New York Regional Health Care Report Card Goes Live

I know, I've been quiet. It's been a while since I posted, and here's why:

First and foremost, I have been buried in data all summer, getting this report card out. More on that in a minute.

Secondly, I determined to take some time to myself this year, so I've taken a slew of short camping trips to spend time with my son, do some fishing, sleep in a tent and generally get some of the city out of me.

Thirdly, I finally had my appendix out after my third and final bout with appendicitis.

So, now it's out. It's online at http://www.nyshaf.org/hcrc and I'd like to take this post to explain how I think it can be used, what purpose it serves, and talk about some of the data involved.

The report card is split into two main sections, HMO and Hospital. In both sections the report is split up by groups of measures that can viewed side by side, some quality, some patient experience, some cost.

One of the main problems with public report cards is that the health data is so complex and so arcane it's practically useless to the lay consumer. Sometimes a lower score is better. Sometimes a higher score is better. Sometimes the score is a percentage, sometimes a range. Sometimes it's a vague statistic definition, such as "not significantly worse that the national mean".

Another big problem is the tendency to predetermine what "good" is, and then try to communicate that top the viewer. Health care providers may say that high quality is paramount, cost is irrelevant. An HMO may say that the best care is given by better high quality, low cost providers. Some people think high volume is a good thing, other's don't. The list, and the permutations are endless.

Finally, the overarching goal is to present as many of these public reports as possible in a single space in a single format. For this year's report we've combined 25 publicly available reports which you'd normally have to obtain from 25 different sources.

So I set about trying to determine how to take all these kinds of different data and represent them in a singular fashion that would be easily and quickly comprehensible, without implying a judgement or a ranking. More than one reporter asked me "which hospital is the best?" My answer is always another question: best at what?

One hospital may be the world's best for cancer treatment; is that where I should go for a scheduled C-section?

There is no best hospital, there is no best doctor, no best surgeon, no best HMO. But there *are* providers that are better for you and your individual needs than others.

So, goals set: translate complex data analysis into visual nuggets of qualitative information, and allow the user to narrow down the qualities and measures that matter to them.


What you see above is one category of HMO data. More detailed information is available with a click or two, but at a glance you can see that for customer service one HMO stands out as being highly rated, three are more or less average, and one has some issues.

At least, I hope you can see that. If not, I just wasted a year.

So how can a consumer use this report card?

Example 1: Heart Attack

I have never heard of anyone having a heart attack and stopping to consult report cards on where they think they should go.

However, once you're in the hospital, your loved ones can consult the report to see how well the facility you ended up at is faring at providing quality treatment. If anything stands out as worrisome, bring it up with your doctor.

Further, several of the measures apply to the care you receive after your emergency treatment. Medications prescribed at discharge for example, including aspirin, as well as smoking cessation counselling.

Mortality rates for heart attack are relatively flat, everyone is going to be pretty much "as expected". If your hospital shows up red for mortality, bring this up with the hospital staff.

You may be looking at a co-pay or even worse, you're uninsured. Use the average charges bill to get an idea of how much the stay will cost you or your employer. You can also see the average length of stay for a heart attack patient, and if it's shorter or longer than you think is right, raise this with your physician.

The overall point is that the level and standard of care can and will vary from hospital to hospital, and nowhere is perfect. It pays to be informed, and remember you are your best advocate.

Example 2: Choosing an HMO

Some employers will offer you a choice of two HMOs. If you or your partner has an ongoing condition such as asthma, have a look at which of the two HMOs available seem to be more on the ball for that condition. Then check out the customer satisfaction ratings for that HMO.

If you don't have a choice and your HMO plan scores poorly, then use that as a reminder to make sure you get the care you need by advocating for yourself. Have a look at the care provided by other HMOs and demand that same care from your primary physician.

If you have children, compare the two youth sections. In my county, only one HMO has all green for appropriate youth care.

Example 3: Appendicitis

I have a bit of personal experience here. I had the symptoms of acute appendicitis for a few days, and finally went to the ER after the symptoms didn't go away. i was a little atypical, and was in little danger of perforation, but nonetheless you may be able to do what I did.

I looked at the five hospitals nearest me, and compared the length of stay for an appendectomy, the surgical infection prevention score,a dn the price.

I'm price-sensitive even though I have good health insurance. The company where I work pays for the health care I receive, and the last two years have seen a steady increase in both the company cost as well as my family rate contribution to the plan. Further, all my co-pays went up significantly this last year.

Because health care is so often paid for with invisible dollars it can feel a bit like Monopoly money, you never see it, you never worry about it, you get a long, arcane bill that you never have to worry about. However, I know that if I can get an appendectomy at hospital A for $10,000 less than hospital B, I just saved the company money. Saving the company money puts more dollars in the kitty for my next pay raise. And being relatively young and by all accounts rather stoic, I'd rather have the cash up front than ploughed into a pool for a rapidly greying employee population.

In my county, appendectomy hospital bills range from $7,000 to $30,000.

Let me repeat that.

In my county, appendectomy hospital bills range from $7,000 to $30,000.

That's before the surgeon's and anaesthetist's bills.

I actually placed more importance on finding a hospital that had a low average length of stay with good surgical infection scores. I wanted somewhere under $15,000 with three or so days stay on average.

The hospital I chose actually had a poor score for timely antibiotics, so instead of choosing a different hospital, I questioned the staff when my first antibiotics were given and ensured I was less than an hour from surgery.

Example 4: Mother to be

Some women search for hospitals that are less inclined to perform a C-section. In my county, the C-section rate varies from 17% to 34%. That's double the rate. For primary caesareans, the rate goes as low as 11% at a hospital that also shows a high rate of vaginal births after C-sections, clearly a hospital that can help you have a natural birth.

Others may choose the scheduled C-section route, and look for a hospital that performs a good number of the procedure. You can compare the number of times the procedure was performed in a year at all your local hospitals, as well as the surgical infection prevention scores.

Looking to get home quickly after the surgery? Some hospitals have you stay for three days, others for five.

--

In my next post I'll go into more detail about the different data sets including the different kinds of measures available, where we get the data from, and how accurate that data is.

In the meantime, I am very interested in hearing from anyone who has used a public report card similar to this one in a real life situation. Was it useful? Did it complicate things? Did you bring anything up with your doctor?

Finally, if you wish you had similar resources in your community, consult www.abouthealthtransparency.org/ and click your state. You can also check out www.consumerhealthratings.com/
‎