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How to choose a hospital
Use our hospital Ratings to find a good hospital in your area. Even if you don't have a choice in hospitals, our Ratings can help you identify and be prepared for any potential problems at the hospital you do go to.
We rate hospitals using three major measures:
- Patient experience: Based on a government survey of millions of patients, these Ratings tell you whether patients would recommend the hospital, their overall assessment of it, and their experience with topics such as communication with doctors and nurses, pain control, and whether their rooms were kept clean and quiet. Read more.
- Patient outcomes: These Ratings, based on data submitted by hospitals to the federal government, or states, provide information on how well hospitals prevent bloodstream and surgical-site infections, and the chance that patients have to be readmitted to a hospital within 30 days of their initial discharge. The need for such readmission can indicate problems in care while the patient was first hospitalized, including a hospital-acquired infection. Read more.
- Hospital practices: Two measures are included under this heading, the use of electronic health records, and the appropriate use of CT scanning. The Ratings for electronic health records are based on a survey of hospitals conducted by the American Hospital Association on the extent to which a hospital uses a computerized system for documenting physicans' and nurses' notes, viewing lab reports, and other purposes. The Ratings for CT scanning comes from billing data submitted to CMS that calculates the percent of scans of the abdomen and chest that are performed twice, once with and once without a dye. Such scans usually aren't necessary and can expose you to unnecessary radiation.
- Safety score: This is a summary of several key categories related to hospital safety: avoiding infections, avoiding readmissions, communicating about new medications and discharge, appropriate use of chest and abdominal CT scanning, avoiding serious complications, and avoiding mortality. The score is expressed on 100-point scale. A hospital would score 100 if it earned the highest possible score in all measures and would score 1 if it earned the lowest scores in all measures. All of the categories are worth 20 points except for avoiding complications and avoiding mortality, each of which are worth 10 points. Read more.
- Avoiding adverse events in surgical patients. This Rating is based on the percenrage of patients undergoing scheduled surgery who died in the hospital or stayed longer than expected for their procedure. Research shows those measures are correlated with complications, and some hospitals themselves use this approach to monitor quality. To develop the Ratings, we worked with MPA, a health care consulting firm with expertise in analyzing billing claims and clinical records data and in helping hospitals use the information to improve patient safety. In addition to an overall surgery Rating summarizing results for 27 different kinds of surgeries, we also provide surgery Ratings for five specific types of surgeries: back surgery, hip and knee replacement, angioplasty, and carotid artery surgery. The Ratings are based on billing data submitted by hospitals to the Centers for Medicare and Medicaid Services. Read more.
In addition to our hospital Ratings, consider these other sources of information:
For more on these resources, read Check up on your hospital.
If you've recently learned that you need to enter a hospital for surgery or another reason, your main focus should be to get the best care possible. But understanding what your medical insurance covers and what it doesn't is also essential. And it might help you avoid some unwelcome surprises when the hospital bills arrive.
While some out-of-pocket expenses are inevitable, there's a lot you can do to prevent unnecessary hospital costs and identify billing errors. Call your insurance carrier to verify critical features of your plan, including:
- Which hospitals are in your plan's network (and be aware that even if a hospital is in the network, doctors who practice there may not be).
- The difference between in-network and out-of-network costs, such as deductibles or coinsurance.
- Whether your procedure requires pre-authorization.
If possible, ask for all this information in writing from your insurer. At a minimum, take notes on all conversations yourself, including date and the name and contact number of the person with whom you spoke. And save all communications you get from your insurer in case you run into a payment dispute later.
Read more about getting the most out of your health insurance.
Your choice of hospital can depend on where your physician or surgeon has admitting privileges. So you want to make sure that you find a good doctor. Here's a checklist that can help:
- Ask your primary-care doctor to recommend a surgeon, if necessary from the list of doctors approved by your insurance company. For complicated or unusual problems, ask your doctor for the name of an expert.
- If you don't have a solid recommendation, it's wise to learn all you can about the prospective surgeons. Start by checking out our list of national doctor resources. You can learn whether the surgeon is board-certified in a relevant specialty, such as Orthopaedics. You can also find out where the physician underwent residency training. Doctors trained at or working in university medical centers may have more experience with a wider variety of cases than those at smaller hospitals. And you can learn whether any disciplinary action has been taken against a doctor. Another good resource is Patientsrighttoknow.org, which offers an interactive map that you can click on to see what kind of physician information is available for your state.
- Talk with the prospective surgeon about his or her surgical results to help you find the best doctor. How many operations of the type you need has he or she performed? This is especially important if you need less common types of surgery, such as neurosurgery. Studies suggest that for some types of operations, experience leads to higher success and lower complication rates. You should also ask whether the doctor has any financial interests in the procedures or devices that are going to be used. This can help you understand if there's a potential conflict of interest. Also ask if the surgeon can provide references from patients willing to speak with you.
Read more about how to choose a doctor.
When people learn they have a serious disease, their first reaction is often, "Where's the best place in the world to go for this?" They're often willing to travel anywhere, and they assume that's what they'll have to do. Finding a good doctor and, if necessary, a good hospital are indeed essential when you're seriously ill. But for the vast majority of illnesses, even serious ones, you can usually find excellent care fairly close to home, especially if you live in or near a big city.
Traveling for health care, however, may offer advantages in certain cases. For example, you might have a rare condition that's adequately treated in only a few institutions worldwide. Maybe you need an unusual or difficult procedure or operation that your local doctors don't perform often enough to keep up their technical skills. Or perhaps you want to enroll in a clinical trial that's taking place far from your home.
In those cases, here are the main challenges you'll face and how to overcome them:
- No or limited insurance coverage Your insurer might force you to use specific hospitals and turn efforts to go elsewhere into protracted battles. You could try switching to a plan that allows more choice, though most people have that option only once a year at open enrollment. A preferred provider organization (PPO) is more likely to have a national network than a health maintenance organization (HMO), and is also more likely to let you go out of network for care. If you are on Medicare you will have no problem if you are in original Medicare, but will likely be in a geographically restricted network if you have a private Medicare Advantage plan. You could also try to appeal your existing plan's restrictions. Most managed care plans have provisions for going out of network for situations that require very specialized care, and the Affordable Care Act will also soon require all heath insurance plans to subject themselves to binding external review of care denials.
- Health insurance rarely pays for travel and lodging However, such costs might be tax-deductible as medical expenses. You can also contact the hospital's social-service department, local charities, or disease-specific support groups about the availability of free or low-cost lodging.
- Isolated care Without your primary-care doctor nearby, you're particularly susceptible to disjointed care from unfamiliar specialists. So it's especially important to have a trusted friend or family member with you to act as an advisor. Also ask the hospital's admissions department if there's a "hospitalist" on staff, a doctor who serves as a temporary primary-care physician. See what records or paperwork you'll need, and ask your local primary-care doctor to help you gather and send them. To ensure appropriate care when you return, involve your local doctors beforehand and ask them to recommend a local specialist, too, if necessary. Finally, make sure you or your friend or family member comes home with copies of all your treatment records and test results so you can make sure your local doctors have them for follow-up care. Too often, even if you request the hospital to forward your records to your local doctors, they don't.
Consumer Reports has no relationship with any advertisers or sponsors on this website. Copyright © 2007-2013 Consumers Union of U.S.
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