A Publication of WTVP

Last month, I challenged you to become an informed consumer of quality health care, and there was a brief mention of ways to look for information on quality health care. This article gives you more detail you can use as an individual patient or refer to your employer to use on purchasing decisions.

One of the most important decisions many of us make is which hospital facility to use. Many hospitals invest in the processes and fees required to earn accreditation from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Medicare also recognizes this achievement when contracting with facilities. This requires a huge commitment on standardizing care processes to reduce variability, providing safe environments, and measuring clinical performance. Some smaller hospitals may not choose to pursue accreditation due to financial costs, so it would be appropriate to ask the hospital representatives if they've still built the processes.

JCAHO added additional recognition awards, such as Magnet hospital status and Primary Stroke Center certification. These awards have tougher criteria and recognize exceptional performance in specific areas. JCAHO has standardized the measure of clinical performance on the treatment of acute myocardial infarction (heart attacks), community acquired pneumonia, congestive heart failure, and pregnancy and related conditions. All accredited hospitals have reported their performance for more than a year now and will know how they perform in comparison to national averages. Wouldn't you like to know their performances before you choose your hospital?

Quality information on physicians is one of the most difficult things for consumers to find. Some physician offices have obtained JCAHO accreditation, but they're small in number. Medicare and other payers are recognizing the potential improvements in quality and safety that can be achieved by using electronic medical records and electronic prescribing-especially handheld units. Across the country, many payers provide financial incentives to providers for using these tools. Is your doctor keeping up?

Health insurance plans can choose to invest in the process and fees to earn accreditation by the National Committee for Quality Assurance (NCQA). Accreditation depends on three measured components: member satisfaction, effectiveness of care, and administrative processes. Member satisfaction is measured nationally using a standardized survey, the Consumer Assessment of Health Plan Satisfaction (CAHPS), administered by a third party. Effectiveness of care is collected in the Health Plan Employer Data and Information Set (HEDIS) and independently audited. These are standardized measures of clinical performance in preventive and chronic care services. Both measures are submitted to NCQA annually and tabulated for performance measures compared to other plans in the nation. HMOs have measured for years and shown progressive improvement year after year. Accredited plans perform better than plans not applying for accreditation. Is your health plan or administrator accredited or measuring their performance?

There are multiple other commercial report cards becoming available for consumers to view. Be cautious with some of these because they don't always use standard measures and can be veiled advertisements. JCAHO and NCQA are independent groups, which is the best way to review performance.

It's your choice to have a high quality health care provider. Help yourself and your employer make informed choices. After all, you deserve the highest measured quality available. IBI