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Thinking About Health
Patients Grade Their Local Hospitals PDF Print E-mail
Written by Wauneta Breeze   
Thursday, 23 April 2015 16:19


Editor’s Note: The Rural Health News Service is funded by a grant from The Commonwealth Fund and distributed through the Nebraska Press Association Foundation, the Colorado Press Association, the South Dakota Newspaper Association and the Hoosier (IN) State Press Association.


By Trudy Lieberman

Rural Health News Service

The government has just announced its first-ever star ratings  HYPERLINK “http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-04-16.html” http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-04-16.html of the country’s hospitals based on patients’ assessments of the care they received. Other organizations have dabbled in this ratings business, many of them to make a buck by selling their rankings. And it’s not uncommon for some of these outfits to get licensing fees from hospitals that get glowing report cards they can then use to market themselves.

I’ve tended to view those ratings schemes with skepticism. The government’s ratings, however, don’t come with any of that baggage and don’t appear to be sugarcoated for commercial purposes. Only 251 of the 3,500 or so hospitals that received a rating got the top score of five stars—about 7 percent of the total.  It turns out many of them are small specialty hospitals like the Heart Hospital at Deaconess Gateway in Newburgh, Indiana.

I checked the  HYPERLINK “http://kaiserhealthnews.org/news/only-251-hospitals-score-five-stars-in-medicares-new-ratings/” http://kaiserhealthnews.org/news/only-251-hospitals-score-five-stars-in-medicares-new-ratings/ rankings for the seven states participating in the Rural Health News Service. Nebraska, South Dakota and Indiana scored in the top group with hospitals averaging the most stars.  Colorado, Wyoming and Illinois ranked in the second highest group, and California was in the bottom tier where hospitals averaged the fewest number of stars.

The government gathers its data by randomly selecting both Medicare and non-Medicare patients and asking them to fill out a questionnaire about their experiences in the hospitals. They are asked if doctors and nurses always communicated well with them; if the area around their rooms was quiet at night and bathrooms were clean; whether the staff explained medications before administering them and patients’ pain was controlled; whether they were given discharge instructions when they left the hospital and whether they understood them; whether they received help as soon as they wanted it and whether they definitely would recommend the hospital to others.

While there are many other components that measure differences between a really good hospital and one that’s so-so such as infection control, patient safety and clinical outcomes, patient experiences are nothing to be sniffed at  HYPERLINK “http://www.cjr.org/the_second_opinion/how_reporters_can_improve_coverage_of_medical_errors.php” http://www.cjr.org/the_second_opinion/how_reporters_can_improve_coverage_of_medical_errors.php.

Why would any patient want to have an operation in a hospital where the bathrooms weren’t clean and they’d always be yelling for pain relief? The problem is many patients have no choice when they need a hospital procedure. They go where their doctors go. Certainly they have no choice when an emergency arises. But in parts of the country where hospitals are competing for your business—and, yes, hospitals are now very big businesses--you might be able to use such  HYPERLINK “http://cdn.kaiserhealthnews.org/attachments/HospitalStarsForPatientSatisfaction.pdf” http://cdn.kaiserhealthnews.org/attachments/HospitalStarsForPatientSatisfaction.pdf ratings when you choose your next health insurance policy.

Increasingly, insurers are asking patients to pick policies that come with very narrow provider networks. Carriers are giving the lowest premiums to policyholders who pick networks where doctors and hospitals have agreed to the prices insurers want to pay. Often those low-cost networks exclude well-known, marquee hospitals that often come with high price tags like Cedars-Sinai Hospital in Los Angeles, Memorial Sloan Kettering in Manhattan and Chicago’s Northwestern Memorial Hospital.

If you will be facing such a choice of networks and the premium trade-offs that come with them---wider networks usually mean higher premiums---the government’s patient satisfaction ratings might tip the balance in favor of one network rather than another.

If your doctors want you to go to a facility that has gotten middling ratings or low scores with one or two stars that should spark a conversation about what the doctors actually know about the care their patients are getting and why they want you to use a particular hospital.

Now that there is a more objective way to measure hospital experience, beware of all that hospital advertising  HYPERLINK “http://www.healthnewsreview.org/2015/03/dissecting-pr-puffery-trudy-lieberman-guest-post/” http://www.healthnewsreview.org/2015/03/dissecting-pr-puffery-trudy-lieberman-guest-post/ aimed to make you think well of the facility and build the brand. The government’s ratings show that sometimes there is no correlation between patient satisfaction and a hospital’s advertising to promote its lucrative services.

In New York City where I live, three hospitals, which received mediocre ratings, advertise widely on TV sometimes featuring over-the-top success stories of patients who have been miraculously cured. They also use subway advertising and banners hanging from street posts to help build their customer base. Clearly the message for patients and doctors is: Come to us.

As I’ve written many times, shopping for healthcare is not as easy or as much fun as buying a new computer or car, but this latest crop of government ratings offers good, straightforward data to help with that task.

