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How Safe Is Your Hospital?

December 10, 2002

January issue also helps you decode your hospital bills to find and fix costly errors

YONKERS, NY – The quality of care you receive during a hospital stay can determine how quickly and how well you recover – or if you recover at all. Consumer Reports® surveyed and e-mailed readers about their recent hospital experiences and found enormous variations. They ranged from a smooth sailing, lifesaving, $1.5 million liver transplant to an 83-year-old Tennessee man’s death after a careless emergency-room staff sent him home without treating the broken bones and internal injuries he had suffered in a fall.
Among 21,144 CR readers surveyed in April 2001 about their experiences in the previous year, those who were less than highly satisfied with their hospital, 22 percent, complained more often of unanswered calls for assistance, inadequate pain relief, pressure to leave the hospital too soon, or recovery prolonged by complications caused by the hospitalization. The remaining 78 percent of respondents were highly satisfied with their stay. Overall, readers rated their hospital experiences higher than our survey respondents have rated service in banks, restaurants, or hotel chains. But unlike most other services, the care you get at a hospital can have serious long-term consequences, so any risk of receiving substandard care must be taken seriously.
Under pressure from managed care, hospitals are moving faster than ever to discharge patients as soon as they no longer need intensive hospital technology and nursing care. Seven percent of our survey respondents said the hospital tried to discharge them or their family member before they felt physically ready to leave. “It pays to be assertive. About half our respondents appealed their early discharge, and of those, two thirds were allowed to stay longer,” said Survey Research Program Leader Donato Vaccaro.
How can you tell whether your local hospitals are up to par? The experiences of our survey respondents, together with research studies and interviews with experts across the nation, helped us to identify three crucial factors: Sufficient staff (especially registered nurses), good systems for organizing care, and lots of experience with your particular medical condition seem to make the most difference in both patient satisfaction and recovery.
· Make an informed choice. Among the most satisfied patients in our survey were the 20 percent who chose their hospital based on a good previous experience or good reputation.
· Plan ahead. Most hospitals have clinical “pathways” for various conditions.
· Bring your own medical history. Include your medication names and dosages.
· Bring your own help. Given the shortage of nurses, bring a reliable friend or family member.
· Know the staff and make sure they know you. This will prevent mistakes in testing and medicating.
· Keep a notebook by your bedside and write down information such as medication changes.
· Double-check your medications.
· Be assertive about pain relief.
· Keep visitors and the number of calls that family members make to the nursing station under control.
· Check available resources listed in Consumers Reports on specific hospitals.
The January 2003 issue of Consumer Reports also explores ways to decode your hospital bills and helps you find and fix costly errors. CR’s survey of 21,000 readers on satisfaction with hospital stays found that of the 11,000 respondents who had reviewed their itemized hospital bills, 5 percent said they found major errors. Respondents with out-of-pocket expenses of $2,000 or more were twice as likely to have found billing errors.
“Consumers need to be vigilant. Making sure that you’re charged correctly is not easy. Health insurers have a different contract with each hospital that spells out how much they will pay, so there’s no single fee schedule a consumer can consult,” said CR Associate Editor Mandy Walker. It’s vital, however, that you make such determinations by performing a hospital bill “autopsy.” If your insurance requires that you pay a portion of your expenses, any overcharges will cost you. And many insurance plans have a lifetime spending cap, often about $500,000 for an individual.
To protect yourself from inflated bills, hitting your spending cap, and harming your credit record, you have to pay attention to the hospital charges you incur from the moment you enter the building until a nurse wheels you out the door.
· Incorrect basic charges.
· Upcoding. Patients can be charged for a more serious condition requiring more costly procedures.
· Unbundled charges. A group of tests may be charged individually when it should be combined as one charge.
· Keystroke slip could reflect additional work not performed.
· Canceled work could still be billed.
· Operating room use, which is billed based on the time it is used, noted incorrectly.
· Know what your health insurance covers and what it excludes.
· Get cost estimates from your doctors, hospital, and other providers.
· Keep a log of procedures and medications if possible.
· Examine your insurance ‘explanation of benefits’ statements and compare them to your bills.
· Compare your records to what’s being billed.
· Check for common billing errors.
· Contact the consumer protection office of your state attorney general (www.naag.org).
The story includes information on state report cards both nationally and by state. Among the national reports is America’s Best Hospitals, www.usnews.com; Guide to Hospitals Consumers Checkbook, www.checkbook.org; and, Hospital Report Cards Health Grades Inc., www.healthgrades.com. For information specific to California, Florida, Illinois, Iowa, New Jersey, and New York among other states use Healthcare Choices, www.healthcarechoices.org. For an expanded list visit: www.ConsumerReports.org.
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Consumers Union
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