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Boasting about rankings can be exagerated. Bills often don't reflect real cost
By Angie C. Marek
Smart Money
Published on Friday, Nov 28, 2008
(6) ''It's all about PR.''
You can hardly log on to a hospital's Web site without a logo proclaiming it ''one of the country's best.'' Rankings have proliferated in recent years and are now offered by such varied sources as the for-profit firm HealthGrades and magazines like U.S. News & World Report. The problem is, consumers still don't know how to assess and research hospitals adequately, says Howard Peterson, managing partner of hospital-consulting firm TRG Healthcare, so ''image becomes everything.''
That's why each year when hospital rankings that factor in the reputation of a facility within the health care community get compiled, ''I can't even tell you how many e-mails I get wanting my vote,'' Peterson says.
How to find reliable rankings? For starters, look closely at what goes into these calculations. For example, a facility might label itself ''best hospital'' when only one division (say, ophthalmology) has won an award. Among rankers, HealthGrades (http://www.healthgrades.com) bases its ratings on more than 90 individual procedures and lets you access ratings based on mortality or complication rates of patients, as well as data on safety and what the hospital charges.
(7) ''You might be paying for the guy in the next bed.''
Hospital CEOs tend to focus on ''the mix of privately insured and Medicare patients at their hospitals,'' says Leah Binder, CEO of industry monitor The Leapfrog Group. And for good reason: Because Medicare reimbursements barely cover the cost of procedures, privately insured patients and their insurers often pay more to compensate. One PricewaterhouseCoopers study predicts one of every four dollars spent by private insurers will
cover such cost shifting by 2009. That can lead to some pretty outrageous charges.
For example, says consumer advocate Nora Johnson, many hospitals bill about $30,000 for appendectomies when the cost to do the procedure is more like $4,200. (Insurers negotiate prices, usually somewhere between those two benchmarks.) But because it isn't easy to compare prices, Johnson says there are ''no checks and balances to keep hospitals from marking things up as much as they want.''
Richard Clark, CEO of the Healthcare Financial Management Association, a professional group for hospital CFOs, says it's ''frustrating'' to hear arguments that pricing is arbitrary, because hospitals painstakingly adjust prices based on the number of patients covered by government programs and on market forces.
(8) ''Our mergers are pretty messy.''
The hospital industry has been rapidly consolidating since the 1990s, with more than 100 merger-type deals announced or completed in 2007 alone. What does this mean for consumers? When a hospital buys another close by, prices can jump more than 40 percent. That's because big chains have more leverage to demand higher rates from insurers, says Robert Town, professor of health policy at the University of Minnesota.
Hospitals say mergers ultimately help them improve quality — they'll spend more on care and less on back-office needs. But the process can cause customer-service troubles and occasionally compromise quality. Hospital consultant Corbett Price says it's ''very common'' for hospitals to have problems coordinating accounting systems after a merger, which can result in duplicate or flawed bills, for example. And because mergers gobble up competition, some critics say hospital CEOs no longer feel they have to address black marks — like low nurse-to-patient ratios — to compete.
Price urges concerned consumers to talk with their primary care doctor about changes at a newly merged hospital and make sure the facility remains accredited by checking http://www.jointcommission.org. Another option: Wait at least three months for the dust to settle before going back.
(9) ''If it were up to me, we'd be doing more breast implants.''
With more hospitals focused on financial survival, many are pushing the most profitable types of care. Nowhere is this trend more apparent than in advertising: A 2005 study of top academic medical centers' ads found that 29 percent of those focused on specific treatments touted cosmetic procedures, while another 38 percent focused on experimental (read: high-priced) services like deep-brain stimulation for Parkinson's disease.
Critics worry hospitals are becoming dangerously out of sync with the needs of the public. Author Mahar says ERs are often crowded because hospitals don't want to expand this low-profit unit. Poor financials also explain why the U.S. doesn't ''have nearly enough burn units,'' she says, and why more than three-quarters of hospitals don't offer palliative care. Clark says that while a focus on building up profitable parts of facilities is ''definitely going on,'' nonprofit hospitals also focus on ''making sure they are still providing the services the community needs while making a hospital financially sustainable.''
(10) ''We don't like you poking into our business.''
Things have improved in recent years, but consumer advocates trying to make data publicly available on such topics as staph infection rates in hospitals often describe a multiphased process of resistance. ''First the executives just flat-out oppose you,'' says Denise Love, executive director of the National Association of Health Data Organizations. ''Then they say they love the idea but begin attacking the data points and methodology.''
At HealthGrades, Chief Medical Officer Samantha Collier says she gets calls ''at least once a week'' from hospital CEOs or their underlings complaining about everything from her methodology to where they fall in the hierarchy of rankings. Granted, hospital execs have some legitimate concerns: For example, there's the issue of whether hospital researchers and raters are properly adjusting data to be easier on facilities seeing the toughest cases and thus posting higher mortality rates. But Mahar says hospitals' stake in keeping the public underinformed is mostly business savvy. ''CEOs realize that patients walk away (from the hospital) knowing whether they like the food and the view,'' she said. ''They've got no idea if they actually got good quality health care.''
(6) ''It's all about PR.''
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Comments
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Akron, OH
Posted 10:13 AM, 11/28/2008
From the standpoint of a patient having been hospitalized in 3 major area hospitals over the last 15 years, I think what matters more is the competency and caring of your doctor and especially the hospital nurses.
Slick ad campaigns, baloney slogans about "trust", and glistening glass and mahogany buildings are of little importance when you're lying in the bed, too sick or in pain to move, and nobody answers your call light for a nurse to come in to help you.
Then later, as you walk the mile-long hallways passing nursing stations, you see everyone's eyes are glued into a computer screen, searching and battling and feeding the slow and INSATIABLE computer records systems.
As the hospitals grow bigger and bigger, individual care of a sick person in the bed appears to be the last priority on the list.
Watching nurse friends in the profession over the years, I see that pay and advancement incentives for nurses are geared more toward cold, hard business-BUDGET management than hands-on patient care.
More and more RN's are dressing like bankers, in business suits and spike heels, which clearly says they are not going to get their hands or clothes dirty by getting directly involved with a sick person in a bed.
Then the nurses and aides they send in "to do the dirty work" often show no more interest or empathy than the guy at the lube shop who changes your oil and rotates your tires.
Of course there are some excellent, caring nurses at the bedside, but they seem to be a tiny minority amongst the others who convey the impression "I'm just putting in my time . . . and then I'm OUTA here".
The more the supervisory and administrative nurses focus on business meetings and budgeting, the less they convey to their staff the importance of alleviating the suffering of a sick person in pain. That used to be what a hospital is for, and it seems like a dying concept.
akron, oh
Posted 10:21 AM, 11/28/2008
Nonsense. I was a patient at General a few years ago and was well taken care of by nurses and doctors. Quit with the hysteria.
Akron, OH
Posted 03:57 PM, 11/28/2008
Notice Kate did not specify which hospital. My experience with AGMC has also been good.
