The biggest mistake you can make when choosing a hospital is to simply go to the closest facility or the “biggest and best” one in your area. Selecting a hospital that’s best suited to your particular needs may mean the difference in how quickly you recover. Find out what questions you should ask to get the most effective treatment possible.
Many people realize that hospitals are not all alike, but most believe the differences are a matter of size and overall quality. In fact, a hospital that excels in coronary bypass surgery may not be the best choice for cancer treatment. Most hospitals are not staffed or equipped to perform all procedures equally well. As with everything else in life, practice makes perfect, and skills in medical procedures and surgery improve when they are done by experts who perform them frequently.
In order to choose a hospital that’s best for you, it is important to discuss your concerns and alternatives with the doctor who is treating you. But you should do research on your own too. This guide will help you decide what your priorities are and it will describe various hospital services and many other factors that you need to keep in mind.
Types of Hospitals
According to the American Hospital Association (AHA), finding out if a hospital offers general or specialized care and if it is a teaching hospital are two major criteria. Consumer advocates add another guideline: They advise you to question whether the hospital is nonprofit or for-profit. Below we discuss all of these considerations.
· General or Specialized Hospitals. There are over 6,500 hospitals in the United States. The majority of them are “general” hospitals set up to deal with the full range of medical conditions for which most people require treatment. But more than 1,000 hospitals specialize in a particular disease or condition (cancer, rehabilitation, psychiatric illness, etc.), or in one type of patient (children, elderly, etc.).
A general hospital may not be able to offer the very latest specialized treatments for every disorder. So if you have a serious or highly unusual medical problem, you may need a hospital devoted to the care of people with similar conditions. But itís also important to consider that such a hospital may be far from your home and may lack the facilities and staff necessary to treat an unrelated medical complication. When weighing the possibilities with your doctor, discuss what would be best for your condition and if any general hospitals in the area may be able to accommodate you.
· Teaching or Community Hospitals. Large teaching/research hospitals have a variety of goals. In addition to treating patients, they are training sites for physicians and other health professionals. Teaching institutions are almost always affiliated with a medical school, which means patients have access to highly skilled specialists who teach at the school and are familiar with up-to-the-minute technology.
You shouldn’t, however, automatically select a prestigious teaching hospital as the primary source of hospital care for you and your family. The quality of smaller community hospitals often compares to that found at large teaching facilities, particularly for routine illnesses and surgeries. The sophisticated equipment and specialized treatment at teaching hospitals can be very expensive, and itís not cost-effective to pay for such services unless you can benefit from them. Check with your physician about the appropriateness of a teaching hospital.
· Nonprofit or For-Profit Hospitals. The important question here is, Who owns the hospital? Is it a voluntary, proprietary or government-supported facility? Even though the quality of care varies widely within each of these categories, knowing who owns the hospital may give you some insight into other questions to ask.
A voluntary hospital is a nonprofit community facility operating under religious or other voluntary auspices. Ultimate responsibility for all that takes place at the hospital rests with its board of trustees, generally selected from the community’sbusiness and professional people, who serve without pay. To manage the hospital, the trustees appoint a paid administrator.
Proprietary hospitals are commercial establishments. They are profit-making institutions. Of course, working for profit does not necessarily make a hospital bad, any more than being nonprofit ensures quality care. Proprietary hospitals are owned by corporations or, less often, by individuals such as doctors who practice at the hospital. Hospital corporations usually own a chain of institutions located in several states, and they often own nursing homes or other types of health care facilities as well.
Government-supported hospitals, like all tax-supported institutions, sometimes have to curtail services when budgets are cut. Also, they may not measure up to other hospitals in terms of comfortable accommodations and the availability of private rooms.
Consumer advocates claim for-profit hospitals are more likely to discharge patients before they are ready, or fail to perform necessary tests or procedures if a patient is not insured or if their insurance won’t cover more time in the hospital. A study published in the Journal of the American Medical Association looked at over half a million discharge records of patients hospitalized in the United States in 1987. The researchers found that although uninsured patients were in worse condition than privately insured patients when they entered the hospital, they were discharged sooner. Although the study did not distinguish between for-profit and nonprofit hospitals, it does demonstrate that the problem does exist.
Questions to Keep in Mind
The following list of questions was compiled from suggestions from the AHA and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Decide which are most important to you and discuss your priorities with your physician. NOTE: Answers to many of these questions can be found in the hospital’s patient handbook. Ask to see one and then talk to a hospital representative about any unanswered questions.
· Does the Hospital Meet Your Needs?
– Is your doctor affiliated with the hospital? If the doctor who is treating you will be performing the procedure, he or she must be affiliated with the hospital you choose. Physicians are usually affiliated with several hospitals, meaning they have met those hospitals’ requirements and are allowed to treat patients in them.
– Does the hospital offer services that meet your particular needs? For example, do they have childbirth services, care for cancer or heart disease?
– How extensive is the hospital’s experience with the type of procedure you need? Exactly how many of them have they done? (Also, see In Search of the Right Surgeon .)
– Who is responsible for maintaining your personal care plan? How is your health team kept informed about your needs? Can you or your family easily be kept up-to-date on your care?
