Contributor: Matt Pickens, WG'03
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In 2017 it is far easier to get reliable information on the quality of a hotel than a hospital. Granted, the factors that go into choosing a hospital are more complex, but the information gap is concerning given how high the stakes are. Emerging sources are providing consumers with greater insight into hospital performance, yet it is still a sea of ambiguous, conflicting data. One need look no further than the roadside billboards in any county touting the local medical center as top rated in some category by some anonymous source. The convergence of safety, clinical, and patient experience data into unified ratings is a step in the right direction; however, the limitations of these ratings leaves the field wide open for a disruptive innovator – the Hotels.com or Uber of healthcare perhaps?
Recently I found myself faced with two decisions: (1) choosing a hotel in Miami for my family and (2) recommending a hospital for my friend’s grandmother, who fractured her hip. The process entailed in researching these two questions involved some similar variables, and yet there was a wide divergence with regard to speed and certainty of the final answer.
Anyone reading this article has likely used Hotels.com or a similar site, so I will only briefly describe this experience. I performed a search for Miami hotels and was able to segment my geographic preference by neighborhood. I filtered on price and minimum acceptable rating, and then sorted by lowest price. The results displayed geographic proximity, consumer feedback (star ratings), and actual comments. I scanned for two variables - number of ratings (n size) and the ratings themselves. A star rating above 4.0 and an n size of several hundred gave me confidence that the hotel was quality and the data was robust. Elapsed time to search and make my selection…less than 5 minutes.
Back to my friend’s grandmother and the question “Which of the two hospitals was the best? This search was simply a question of quality. Neither proximity nor value factored into our conversation. Either cost was a lower priority than clinical quality, or perhaps we lacked a shared framework for comparison shopping healthcare services on value.
For clinical quality, you need to know where to look and what quality measures are relevant. The CMS website HospitalCompare provides various quality measures on hospital performance relative to the national average.
I scanned the dozens of clinical measures, and it was not clear that any of them were especially relevant to a hip patient. I am probably wrong, but that is part of my point - how can a layperson know? So I basically skipped quality. Being familiar with the website HospitalSafetyScore.com, that aggregates publicly available safety data, I learned that both hospitals were rated a “B” for Safety.
My final stop was HospitalCompare to assess publicly available patient experience data, which turned out to be middle of the road for both. At this point, about 30 minutes had elapsed, and I did not feel very good about either choice.
I then decided to reframe the question to “What is the closest hospital with an acceptable level of performance?” Now proximity became important. I created a spreadsheet and used Google Maps to determine the distance of over 15 hospitals. Then I ran the same checks, hospital by hospital, on HospitalSafetyScore and HospitalCompare. At the end of this manual process I selected a hospital that was about 5 minutes further than the original two, was “A” rated for safety, and had patient experience scores in the top quartile. Elapsed time to conduct my search and make my selection? Well over an hour and, although I felt good about ruling out the original two hospitals, I still didn’t have a clear view of the clinical quality of my selection. Had there been a top-rated academic medical center for orthopedic surgery, it might have made my search simpler, yet this option did not exist.
Since conducting this hospital search, two elements of the rating landscape have changed. First, in April 2016, HospitalSafetyScore began incorporating the following patient experience items from the HCAHPS survey into its ratings: Nurse and Doctor Communication, Staff Responsiveness, Communication about Medicines, and Discharge. While there is general agreement that communication in the hospital setting is a key driver of quality care, a limitation of the new HospitalSafetyScore is that it still does not include actual clinical quality measures.
In July 2016 CMS released Overall Hospital Quality Star Ratings on its Hospital Compare website. Previously the website had featured star ratings based solely on patient experience, in addition to over 60 items related to clinical quality and safety. It was up to the consumer, however, to sift through the large volumes of information on safety and quality, without a lot of context as to its relevance. The new five star rating aggregating safety, quality, and experience data provides a more holistic single measure for the consumer to evaluate. This is a big step forward, as consumers readily comprehend a 5 star rating, and the need to interpret the meaning of various measures has been eliminated. It remains to be seen if these new star ratings will be readily adopted, as reaction to the previous star ratings based solely on patient experience has been mixed.
While hospital quality ratings have evolved, the value of these ratings relative to helping consumers make informed choices is still in question. In contrast, consumer sites like Hotels.com, Amazon, and Uber make the experience of searching for goods and services tailored to our preferences easy and satisfying. While there are a host of sites vying to provide information regarding individual physicians, there currently is not yet a widely adopted, single source of hospital information that has proven itself to be consumer-friendly. The opportunity is ripe for a disruptive tech innovator that can source and aggregate meaningful healthcare data and then connect consumers to that data in an efficient, intuitive fashion.
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