least two and a half times more on health care than most developed countries across the globe. But, Americans get lower quality, less efficiency and have the least fair system than other countries. (2014 Robert Woods Johnson survey)
Even though patient safety is a priority for health care providers, medical mistakes do happen. These mistakes can involve medicines, surgery, diagnoses, and equipment failures or inaccurate test results among others. They can occur anywhere in hospitals, clinics, surgery centers, doctors’ offices, nursing homes, pharmacies, and even patients’ homes. This unsafe care kills tens of thousands of Americans each year.
- 10% of Medicare patients die due to safety failures
- Medication errors harm about 1.5 million Americans
- Preventable medical mistakes in hospitals are the third leading cause of death, surpassing the number deaths caused by car accidents, breast cancer, and HIV/AIDS
- Research indicates that over 200,000 Americans die from preventable hospital errors annually
- When researchers include the diagnostic errors, errors of omission and failure to follow medical guidelines, this number is 440,000 preventable hospital deaths
- Diagnostic errors may account for 40,000-80,000 deaths
- Health care associated infections kill more people than prostate and breast cancer combined.
- These are infections patients acquire while being treated for non-related medical care
- The most common are catheter-related bloodstream infections, surgical site infections, and hospital-acquired pneumonia.
(Agency for Healthcare Research and Quality)
See the Patient Safety section to understand how to help prevent medical errors.
“American health care faces a crisis in quality. There is a dangerous divide between the potential for the high level of quality care that our health system promises and the uneven quality that it actually delivers. Clearly, consumers are aware of it. There are too many errors, too much misuse of medical treatments and, too often, poorly coordinated care among a patient’s different health care providers.” (Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation)
With rising health care costs, along with higher annual deductibles, consumers increasingly have to shop around for high-quality health care that they can afford. (National Quality Forum) Most information is from friends or family (63%), from a rating website (53%), or directly from their doctor (53%). (2014 Robert Wood Johnson Foundation consumer survey)
According to a new study, when patients are shown Leapfrog Hospital Safety Score Grades and cost information together (http://www.leapfroggroup.org/policy_leadership/leapfrog_news/5232018), consumers will choose safer hospitals 97% of the time, regardless of cost. . The vast majority would not sacrifice greater differences in safety for a lower price. Higher incomes, higher health literacy, and being female were associated with an even stronger preference for the safer hospital. (Altarum Institute research published in 2014 The Journal of Patient Safety, “The Effects of Hospital Safety Scores, Total Price, Out-of-Pocket Cost, and Household Income on Consumers’ Self-reported Choice of Hospitals”)
How can you ensure that you get high-quality health care? Back to top
The best ways consumers can make sure they receive quality care are to:
- Become health literate
- Be involved in every decision
- Speak up if you have questions
- Use quality providers.
There are several websites that compare health care quality, but beware; many sites are not evidence-based, reliable, or accurate. You can find several valid quality comparison tools at www.medicare.gov. The Center for Medicare and Medicaid Services (CMS) is the federal agency responsible for Medicare and medicare.gov. CMS works hard to make sure that Medicare patients get high-quality health care. Their quality comparison tools are based on data collected from Medicare providers. However, these comparisons do not include patients of all ages, only the older Medicare patients. But they are still an excellent source of quality comparisons for most types of care (excludes maternity and pediatric care). The following CMS comparison tools are available.
The Physician Comparison tool includes the following information:
- If the doctor accepts Medicare and if they bill Medicare directly
- Contact information and maps to where they see patients
- Primary and secondary specialties
- Board certification
- Medical school education and residency information
- Hospital affiliations and the quality scores of those hospitals
- Group practice affiliations
- Other languages spoken
- Whether they participate in the CMS quality programs
- Doctor Quality Reporting System which uses incentive payments for reporting quality information
- Electronic Prescribing Incentive Program which uses incentive payments to encourage the use of electronic prescribing
- Electronic Health Record (EHR) Incentive Program for professionals, hospitals and other health care facilities to implement the use of electronic health records.
Unfortunately, there are currently no tools that compare the actual outcomes of a doctor’s treatments. Consumers are most interested in this type of information, but there is no generally accepted, consistent set of doctor quality metrics and data – yet.
Many consumers see reviews of doctors’ interactions by other patients as an indicator of quality of medical care. The generally accepted tool for patient reviews are based on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. (National Quality Forum) These reviews rate the ease of getting an appointment, the time it takes to see the doctor, the amount of time the doctor spends with the patient, and if the doctor uses understandable language. (Agency for Healthcare Quality and Research)
Not every hospital is good at providing quality care for every type of medical issue. This is something that consumers must understand. There are differences in hospital quality of care. In fact, hospital errors are the third-leading cause of death, surpassing the number of deaths caused by car accidents, breast cancer, and HIV/AIDS. (Leapfrog Group) It is important to research hospital quality and/or talk with your doctor regarding the best hospital for the specific treatment you need. The CMS hospital comparison tool rates the quality of care for over 4,000 Medicare-certified hospitals across the country. The comparison includes hospital characteristics, inspection results, patient care medical errors, complications and deaths, and patient reviews.
In addition to the CMS tool, The Leapfrog Group also provides hospital quality and patient survey ratings for more than 2,500 general hospitals. Their Hospital Safety Score Grades are based on hospitals’ ability to prevent errors, injuries, and infections. The Leapfrog Group (www.leapfroggroup.org) is an organization of the nation’s largest corporations who use their combined purchasing power to push the health industry to improve health care safety, quality, and value.
Nursing Homes Comparisons
This CMS tool compares the quality of care of every Medicare and Medicaid-certified nursing home in the country (15,000). Consumers can find nursing homes in a selected area by type of facility, with overall ratings, health inspection reports, staffing data, and quality measure ratings.