– How extensive is the hospital’s referral network? What arrangements do they have with other facilities to provide services they themselves cannot?
· How Good is the Hospital Staff?
– What is the training of the specific surgeon or surgical team who will perform the procedure?
– What percentage of the staff is board certified in their specialty?
– How many registered nurses (RNs) are there on staff? According to the AHA, the national average is little more than four RNs to every licensed practical nurse (LPN) who is qualified to perform a limited range of duties.
– How many nurses are there for each patient? One nurse can usually care for three to six patients, except in intensive care units (ICU) where the ratio is more likely to be one nurse for every one or two patients.
– Is there an infection control practitioner on staff? If not, how does the hospital coordinate infection control? About one in twenty American patients gets sick because of their stay in the hospital. Hospital-acquired illnesses are a major concern, especially since one-third to one-half of acquired infections are preventable.
– Is there a patient representative or ombudsman on staff? If so, ask what services the representative can provide for you and your family. If not, how are patient complaints handled?
– Does the hospital have social workers? These experts usually help patients and their families find emotional, social, clinical, physical and financial support services.
· Are the Hospital’s Facilities Adequate?
– Is the hospital accredited by a nationally recognized accrediting body, such as the JCAHO?
– Does the hospital accept Medicare patients? If not, check with your state health department to see if the hospital has been suspended from participation in this government program or if it is on probation.
– Is the hospital clean? Visit it and look around. Ask to see the waiting rooms and patient care rooms. Do they look comfortable? Would you want to recuperate in the patient rooms? How much privacy would you have in these rooms?
– Does the hospital offer pre-admission testing services (lab tests, x-rays, etc.) on an outpatient basis? If so, it could save you money not to be hospitalized for these tests.
– Proper management of pain has been shown to speed healing after surgery. If prescribed, is the hospital prepared to provide such measures as patient-administered pain medication through intravenous infusion pump?
– Are operating room services available at all hours? How about lab and x-ray and emergency department services?
– What hours can patients make and receive phone calls?
– Where can patients sit outside of their rooms? Is there a patient lounge or court yard?
– Can the hospital accommodate special diet requests? Are visitors permitted to bring you food from outside? Ask to see a typical weekís menu to get an idea of what is available.
– Is the hospital conveniently located? What are the visiting hours and are there any restrictions on visitors? Is it near public transportation? Is affordable parking available?
– Does the hospital offer education programs for patients and members of the community? If so, you may want to attend one to see how the hospital is represented.
– Does the hospital provide you with the necessary training to continue your care at home after discharge? Does the hospital provide you with easy to understand written instructions?
– What kind of follow-up services does the hospital provide after discharge (i.e. home care, a nursing home)?
· Paying the Bills
– What is the charge for a bed in a semiprivate room? Are private rooms available? How much are they? What do these charges include? What is billed separately? Find out what and how much your insurance will cover. If the hospital’s charges exceed what your insurance company considers “reasonable and customary”, can some compromise be reached on the price?
– If you are paying your bills out-of-pocket, does the hospital have a payment counselor to help arrange such things as installment payments? What resources does the hospital provide to help you find financial assistance if you need it? Does it require a deposit?
– If a procedure can be done on an inpatient or an outpatient basis, what is the cost difference?
Is the Hospital Accredited?
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), an independent, nonprofit organization, conducts a quality assessment of about 80 percent of all hospitals in the United States every three years. The Joint Commission accredits more than 5,000 hospitals and over 6,000 other health care facilities, including outpatient surgery, home care, long term care and mental health care organizations. Hospitals do not have to be accredited by JCAHO to operateóthe accreditation process is entirely voluntary. Accreditation by the Joint Commission means that a hospital meets at least minimum standards of quality. JCAHO rates hospitals in 28 different performance areas, including assessment of patients, medication use, operative procedures, patient rights, staff, laboratory and emergency services, infection control and social services.
Of the hospitals accredited by JCAHO, 90 percent have Accreditation with Recommendations for Improvement, meaning the hospital generally meets the standards, but does not meet certain important standards in at least one important area. In order to remain accredited they must meet the identified standards within a specified period of time. Four percent have Full Accreditation, which indicates that the hospital meets the Joint Commissionís standards in all performance areas. Another four percent receive JCHAO’s highest level, Accreditation with Commendation, awarded to hospitals that demonstrate exemplary performance overall. Conditional Accreditation, which means the hospital is performing only marginally and must correct the problem areas within a specified period of time, is given to one percent of the hospitals. Less than one percent of the hospitals are Denied Accreditation because they do not meet the Joint Commission’s standards. In addition, Provisional Accreditation may be granted to a new hospital if it demonstrates satisfactory compliance with the Early JCAHO Survey. Two more surveys must be performed within six months of opening to determine final status.
You have the right to know a hospital’s accreditation status. To find out, you can call JCAHO at 630-792-5800. Also, as of December 1994, the Joint Commission is making individual hospital performance reports available to the public for $30.00. Only hospitals reviewed after January 1, 1994 will be available. See our comparative charts for detailed information on hospitals in your area.