We’d like to hear your experiences with hospital care. Write to Trudy at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Editor’s note: The Rural Health News Service is funded by a grant from The Commonwealth Fund and is distributed through the Nebraska Press Assn. Foundation, Colorado Press Assn., South Dakota Newspaper Assn., Hoosier (IN) State Press Assn., Illinois Press Assn., Wyoming Press Assn. and California Newspaper Publishers Assn.


TRUDY LIEBERMAN is a contributing editor to the Columbia Journalism Review where she blogs about health care and retirement. She is also a fellow at the Center for Advancing Health where she blogs about health.

 

 
Think twice before buying drugs that may not be effective PDF Print E-mail
Written by Wauneta Breeze   
Thursday, 26 March 2015 17:53

Editor’s Note: The Rural Health News Service is funded by a grant from The Commonwealth Fund and distributed through the Nebraska Press Association Foundation, the Colorado Press Association, the South Dakota Newspaper Association and the Hoosier (IN) State Press Association.


By Trudy Lieberman

Rural Health News Service

 

Word has just come from Express Scripts, the big pharmacy benefit manager, that per capita drug spending in the U.S. increased more than 6 percent last year. When  high prices for specialty drugs like the hepatitis C medicine Sovaldi is factored in, the increase is even greater. There are more expensive specialty drugs in the pipeline, and prices of traditional drugs especially generics are rising too. We know that if we’ve refilled any prescriptions.

The National Coalition on Health Care, a group of businesses, healthcare providers, consumer groups and faith-based organizations, has warned, “getting these prices under control is imperative. All the new therapies won’t do much to improve health if Americans can’t afford them.” We know that, too.

And that brings up what we might not know. What can we as patients do to be better consumers of medicines and help lower our own spending for costly drugs.  And since flu season will be with us for a bit longer, the drug Tamiflu came to mind.

Obviously hundreds of drugs improve health and save lives, but many others are more questionable, and the benefits are less clear. Tamiflu may be one of them.

Throughout this flu season the media citing recommendations from the Centers for Disease Control and Prevention (CDC) suggested people take the drug.  In fact CDC  Director Tom Frieden told journalists at a press conference when this year’s flu season began that if he or a member of his family got the flu or a flu-like illness, “I would get them or me treated with Tamiflu as quickly as possible.” Much of the press reported uncritically on that advice.

But what’s the evidence that the drug, which generates millions of dollars in sales each year, actually does any good?  Larry Sasich who is a founder and publisher of www.patientdrugnews.com Patient Drug News, which offers unbiased clear information about the use and safety of medicines based on scientific evidence, says  “for almost 15 years the FDA has said the drug is minimally effective in shortening the number of days you have flu symptoms, and there’s no convincing evidence it prevents serious bacterial complications of the flu.”

Sasich cited the FDA’s 1999 professional product label written for doctors and pharmacists which notes that taking the drug may result in a 1.3 day reduction in symptoms for adults and adolescents who already have the flu and a one day reduction for people over 65. (That result was not statistically significant.) For people who didn’t have the flu but were exposed to someone who had it, the drug taken once daily for 42 days reduced flu cases from 5 percent to 1 percent.

In 2000 the FDA changed the product label to indicate that although serious bacterial infections may begin with flu-like symptoms or may occur as complications “TAMIFLU has not been shown to prevent such complications.” That finding still stands. Consumers can find it on a website called DailyMed, at http://dailymed.nlm.nih.gov/dailymed/index.cfm, a service of the National Library of Medicine. The website lists more than 70,000 drugs and is the official provider of FDA labeling information which anyone taking medicines should consult.

The FDA and the CDC seem to be telling Americans different stories about Tamiflu. Sasich told me the difference appears to be the quality of the evidence each agency has used to make its warnings and recommendations. The FDA has used randomized controlled trials, the gold standard for scientific work. The CDC has used observational studies, often considered less reliable, in formulating its advice.

Sasich says he favors the FDA recommendation, and believes consumers should think hard about spending their money on a drug that doesn’t prevent influenza and minimally reduces symptoms of the flu. Tamiflu isn’t cheap. The website www.goodrx.com shows prices generally in the $133 to $143 range. The retail price at my local pharmacy is $152 for 10 75-milligram tablets.

Whether you buy the drug at the first sign of a sniffle comes down to whether you want to plunk down more than $100 for a marginally useful remedy especially if you are still in the deductible period of your insurance policy and paying out-of-pocket. We may not be able to change the way the drug industry prices its products, but we can examine the evidence and make an informed choice to take a drug that doesn’t help much.

We want to hear about your experiences with the high cost of medicines. Write to Trudy at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .


TRUDY LIEBERMAN is a contributing editor to the Columbia Journalism Review where she blogs about health care and retirement. She is also a fellow at

the Center for Advancing Health where she blogs about health.