LA Times -- July 23, 2007

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How Well Do You Know Your Health Care Provider? , by Lev Grossman

Even in this digital age -- when one can get the temperature in Kuala Lumpur or the Zuma Beach surf report at the click of a button -- most people still rely on word of mouth to pick their doctor or check up on their local hospital.

Others choose from lists provided by their health plans, cross their fingers and, well, hope for the best.

Increasingly, insurers, the government and other sources are providing information, especially on the Internet, about the quality of the nation's doctors and hospitals -- details that were simply unavailable a decade ago.

"The fact is healthcare consumers need more information," said Sarah Loughran, executive vice president of Health Grades Inc., a healthcare rating company. "Can you imagine buying a car and not being able to research it beforehand?"

Many of the more sophisticated tools are still in their early stages and the information they provide can be incomplete. Some can also be hard to understand unless you're a statistician or have a medical degree.

With a little homework, though, consumers can get their hands on all kinds of information.

Georgina Petruzzi of San Clemente hired a new service, PinnacleCare, last year to help her find a doctor for a second opinion. After Petruzzi gave birth last summer, her endocrinologist suggested she go on medication to treat her gestational diabetes, something she didn't want to do.

The company, which charges clients for individual requests or through annual memberships that range from $2,500 to $30,000, helped her find a specialist in Los Angeles who later decided her endocrinologist misdiagnosed her, and so never put her on medication.

"He listened to me and explained why the meds weren't necessary," said Petruzzi, whose diabetes has subsided.

Experts say more patients should do such research. Last week, a study from the Harvard School of Public Health found that patients who went to hospitals ranked higher according to specific quality measures had a lower chance of dying than patients at lower-ranked hospitals.

The researchers calculated that if the lowest-performing hospitals had similar patient mortality rates to those of top-performing hospitals, 2,200 fewer elderly Americans would die each year.

"More transparency about the quality of care helps patients make more informed decisions" said Maribeth Shannon, director of the Market and Policy Monitor program at the California HealthCare Foundation.

How to check up on your doctor

A good place to start is with the state medical board. It generally provides the basics of a doctor's biography, location and education.

On the website of the Medical Board of California (www.mbc.ca.gov), you can find out, among other things, whether a physician has been accused of wrongdoing, been disciplined by the board, or made repeated medical malpractice settlements within the last decade.

There are other databases connected with insurance companies, the government and private firms that publish doctor and hospital ratings.

Aetna Inc.'s Aexcel network, for example, is made up of doctors the insurer encourages members to visit -- based on clinical performance and cost of care. Doctors are graded on factors such as how well they follow best medical practices and their patients' hospital readmission rates.

Next year, UnitedHealth Group Inc. is expanding a similar network, UnitedHealth Premium, to the West Coast. Others are expected soon.

(Insurers' rating systems can be controversial: The New York attorney general's office this month asked UnitedHealthcare, a unit of UnitedHealth Group, to stop the planned launch of such a network there, citing critics' accusations that the rankings primarily reflect the cost of care to the insurer, not patient care. The insurer denies that.)

Health Grades (www.healthgrades.com) offers reports that list doctors' medical training and any recent disciplinary actions. Some information is free, although there's a fee schedule for more detailed records that starts at $18.

"Doctors can add their personal information and allow patients to set up appointments on the site," said Loughran of Health Grades.

California's Office of the Patient Advocate (www.opa.ca.gov) rates medical groups and offices -- rather than specific doctors -- by surveying patients.

Consumers' Checkbook (www.checkbook.org) is a local rating service that includes doctors. The company, which also rates services such as dry cleaners and car dealerships, asked about 260,000 physicians which specialists they would want to care for a loved one.

This database lists the 20,000 specialists who were mentioned most often. It's available online or as a book for $24.95.

How to check up on your hospital

Hospital choices are made in many ways. Patients often take the advice of their doctor or surgeon; some prefer the hospital closest to their home; accident victims are usually taken to the nearest trauma center.

Few of us know much offhand about our community's hospitals or what they're good at.

But there is a growing number of sources offering detailed reports. Some include pricing information, which can be helpful for those with insurance plans that require them to pay a larger share of their medical bills.