Home Health Agencies Comparisons
This CMS tool compares the quality of care provided by home health agencies including demographics, services provided, how well home health agencies care for their patients, and how often they use best practices. It also includes patient reviews of recent home health care visits.
Dialysis Facility Comparisons
This CMS tool provides detailed information about Medicare-certified dialysis facilities. You can compare the services and the quality of care they provide. It also includes resources to learn more about chronic kidney disease and dialysis.
Health Plan Comparisons
Health plan quality comparisons are available from The National Committee for Quality Assurance (NCQA). They evaluate private health plans based on clinical performance, member satisfaction, and NCQA accreditation standards. The health plans are required to publicly release their performance information with enough data for statistically valid analysis. The tool is available at http://reportcard.ncqa.org. Additionally, the Consumer Reports magazine ranks health plans, which can be viewed at www.consumerreports.org; however, a subscription is required to view some of the comparisons online.
What are the costs of health care?Back to top
Currently, it is difficult for consumers to determine the cost of a health care service until their bill arrives. The health care industry cannot yet provide reliable, personalized patient costs of treatment options. This makes it impossible for consumers to identify providers with the best quality at the lowest cost.
The New York Times’ recent poll of readers finds that nearly half of respondents report that the affordability of basic medical care is a hardship for them and their families. Examples include a $3,421 bill to ride 200 feet in an ambulance. “One healthy insured couple remarked that they were slowly going under financially because their premiums, co-pays and deductibles are now twice as high as their mortgage and food costs.” (Elisabeth Rosenthal, How the High Cost of Medical Care Is Affecting Americans, The New York Times, December 18, 2014)
According to the 2014 NerdWallet Health Study, consumers cannot afford their medical care. Read the study. The increase of cost-sharing (consumers paying more of the cost) with fixed copays, higher deductibles, and out-of-pocket minimums has caused many consumers to delay or skip needed care. Nearly 43 million consumers have unpaid medical bills because they can’t understand the information they receive about the costs of their care. (Consumer Financial Protection Bureau) Also, medical bills are the leading cause of personal bankruptcy affecting nearly two million people in 2013. Bankruptcy is used as a last resort after families have drained their savings, maxed out their credit cards and even refinanced their homes. (NerdWallet Health 2013 study)
Regina Hertzlinger, a professor at the Harvard Business School, says, “If we had full health care cost transparency, consumers would be able to make more informed decisions regarding health care. That would begin to level out and provide for a more equitable system for all.” She aggressively supports government demanding price transparency “to end the notoriously secretive relationship between hospitals and insurance companies when it comes to negotiating prices. This will shift power from industry giants to the patients who will now have more information at their disposal to make a more informed decision based on prices.”
A new CMS database provides information that shows hospital costs vary for 100 of the most common inpatient procedures billed to Medicare. In the “New York City area, a joint replacement is anywhere between $15,000 and $155,000. Garfield Medical Center in Monterey Park, CA, charges $241,654 for a patient undergoing renal failure with a major complication. The cost of the same care is almost 10 times the price at Beverly Hospital about 5 miles away in Montebello. (May 2013 Huffington Post article)
The high price of medications is also a contributing factor to the $2.9 trillion cost of medical care in America. The increasing cost of patented medications (brand names) has almost offset the savings of generic medications, which can be 25% less than the brand name versions.
Another major factor in health care costs is the treatment of chronic diseases. They are among the most prevalent, costly, and preventable of all health problems and cause 7 out of every 10 deaths. As of 2012, according to the Centers for Disease Control and Prevention, about half of all adults—117 million people—have one or more chronic health conditions. These include Arthritis, Asthma, Cancer, Heart problems, Depression Diabetes and Obesity. Many have two or more chronic health conditions. The costs related to diabetes alone are over $92 billion a year. (www.cdc.gov/chronicdisease/overview/index.htm)
There are several ways to reduce health care costs. Reducing adverse events and diagnostic errors, correcting medical billing errors, eliminating fraud, reducing the cost of medications and illuminating variations in costs for identical medical care in similar geographic markets are but some of the ways.. Correcting even a few of these issues could significantly reduce the $2.9 trillion cost of health care (2013 costs).
What Can You Do To Reduce Costs?Back to top
The best way consumers can help reduce health care cost, as well as prevent medical errors, is to be an informed consumer and an active member of your health care team. Other ways consumers can save money are:
- Understanding covered health benefits and cost-sharing rules
- Using in-network providers and pharmacies
- Finding a local stand-alone provider for blood work or diagnostic imaging
- They can be as much as 70% cheaper than using a hospital lab or x-ray department
- Reviewing every medical bill against the insurance company’s Explanation of Benefits
- Medical billing errors are very common, with eight out of 10 hospital bills containing numerous mistakes and overcharges (Medical Recovery Service)
- Understanding the difference among the
- Charge (what the provider bills)
- Allowed Amount (what the insurance has agreed to pay)
- Not Covered Amount (what you may have to pay).
- Keeping track of deductibles and maximum out-of-pocket costs to determine when your plan will begin to pay the majority or 100% of the cost of care
- Appealing any billing mistakes and always appealing any denied claims
- Negotiating your bill with a provider if you cannot pay the full amount
- Applying for financial aid from hospitals (they budget for charity care), other charity organizations or state and federal aid.
The contents of this site include educational information only and are not meant to be a substitute for professional medical advice. Never ignore professional medical advice or delay getting the advice because of something you have read on this site. Always seek the guidance of your physician or another qualified health provider with any questions regarding your personal health or medical conditions. Reliance on any information provided on this site is solely at your risk. Call your doctor or 911 immediately if you think you may have a medical emergency.