Hunting For Hospitals That Measure Up
Godfrey Wood of Portland, Me., had a lot to learn, fast, about New York hospitals after a 93-year-old relative suffered an aortic aneurysm in the relative's Long Island home last summer. So he fired up Subimo (subimo.com), a Web service that lets you find and compare health-care providers based on criteria such as complication rates, cost, and availability of the latest technology. Once Subimo helped narrow his choices, Wood picked a cutting-edge therapy offered by a hospital 100 miles from his relative's house. "Your normal resources are to listen to your doctor and probably go along, but this was a major situation and we wanted to look at all the resources available," Wood says.
His experience shows how the Internet's role in health care is reaching a new stage. The 1990s brought general information sites such as WebMD (HLTH ) and DrKoop.com. Now Subimo and a host of services provide specific data people can use to help them choose hospitals, doctors, and health plans. In April, Medicare launched its own site, Hospital Compare (www.hospitalcompare.hhs.gov). Health Grades (HGRD ), based in Golden, Colo., offers detailed reports tracking performance in seven specialties from heart care to orthopedics at HealthGrades.com. The new sites use various grading systems, from HealthGrades' star-based ratings to Subimo's 0-to-100 scale, to simplify databases full of information, adjust hospitals' complication and mortality rates for the difficulty of the cases they treat, and let consumers turn a once-overwhelming decision into something they can handle confidently. "These sites are a major, major step because people have not had access to any significant information about hospitals before," says Dr. Barry Straube, acting chief medical officer for the Centers for Medicare & Medicaid Services in Baltimore.
These sites' emergence reflects increasing involvement by patients and their families in decisions about their health. Most people used to pick hospitals based simply on where their doctors practiced. But the wider availability of data on complication and infection rates, new technology, and other key factors has made it possible for patients to make smarter choices. According to a survey by Solucient, a health-care data services company, 26% of adult consumers say they're "very likely" to use data on hospital quality. Two-thirds say they would switch hospitals over their doctor's objections to go to an excellent facility or avoid a below-average one.
How good are these services? We checked four: Subimo, HealthGrades, HospitalCompare, and MyUHC.com, run by insurance provider UnitedHealth Group (UNH ) for the site's 9 million registered users. The sites are most useful when it comes to evaluating hospitals. For physicians, most offer little beyond the basic info about where the doctors went to medical school, in some cases the hospitals where they did their postgraduate training, and how long they've practiced.
As a test, I tried to help a friend of a friend recently diagnosed with stomach cancer find a hospital. He wanted to know whether he should go to one of the big New York City centers or to a well-regarded suburban hospital near his home in New Jersey. He also wanted help in reviewing his doctor's recommendations. Could he get by with less-invasive laparoscopic surgery or would he need the traditional operation that leaves you with a nine-inch scar and a six-week recovery?
Generally, I found Subimo to be the best of the bunch, because it offers the widest range of hospital data, along with layman-friendly guides to the latest disease research and treatments. MyUHC was even stronger on hospital rating -- especially since it backs up rankings with a center-of-excellence program in which the plan clearly identifies hospitals with good records and even calls patients with serious health problems to recommend specific hospitals. And it was slightly more comprehensive on rating doctors, though its criteria for identifying "UnitedHealth Premium" physicians rely a little too heavily on questionnaires filled out by the doctors themselves. HealthGrades was a bit narrower in its focus, followed by HospitalCompare, which had information relating to just three health problems: pneumonia, heart attacks, and heart failure.
All the sites are most helpful if you have a fairly common diagnosis. During our trial run, I found little on stomach cancer because only about 22,000 new cases are reported in the U.S. each year. Instead, I had to rely on general ratings for cancer surgery. Mostly through data offered by Subimo, I learned that my friend had equally good options in Manhattan and in New Jersey. Within 50 miles of his house, both New York Weill Cornell Medical Center in Manhattan and Hackensack University Medical Center in New Jersey received perfect scores of 100 from Subimo. We eliminated Somerset Medical Center, where his condition was diagnosed, because its score of 72 reflected low cancer-surgery volumes and the fact that Somerset does not have all of the new technology Subimo looks for.
Subimo's system also lets us take into account quality-of-life concerns. Another hospital, Robert Wood Johnson University Hospital in New Brunswick, N.J., scored a 94 and is only 11 miles from the patient's house. If he needs daily radiation treatments, the difference between driving 11 miles and 35 miles to New York or Hackensack will matter a lot. At MyUHC, we learned that RWJ has slightly better complication rates and mortality rates than Hackensack for this kind of surgery. Our confidence was bolstered by the fact that HealthGrades has twice given RWJ its Distinguished Hospital Award for Clinical Excellence. HealthGrades didn't have stomach cancer data, either: The closest it had was for gastrointestinal care. Ultimately, the patient did choose RWJ -- and the surgery is set for June 20.
Despite the flaws, this research would take weeks to match by talking to friends or doctors. Subimo figures that 55 million people can access its data -- through its site, their employers, or their insurers. Typically, the health plan or employer pays Subimo a bulk rate to let all of its members or employees have access, and then each consumer uses the system for free. UnitedHealth Group makes its information available to its customers only, also at no charge. HealthGrades charges $9.95 for a report on one hospital and $2.95 for each additional hospital.
To get the most out of resources such as these, use them in addition to consulting with your doctor and reviewing the medical literature. Most hospitals will have their medical library do research in journals or on the Web for patients -- if you know to ask for it. One of the most comprehensive health-education sites is Medline Plus, run by the National Library of Medicine and the National Institutes of Health (medlineplus.gov). Insurers, too, can be valuable resources. Many make nurses available to help patients interpret hospital-rating data, says UnitedHealthcare Executive Vice-President Dr. Lewis Sandy. "In addition to looking at Web sites, pick up the phone," he says.
The Net is emerging as a huge help in disseminating data on quality of care, reflecting a still-developing consensus on how to measure quality in the first place. The payoff: smarter consumers more in charge of their own care -- increasingly vital since changes to insurance plans mean patients are footing more of the bill. Not all doctors or hospitals like it. But they had better get used to it.
By Timothy J. Mullaney