How to pick a provider: hospitals
This is the first in a two-part story on finding the best health care provider for you.
Whether choosing a new diet or picking the right school for your child, you’re going to do some research. The same applies when picking the right health care provider. But with several ratings, reviews, and other metrics to consider – plus general word of mouth - experts admit it may be confusing. So they encourage you to have a keen eye.
Brandon Hedgspeth deals with these metrics all the time as manager of quality and safety for OSF HealthCare in Danville, Illinois.
He says a hospital rating the public commonly looks at is from The Leapfrog Group, a national watchdog organization for patient safety. Leapfrog looks at hospitals of a certain size and those treating a minimum number of specific conditions, so some facilities are not included. Leapfrog assigns a letter grade – A, B, C, D or F – to a hospital each spring and fall based on 30 performance measures like patient care management, medication safety, hospital-acquired infections and maternity care. Hedgspeth says Leapfrog gives different weight to different metrics, and that weighting system changes frequently.
Hedgspeth says the fall Leapfrog rating is the more telling of the two.
“What we do every spring is answer a bunch of questions about processes that we do,” Hedgspeth says, and that data is used the following fall. “And that [data] can adjust your score based upon how you answer that and if you've done any action plans to adjust for what they're seeing or what it is they're looking at.”
Hedgspeth notes the Leapfrog ratings are complex, and some of the data used may be a year or two old. For present-day ratings, that means a rating could factor in some pre-pandemic performance and some performance during the pandemic – an apples to oranges comparison, Hedgspeth says.
Hedgspeth suggests that if you see something on a Leapfrog rating that gives you pause about choosing that hospital, call the facility and ask what it is doing to make improvements. The hospital likely won’t be able to give you specifics due to privacy concerns, but it should be able to give you a high-level summary.
Another rating for some hospitals comes from the Centers for Medicare and Medicaid Services (CMS), a federal agency within the Department of Health and Human Services. This looks just at traditional Medicare patients, Hedgspeth says. It also uses a weighted average and focuses on five groups – mortality, safety, readmission, patient experience and timely and effective care – to assign a yearly star rating of one through five.
In the ratings released in April 2021, most hospitals ranked were a three or four-star. This year’s rankings are expected in July.
Accreditation and certification
“They take the CMS regulations, and then they can get more specific because they want to see higher quality,” Hedgspeth says. “They want to see something different than what CMS does.”
Hedgspeth again states that accreditation is complicated, so most patients can just ask: Is my hospital accredited? If yes, it’s a good sign. If a hospital is in danger of losing its good standing with (and funding from) CMS, that news will likely be widespread.
Separate from but related to accreditation, Hedgspeth says hospitals can go through an even more rigorous process to be certified by The Joint Commission in specific areas, like stroke care or chest pain care.
“They want to see excellence in that particular care with those particular patients and how we can make improvements upon the care,” Hedgspeth says.
Widely accepted as the gold standard of patient care, the American Nurses Credentialing Center (an affiliate of the American Nurses Association) awards Magnet designation to hospitals based on excellence and professionalism in nursing. It’s a rigorous process to achieve this award, with written documentation and a site visit. Research shows Magnet hospitals are better at attracting and keeping quality nurses and perform better in patient safety. Magnet designations are valid for four years.
Only around eight percent of hospitals earn Magnet designation, so think of it as a cherry on top of a health care system’s portfolio.