Want to avoid a C-section if at all possible?
The state Department of Health Services may be able to help.
New data has just been uploaded onto an agency-run web site to help would-be patients learn which hospitals have the highest rates of pregnancies ending with surgery. State Health Director Will Humble said that should give patients an idea of where procedures are more likely to short-circuit normal labor and delivery.
But that's only the start of it.
The site also helps compare, on a hospital-by-hospital basis, outcomes on all sorts of medical issues, like how often a surgery patient bleeds after a procedure to the chances of dying in the hospital after heart failure. There even are results of more subjective surveys of patients of how well doctors and nurses communicated with them.
And there even is a whole section devoted to what various procedures actually cost each hospital — and how much above that a patient is going to be billed.
Humble conceded that information may not be very useful for someone with good insurance and a set co-pay for a hospital stay.
But he pointed out that some of the coverage offered under lower-cost options of the Affordable Care Act not only have high deductibles but require patients to pick up a percentage of the cost. That, Humble said, could make it important when shopping around for a non-emergency procedure like a hip replacement, where the typical bill, as determined by median charges, could be less than $33,000 at Tucson Medical Center, $76,460 at Havasu Regional Medical Center, or as high as nearly $136,000 at Payson Regional Medical Center.
And here's where it really gets interesting: The web site, using figures hospitals provide to the federal government, list their actual costs.
So TMC shows its median cost for that same hip replacement at less than $10,000, with that $76,460 bill at Havasu based on costs of $18,358, and Payson lists its cost at less than $21,000.
And that C-section if you have to have it?
A patient could pay as little as $10,810, the median figure at Cobre Valley Regional Medical Center, on its costs of $5,864. By contrast, Western Arizona Regional Medical Center, which lists its own costs at $5,035, charges an average of $44,482.
Humble said that provides a powerful tool for would-be patients to negotiate, up front, with a hospital for a better deal. He compared it to knowing a dealer's cost on a new car before going to the showroom.
Humble said even those who went to the hospital for an emergency procedure, like a gall bladder operation, can use that information to negotiate down that $70,000 bill.
“It happens all the time,” he said.
But Humble said the more useful part of the web site for most patients is going to be on the medical end, particularly for procedures that can be planned, like pregnancy.
He said that can be important for a woman who, facing an otherwise uncomplicated pregnancy, does not want a C-section delivery. Humble said that involves more than the doctor's personal preferences.
“It has more to do with the system inside of the hospital and the decision-making protocols that they have in place,” he explained. That can even include whether there are nurse-midwives on staff to help with the delivery.
And the ratings can get pretty detailed.
For example, one looks at the percentage of vaginal births after a previous C-section. The University of Arizona Medical Center and Maricopa Medical Center were highest in this category at a third of all cases, more than twice as high as the state median. By contrast, of facilities with enough procedures to measure, Northwest Medical Center and West Valley Hospital were at the bottom, each at fewer than 4 percent.
The web site has other factors a pregnant woman might consider, like what percentage of newborns have a birth injury or infection.
Donna Courtney, the health department's hospital data manager, said there are more subjective things that could be important to would-be patients.
“There are things that you can't put a dollar amount on,” she said, beyond things like surgical practice and even complications.
“There's also a particular quality measure for patient experience that addresses things such as, ‘my pain was kept under control,’ ‘how quickly did the nurse come when I called,’ ‘how well were things explained to me in my care as a patient,’” she said. “These come out of real patients that were treated in Arizona hospitals.”
Visit http://pub.azdhs.gov/hospital-discharge-stats/2012/index.html for additional information.