Medical mistakes in hospitals are the third leading cause of death in the United States.1 In fact, an American College of Surgeons study found that 8.9 percent of surgeons said they’d made a medical error in the last three months, and 1.5 percent said they believe that error led to a patient’s death.2 Although the cause for error was attributed to burnout in this study, other factors exist that can contribute to care complications and affect quality, such as safety precautions, infection control, and surgeon experience.
How can you make sure your employees are receiving quality care from hospitals and surgeons with a track record of success?
How quality is measured
Even though healthcare quality is important, not every healthcare or insurance company measures outcomes. Currently, 90 percent of insurance companies use the Healthcare Effectiveness Data and Information Set (HEDIS) to measure provider quality.3 But a common complaint of the system is that it focuses on processes instead of outcomes.
Recently, some insurers have started using healthcare rating services such as Healthgrades to help members determine the quality of their providers. However, Healthgrades doesn’t measure outcomes. It gauges patients’ level of trust, how well the provider explains conditions and answers questions, and whether they spend an adequate amount of time with the patient. Definitely not a true representation of the quality of provider and surgeon health outcomes or expertise.
How can you measure true quality?
Some benefits management organizations are ahead of the curve in their move toward value-based healthcare. They don’t pursue fee-for-service care models, and their provider partnerships are directly tied to successful outcomes, not just low costs.
When working with a benefits manager, look for those that include hospitals with Magnet Recognition and other respected ratings by healthcare associations such as the American College of Surgeons. Independent rating systems such as CareChex actually focus on quality of care and outcomes. Unlike other publicly available quality ratings, CareChex provides a comprehensive evaluation of inpatient hospital quality performance using a variety of outcomes of care measures, expressed as a composite quality score (CQS).
Your benefits management organization should also be partnering with Centers of Excellence and hospitals with vetted quality, preferably ranked in the top quartile nationally for their specialties. They should be rated on areas such as outcomes, mortality, complications, readmissions, patient safety, processes and patient satisfaction.
After all, good outcomes lead to healthier employers who can return to their work and an improved quality of life more quickly. And this leads to greater productivity.
How BridgeHealth can help
BridgeHealth works only with providers and surgeons who providing top quality care in their surgical specialty. We identify them using the best available third-party objective quality measures, such as Comparion’s CareChex and Physician Quality Rating Analysis (PQRA). Quality care is our top priority, and we continually work to partner with providers who meet our high standards for surgical care.
1. Cha, Ariana Eunjung. “Researchers: Medical errors now third leading cause of death in United States,” https://www.washingtonpost.com/news/to-your-health/wp/2016/05/03/researchers-medical-errors-now-third-leading-cause-of-death-in-united-states/?noredirect=on&utm_term=.d1c4c04d8957, May 3, 2016.
2. Shanafelt, TD; Balch, CM; and Bechamps, G; et al. “Burnout and medical errors among American surgeons.” https://www.ncbi.nlm.nih.gov/pubmed/19934755, June 2010.
3. The National Committee for Quality Assurance. “HEDIS® and Quality Compass®. “HEDIS® and Quality Compass®,” http://www.ncqa.org/hedis-quality-measurement/what-is-hedis.