Going to need hospital care?
A new state-run website lets you compare among more than 100 hospitals around the state for how likely it is you’ll develop an infection, a bed sore or have a surgical instrument left inside you. It even rates the hospitals on your prospects of dying while getting care for something that rarely results in death.
And there’s a tool to help negotiate your costs if you’re footing your own bill, listing what each hospital in the state bills for each of several hundred different medical procedures. Potentially more useful, it spells out what each hospital reports the procedure actually costs them.
State Health Director Will Humble said it gives prospective patients the chance to do the same kind of negotiating for a price on a hip replacement as if they were buying a new Kia: They know what it costs the dealer.
“That’s powerful information when it comes to negotiations,” he said Monday. “In the absence of that information, you’re at a real disadvantage as a consumer.”
Donna Courtney, the agency’s hospital data manager, also said consumers should not be fooled by hospitals into thinking the numbers for both costs and complications are not comparable.
She said the data, drawn from 801,926 hospital stays in Arizona in 2011, are coded according to diagnosis-related groups. So a hip replacement performed at University Medical Center in Tucson for an average bill of $91,291 is pretty much the same procedure performed at Flagstaff Medical Center for $54,028, for $62,337 at Sierra Vista Regional Health Center, or at Havasu Regional Medical Center for $63,135.
And Courtney said hospitals cannot just explain away why they have higher rates of complications. She said these figures are “risk adjusted” to consider the fact that one hospital might be treating a higher percentage of elderly patients with thinner skin.
Humble said the state has been gathering information for years. But it took until now, working with a computer program prepared with the help of a branch of the U.S. Department of Health and Human Services, to put it into form useful for consumers.
“Gone are the days of having unanswered questions about how hospitals do relative to one another in terms of how they treat patients and their outcomes,” he said.
The information is most useful for those who are not in an emergency situation. That includes not only elective surgery but medical conditions that can be planned for, like labor and delivery.
Humble said patients, working with their own obstetricians, can use the data to minimize the chances they might be forced into delivering by Caesarean section.
So, for example, about 22.8 percent of births at Tucson Medical Center are performed by C-section. The figure at Sierra Vista Regional Health Center is 26 percent, and 27 percent at Casa Grande Regional Medical Center.
But nearly 32 percent of births at Scottsdale Healthcare at Shea are C-section.
“Part of the answer to that question might be that you’re going to see some hospitals more patient with deliveries and that they’re going to give young women more time, watchful waiting, etc.,” Humble said. “It could mean that others are quicker.”
But Humble said it also could mean that some hospitals have a higher percentage of women who want to schedule their deliveries for a specific date.
Separate tables for infection rates show that places like Yavapai Regional Medical Center, the main campus of Tucson’s University Medical Center and Casa Grande Regional Medical Center have higher than average rates of severe bloodstream infections following surgery. The rate at Verde Valley Medical Center is about average, with a below-average infection rate at Carondelet Heart and Vascular Institute in Tucson.
Humble said if hospitals are unhappy with the database, that is ultimately is a good thing for patients.
“When you have transparency like this, it’s going to drive system improvements in terms of reducing hospital-associated infection rates,” he said. “Now there’s easily digestible information that the public can see for the first time and really help improve the care.”
Courtney said having that information publicly available plays directly into a hospital’s concern for its public image, putting the onus on each facility to figure out why the numbers do not look good.
The financial end of the reports presents a different set of opportunities.
Humble said those with health insurance are unlikely to worry about the ultimate cost of a procedure. Not only do the patients not see the bill, perhaps being responsible only for a co-pay, but the insurers themselves negotiate lower rates than the full bill charges.
But Humble said the database provides those without insurance, or who are going into the hospital for uncovered procedures, a chance to do that same kind of negotiating.
Take that hip replacement procedure.
While University Medical Center lists its average bill at $91,291, it also lists its costs at $23,736. And a $62,637 average bill at Sierra Vista Regional reflects an actual cost of $22,731.
Courtney said that an informed consumer can use that actual cost information the same way as someone who has researched what a dealer pays for a new car from the manufacturer: Start at that point and negotiate up, versus starting at the hospital’s full bill charges and negotiating down.
“It arms you with information,” she said.
“You can go to the hospital and say, ‘Look, I know it costs approximately this. You charge that. I want to negotiate my rate,’” Courtney said.
She said nothing precludes individuals from doing the same kinds of negotiations that insurance companies already do.
So far, the Arizona Hospital and Healthcare Association is not complaining on behalf of its members about all this new data being publicly available. In a prepared statement, spokesman Pete Wertheim said his organization supports the effort to “provide consumers with meaningful data and analysis on hospital quality and pricing in a single location.”