I don’t feel well. What do I do now?

I don’t feel well. What do I do now?

I don’t feel well. What do I do now?

 

Where should I go for my care? That is a loaded question. Do you have a choice?

Sometimes you don’t have a choice, like if you have been in an accident. Sometimes you are required to go to a particular location as part of your insurance coverage.

Yep – super user friendly!!! Right???!!!

Keep reading for some helpful tips on comparing hospitals and nursing homes!

I am a nurse. If someone…anyone in my family gets sick, I get a phone call, an email or a text. What should I do? Where should I go? Do you know anyone at (insert hospital name here)? For the most part, I do know what to do. I do not have all of the medical answers, for sure, but I can do a quick enough triage to know whether I have enough information to make a decision. Go to the emergency room. Make an appointment. Get a referral for a specialist. I agree with your doctor.

What if you don’t have a nurse or other medical professional in the family? How do you know where to go? How do you even know if you have a choice? These are questions asked every day by folks who are likely already stressed out by some health concern.

Luckily, if you have access to the internet, there is a wealth of information at your fingertips provided you know where to look.

The first question to ask is, “Do I have a choice of where to get my care?” That is a tricky question. It is best to check with your insurer to see which facilities are considered in-network. That will help keep your costs down for elective procedures. If you have a Primary Care Physician (PCP), ask where they “have privileges” to practice. This means they can be your primary doctor while you are in the hospital. Some PCPs do not practice in the hospital and leave the job of in-hospital care to a group of physicians and mid-level providers (nurse practitioners and physician’s assistants) called “Hospitalists.”

Urgent and Emergent Care is another can of worms and perhaps the topic of another blog. Suffice it to say that The Affordable Care Act of 2009 requires that insurers cover emergent care regardless of location or whether the provider in a location is in or out of network. If you need to go to the Emergency Room, call 911 or go to the nearest one!

Let’s get back to finding the best place for an elective procedure or hospital stay due for a non-urgent issue. Head to the Medicare website, “Hospital Compare” and follow along.

Using Hospital Compare from the CMS website, can compare hospitals against a number of variables. This tool is available for nursing homes 

 

 

 

 

 

 

 

 

 

 

 

After entering your zip code, you can see, at a glance, how many hospitals there are in a 25 mile radius, a list of those hospitals and a few key data points. Select the “Add to Compare” button to add up to 3 hospitals to your comparison list. I have my 3. Do you? Yes? Ok, now select “Compare Now.”  Across the top of the page, you will see seven tabs with different topics. Here are my tips for viewing this section.

  1. You will not notice much variation in any of the Acute Care Hospitals’ General Information. Skip it!
  2. The next tab is “Survey of Patients’ Experiences.”
    1. These are results of the “Hospital Consumer Assessment of Healthcare Providers and Systems” surveys.
    2. The results are much like when you go to the car dealership and they ask you for a 5 out of 5 rating. The same thing is true here. Notice words like “Always,” “Strongly Agree” and “Definitely.”
    3. If you want to see a little bit more information, select the “View More Details” button.
    4. What you will likely notice is that all of the major hospital systems are pretty close together as far as their patient experience scores go.
    5. The take home message in patient experience – There will be good things and bad things no matter where you go.
  3. The subsequent 5 tabs: Here is where you can go to see more specific information about topics like surgical site infections, outcomes and payment information on hip and knee replacements, readmission rates (i.e., I got discharged from the hospital too soon and had to go back), and the like.
    1. I get a little nervous when I’m looking at something and the information says something like “sample too small.” What this says to me is that the facility isn’t doing a whole lot of this procedure and maybe it’s a good idea to find a place that is.

If you are looking for a rehabilitation hospital or skilled nursing facility, Medicare.gov also has “Nursing Home Compare” This is a great place to start looking for a longer term care facility if needed. In this comparison, you can see health inspections, fire safety information and quality of care evaluations.

It’s probably a good idea to still call that family nurse or doctor friend. We’ll wonder what’s wrong if you don’t!

Many would agree that health care is complex even for those who have chosen this noble profession as their life’s work.  As the industry grows, debates surrounding policy are fueled, providers and payers seek avenues to streamline their efforts to the patients and of course, the breaking neck pace of health tech innovations being developed, a return to simplifying processes so that the ill can seek care is wise first step.  As a long-time practitioner and one who remains in close touch with my passion to serve others, it is important to first help those in need, understand that quality care is not as far as they may think.  Many of us have had the misfortune of a varying degree of ailments and dealing with them while trying to think through locating care can be a herculean effort particularly for the majority of the population who isn’t fortunate enough to have someone close who works in healthcare.  Let’s break it down to make it easy so that we can provide everyone with the best chance of locating the best care they may have available to them.

By Rachel Rogers, MS, BSN-RN, University of Denver
Assistant Academic Director/Assistant Teaching Professor

Healthcare Management Program

11.17.19

“Find And Compare Information About Hospitals | Hospital Compare”. 2019. Medicare.Gov. https://www.medicare.gov/hospitalcompare/search.html?.

 

“Affordable Care Act Implementation FAQs – Set 1 – Centers For Medicare & Medicaid Services”. 2019. cms.gov. https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs.html#Out-Of-Network%20Emergency%20Services.

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