How to Know if a Hospital Delivers Quality Care

Patients and their families expect quality healthcare, but often do not truly know if it is being delivered. Hospital workers will say the care is high qaulity, but often, even they do not know the truth of the matter.

Healthcare's biggest customer nationwide also expects quality care for its subscribers. Hands down the biggest payer of healthcare dollars in the United States is the Center for Medicare and Medicaid Services. (CMS) And now, not only does CMS expect quality care, they are requiring the proof from the hospitals caring for their patients.

A simple explanation of CMS is to say it is a government funded health insurance company. It has subscribers all over America who are generally older folks, having reached the "magic" age to start receiving these benefits; or they are younger folks with specific chronic conditions making them eligible for these government benefits at an earlier age. Either way, by nature of age and/or condition, it is safe to say the population of Medicare beneficiaries make up the vast majority of folks who access healthcare services in this country. This makes CMS a big customer. In marketing terms, CMS is a huge account hospitals do not want to lose!

CMS is one tough customer. CMS not only demands quality healthcare for its subscribers, in fact, CMS says to hospitals, "Either you prove you deliver quality care or we will dock your pay."

Almost all hospitals are now required to submit data to CMS to show they provide quality care. This determination is made by how hospitals provide care according to the "Best Practices" of the day.

A "Best Practice" is a set of specific interventions proven to have the best patient outcomes with a correlating diagnosis. For example, when a patient comes to the hospital having a heart attack, a vital intervention is to administer a type of drug called a Beta Blocker soon after that patient arrives. This drug will decrease the workload of the heart by making it beat slower and pump blood more efficiently, thus decreasing damage to the the heart muscle. Administering this drug in this circumstance has been shown to increase the likelihood of a patient surviving a heart attack and improve the long term outcomes for those patients.

Another common example is one intervention for Pneumonia. In the case of Pneumonia, an important intervention is the administration of antibiotics within a certain time frame of a patient's arrival to the hospital to help prevent the infection in the lungs from becoming life threatening. Routinely administering these antibiotics in a timely manner has clearly shown to decrease deaths from Pneumonia.

CMS started this program with the top medical diagnoses and the top surgical procedures performed and listed the respective best practice interventions for each. It is compliance to these interventions, referred to as "Core Measures," that CMS monitors and determines the quality of care.

Reimbursements for Medicare cases with these diagnoses are then allotted according to the actual compliance scores of the hospital. The better a hospital's complaince, the higher the reimbursement.

Hospitals audit their care for these cases and report the results to CMS. CMS then provides a sampling "double check" to guarentee accurate reporting. In this way, all scores and reimbursements are assured of being an accurate reflection of a hospital's quality of care.

When the Core Measures program was initiated, CMS also initiated the age of "transparency" in healthcare.

Transparency means an organization is "see-through." Quality performance is no longer hidden from view. Because these quality results are easily accessible, healthcare organizations are now "transparent" to the public. In other words, everyone has access to how well (or how poorly) a hospital has performed, based on its compliance with the Core Measures.

CMS operates a website where this information is posted on a quarterly basis. http://www.hospitalcompare.hhs.gov/ This site can be accessed by anyone with a computer and the Internet. Once there, one can search by the hospital name, city and state, zip code or state and county. A person may slecet one hospital or compare several hospitals at once.

The time for informed choices in selecting a hospital is here. Hosptals have always told the public they deliver quality care, but now they must put their money (in reimbursements) where their mouth is - and everyone can know the score.