Overview of Important Health Care Information

As a patient, you have many factors to consider when thinking about your hospital care. Often the factors include: what services are available, how long will I have to wait for the service, how well will I be treated, how far will I have to travel, what days and times is the service available, how difficult will it be for me to find the service once I get to the hospital, etc.  However, two of your most important considerations will most likely have to do with the Quality and Cost of the services that you will need or want.

While no standards are currently available for determining what "good" health care is, many federal and statewide efforts are underway to establish standards of care that will be meaningful, fair, and scientifically sound.  Your Hospital Guide is the beginning of a process of information sharing that is intended to inform and educate Marylanders about hospital services in Maryland.  The Guide’s current focus is dedicated to providing information on Quality and Costs.

Why Provide Information on Quality?

Providing information about quality can offer you a way of comparing how well certain procedures are performed at Maryland hospitals. You may not always have the opportunity to choose the hospital from which you receive care, especially in an emergency. However, when you or a loved one are planning for admission to the hospital, getting some important information first can help make your hospital experience a positive one. Reviewing information about quality helps make you an active participant in healthcare decisions.
This guide uses quality measures to identify a standard level of care. The measures used in this guide are treatments that have been proven through extensive use and research to be effective treatments for common medical problems. The quality measures reported in the Hospital Guide are for adults who have been hospitalized for childbirth, heart attacks, heart failure, or pneumonia. The reports deal with how care was given to only those patients who needed standard treatment, not intense treatment.

The guide also tells you about what questions to ask your doctor if you do not receive the treatments outlined here. The Hospital Guide is intended to help consumers select a hospital or provide guidance on what to expect in a hospital setting. However, you should not base your decision on the data provided here alone. We recommend that you talk with your doctor, seek out other resources, and also use the consumers’ checklist to help make your decision.

What is Quality?

Defining “quality” is always difficult. For years, researchers, physicians, nurses, and quality improvement specialists have struggled with how to judge the quality of medical care. This guide attempts to do so by showing the most up-to-date treatments for certain medical conditions, and then providing reports that compare how often each Maryland hospital provides treatments for those conditions. In doing so, we hope to provide some indication of the quality of health care that is delivered by the various hospitals in the state. 

Eventually, we anticipate having appropriate data on specific outcomes associated with various medical conditions. Because this data and information are not yet available, we have decided to use ‘volume’ as an alternative indicator of quality for your consideration. Please remember, however, that ‘volume’ (i.e. how often the procedure is performed) is an imperfect alternative for "outcomes” (i.e. the results of the procedure). 

Costs

Often, patients do not know about the costs of health services because insurance companies to which they pay premiums pick up the bill for the true cost of health care. Most insurance plans require participants to pay a co-payment (or coinsurance), which is a small part of the overall cost. Co-payments vary based upon the service you receive. For instance, you are generally charged a high co-payment if you visit the hospital emergency room and are released. That same co-payment is often waived if you are admitted overnight.

And, many insurance plans have differing service levels and agreements. When choosing a hospital, find out whether or not your health care plan participates with that hospital and if you need to be pre-qualified for admission. You should also determine how much it will cost you for various expected and unexpected services at each hospital. How much for a bed in a semi-private room? How much for a bed in the intensive care unit (ICU)? What are the costs for specialty procedures—and associated services—that you might need?

If you fail to look into these issues, you may be faced with a large bill when you are discharged that you are unable to pay. 

The Relationship Between Costs and Diagnosis-Related Groups

In 1983, the federal government addressed problems of soaring healthcare costs by changing the way hospitals are paid. Instead of paying hospitals for what they charged for care, the government set up guidelines for treatment of each type of medical condition, called diagnosis-related groups (DRGs). Under this system, hospitals are paid a certain amount of money for patient care according to the patient’s diagnosis, or DRG. About 500 DRGs exist that categorize patients with similar conditions. These Federal guidelines encouraged hospitals to use similar resources to take care of the patients with the same DRG, and for their stay at the hospital to be of similar length. This method encourages shorter hospital stays, getting patients home as soon as possible, while providing the care they need.

Each patient who is admitted to the hospital is assigned one DRG for that visit. The choice of DRG is based on a number of factors including the patient’s diagnosis, age, and medical procedures that have been performed. The hospital also considers the patient’s other conditions, which are called “complications” and "co-morbidities." A complication is a condition that occurs while the patient is in the hospital; it can cause the hospital stay to be longer than expected. A co-morbidity is a condition that existed before the patient went to the hospital and which also can cause the patient’s hospital stay to be longer.

How Does Information on Diagnosis-Related Groups Relate to Quality?

This guide provides information about DRGs to show the types of cases that particular hospitals are seeing most frequently, including:

• how many times a hospital has recently discharged a patient with a certain DRG;
• the average length of stay for that DRG; and
• the number of times the patient was readmitted to the hospital for the same condition (or for complications as a result of the condition or its treatment) within a certain period of time.

Ongoing Efforts

Additional measures of quality continue to be developed and are added to this guide from time-to-time. Since this guide was created, the list of medical conditions was expanded to include obstetric care, and, this year, reports on surgical care will be included. In addition, hospital based infections are planned to soon be reported in the Guide. In 2003, Maryland hospitals participated in a pilot program focusing on patient satisfaction. This dimension of hospital performance reporting may be available in the future.

Research on quality health care is an ongoing effort. We encourage you to check this website frequently to see additional updates. The home page for this guide will notify you of changes as they occur.