Few agencies have better records than the U.S. Department of Health and Human Services (www.hospitalcompare.hhs.gov), which oversees the Medicare program.

Its website includes information on how well most of the nation's 6,000 hospitals treat heart attack and pneumonia patients and how well they follow certain safety practices.

This spring, the Oakland-based nonprofit California Healthcare Foundation introduced a free comparison tool of California hospitals at www.calhospitalcompare.org.

The site, which has received 77,000 visitors so far, allows consumers to search for a hospital by location, name or medical condition and to see how it rates in more than 50 performance categories such as patient satisfaction and patient safety. The foundation expects to expand what it reports on the site this month.

"It is important to report a variety of measures, as no hospital is good at all things or bad at all things," said Maribeth Shannon of the foundation.

A nonprofit group of large employers including General Electric Corp. and Boeing Co. has started a rating agency of its own. Leapfrog Group (www.leapfroggroup.org) rates hospitals, searchable by ZIP Code, on a series of factors it collects using surveys.

Factors include how well the hospital follows established safety practices and whether its doctors issue their orders using an advanced computerized system that cuts down on errors. The surveys are voluntary, so not all hospitals are included.

Some of the most-sought-after statistics are mortality outcomes.

California's Office of Statewide Health Planning and Development is one of the small but growing number of sources that give consumers hospital-specific data on death rates.

The state collects mortality data for specific procedures, including the percentage of patients who survive pneumonia and heart bypass surgery. The downside is that the information can be years old because the office statistically weights the data so that hospitals can be compared no matter how sick a patient is -- a time-consuming process.

Debby Rogers, vice president of quality and emergency services for the California Hospital Assn., said the data were helpful but far from comprehensive.

"Although they are not perfected yet, it's a good thing these services are out there. It's going to help."

Rating sites

A growing number of public and private services rate doctors and hospitals on quality of care. Here are a few:

Health Grades Inc. (www.healthgrades.com)

Users can find ratings and cost information on 5,000 hospitals and 16,000 nursing homes as well as profiles of hundreds of thousands of doctors. The site receives more than 3 million visitors each month, according to the company.

Price: Some information is free; more detailed reports start at $18.

California HealthCare Foundation (www.calhospitalcompare.org)

The site allows consumers to search for a California hospital by location, name or medical condition and find out how it rates on as many as 50 performance benchmarks including patient satisfaction and patient safety. Participation is voluntary, so not all hospitals are included.

Price: Free

WebMD Health Services (www.webmd.com)

On its free site, consumers can search for doctors by ZIP Code, name or specialty. The company offers more-detailed information on doctors and hospitals though employers' and health plans' websites for use by their workers or members.

Price: Free for its consumer website

U.S. Department of Health and Human Services

(www.hospitalcompare.hhs.gov)

The federal website uses Medicare and Medicaid data to assess the track records of more than 4,000 hospitals around the country. Results show how often a hospital provides recommended treatment for heart attacks, heart failure, pneumonia and surgery, as well as mortality data on a limited number of conditions.

Price: Free

Leapfrog Group (www.leapfroggroup.org)

Each year, Leapfrog, a nonprofit group of large employers including General Electric Corp., gathers data on 1,300 hospitals and reports information on quality and patient safety efforts.

Price: Free

Looking for a personal touch

Not everyone wants to be an online detective, hunting for the inside story on a hospital or doctor.

For patients with specific medical needs, experts say it may be worthwhile to look into one of the growing number of more personalized services.

The Doctor-Patient Advisor (www.castleconnolly.com), a site maintained by New York-based Castle Connolly Medical Ltd., provides one-on-one consultations for patients or their family members.

A company doctor or nurse practitioner helps them determine what kind of medical specialist is needed and recommends local doctors and hospitals for treatment. The cost is $275 per consultation.

Baltimore-based PinnacleCare (www.pinnaclecare.com) offers family memberships that include helping consumers locate recommended doctors in their area and organizing medical records and appointments.

The fees vary for individual requests, and annual memberships range from $2,500 to $30,000. The company plans to open an L.A. office by next year.


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