Could a two-mile drive to a better hospital save your life?

OdometerHealth care economists have a simple prescription for patients wanting better care: Drive a little farther to a better hospital.

As Austin Frakt writes in the Upshot column for the New York Times, there were measurable and significant survival gains in heart attack patients who chose superior care at hospitals a mile or two farther away. Those improvements were “half as large” as those achieved with “breakthrough technologies,” such as the increased use of stents and clot-busting drugs.

Patients saw similar benefits, albeit at a lesser degree, by going a little farther to high quality hospitals for heart failure and pneumonia, he says, quoting a new research paper still in the works by health care economists from Harvard, the University of Chicago and MIT.

The better outcomes all have led us as patient-consumers to reward these high-performing institutions by flocking to them, such that they are increasing their market share, the health economists say.

Although this all seems sound, and it prompts the swift question of where are these excellent hospitals, Frakt in his column fast finds himself dealing with a tough, practical problem: How do patients know and decide which hospitals are really good and worth traveling more for?

Frakt runs down the usual suspects, describing the various publicly available hospital ratings and individuals and organizations that issue them at the state and federal levels. I’ve written about these before and recently, including Uncle Sam’s own, new initiative to roll up lots of different quality measures into a simpler to understand system featuring varied numbers of stars.

As Frakt and other experts concede, patients struggle with not only basic data about hospital quality and performance but also how to compare this information, institution to institution. Instead, they may turn to pragmatic sources, such as physician recommendations, advice from friends and family members, and, ultimately, just their sense of “personal satisfaction” in their own experiences with medical institutions.

To be sure, it’s also tough for even the best informed patients to pick one hospital over another in the midst of a cardiac emergency. Still, and somehow, communities sort out which hospitals offer excellent care and how that matters. This also occurs even though, the health care economists point out, patients aren’t driven solely by cost considerations, since, for many, insurance still will pay a big chunk for their care.

There’s some further good news for hospitals in the health care economists’ study: They point out that, contrary to what might be assumed, quality of care matters, and patient-consumers’ personal satisfaction with their care isn’t as sensitive to factors that administrators fret over. These include items like whether their rooms are too noisy or whether they have flat-screen TVs. Hospitals have sharply criticized Uncle Sam’s collecting of patient satisfaction information, and, as part of reforms under the Affordable Care Act, incorporating it in reimbursement considerations for programs like Medicare.

It’s also worth noting that patient-consumers should look with appropriate skepticism at physician recommendations about hospitals. Doctors not only have privileges and relationships at specific places, their business dealings with hospitals may go deeper, with agreements about equipment, staffing, and other resources that also may not be apparent to patients. University of California regents recently agreed to pay $8.5 million to resolve two patients’ lawsuits, accusing the UCLA hospital and a surgeon who operated there of failing to disclose conflicts of interest and of harming them in complex procedures involving off-label use of medical devices.

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