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Why It’s So Hard to Pick the Right Hospital

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Selecting the right hospital to receive care can save your life, lower your risks of getting a complication, or even reduce your financial hardship.

The problem is that it's extremely hard for patients to make that judgment. Sometimes, the data they need to select the best hospital for their care doesn't exist. In other cases it's hard or impossible for the public to find.

For instance, if you're getting an esophagus resection or other high-risk procedure at a hospital that rarely performs it, your chance of death could be several times greater than if you went to a high-volume facility. This finding is consistent with decades' worth of studies linking higher surgical volumes to better outcomes. You would think that if it's so consequential, consumers should be able to find how many cases their doctors or hospitals have done, and compare that against a threshold signaling proficiency. Yet that data is rarely available. California is a recent exception, where hospital-specific volumes for 11 cancer procedures are now online. Lo and behold, in a majority of hospitals, at least one of these procedures was performed only once or twice that year. Why can't patients elsewhere get that kind of information?

Central catheter-related bloodstream infections, a potentially fatal complication, can be 10 times higher in poor-performing facilities than in high performers. On its Hospital Compare website, the Centers for Medicare and Medicaid Services provides general assessments of performance in this area — better, worse or no different than the national benchmark. Consumers should be able to identify with more precision hospitals that are extreme outliers.

Similarly, cost data is difficult to track down and varies widely. With out-of-pocket expenses increasing, this variation could end up costing you. But we have seen that patients will act on this information if it's available. In California, after state government retirees seeking orthopedic surgery were required to pay the difference between the state's contribution limit and the price paid to the hospital, surgical volumes for these patients increased by more than one fifth at low-priced facilities and decreased by roughly one third at high-priced ones. Meanwhile, prices charged at the costlier facilities dropped by 34 percent.

This remains the exception, not the rule. We need health-care performance and cost data to be as open, valid and transparent as the financial data reported by public companies. In business, the Financial Accounting Standards Board (FASB) sets requirements for the reporting of financial data. It defines the measures to be used in earnings reports and annual reports, providing a common book of truth that is audited. While not perfect, it provides much more information about financial performance than we have about health-care quality performance. Yet such a body doesn't exist in health care, where governments, insurers, private ratings companies, consumer organizations and journalism outfits issue metrics. These measures often paint a conflicting picture of the quality provided by any hospital or physician.

For the sake of patients and health-care organizations, we need a FASB-like body to provide that book of truth and help develop measures that matter to patients.

This post first appeared in the Wall Street Journal's blog, The Experts.


Peter Pronovost

One of the world’s leading authorities on patient safety, Peter Pronovost served a the director of the Armstrong Institute, as well as senior vice president for patient safety and quality, at Johns Hopkins Medicine from 2011 until January 2018.

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