You just had your annual physical. Your family doctor says he wasn't happy with your electrocardiogram and wants you to see a cardiologist for tests. Before you make an appointment, you might want to check out local hospitals to see which rate best at treating heart disease. Why do that? If you eventually need surgery or other intensive treatment, you want to make sure your cardiologist will do the work at a top-ranked facility.
Where do you start? While objective hospital ratings are in their infancy, heart disease is one illness for which the quality of care can be gauged. For instance, it is widely believed that patients with heart disease should be given drugs called ACE inhibitors or ARBs. So hospitals that prescribe them get higher ratings than those that don't.
One good resource is Hospital Compare, operated by the federal Centers for Medicare & Medicaid Services (CMS). It allows you to search local facilities to see how well they treat both heart disease and heart attacks (www.hospitalcompare.hhs.gov). While on the site, compare infection rates, which are a powerful predictor of hospital quality. Avoiding nasty bugs should be a top priority for anyone about to be admitted to a hospital.
The Joint Commission on Accreditation of Health Care Organizations (JCAHO, pronounced Jayco) is another good place to turn. This private, nonprofit organization sets standards for patient care and safety, and certifies hospitals and other medical care providers. Its site, jcaho.org, is full of information, although it isn't easy to navigate. Click on Quality Check, plug in your zip code, and you'll find a link to your local hospitals. From there, you can look at an individual facility or compare several. For each hospital, look at how they rate for heart-attack care and heart-failure care.
Another national resource is the Leapfrog Group (leapfroggroup.org), which rates hospitals on a handful of high-risk procedures, including heart bypass surgery. Leapfrog, funded by major employers and some insurers, does not cover as many hospitals as CMS, in part because it rates only those hospitals that volunteer to respond to its surveys. Hospital Compare, by contrast, uses more extensive Medicare claims information and other sources. Leapfrog does tell you exactly how many heart surgeries are performed at each hospital, useful since hospitals that do lots of these procedures tend to have the highest success rates.
BROADENING THE SEARCH
Dr. Vince Bufalino, a Naperville (Ill.) cardiologist, warns consumers to be careful when they evaluate the sites. Take the numerical grades that Hospital Compare provides. Patients need to remember there is no real difference between a hospital that scores 94 and one that scores 92, says Bufalino. The sites "should be one bullet point in your evaluation."
You can also check your health insurer's site. Most now include some guidance for choosing a hospital, although few provide the detail that you'll find at Hospital Compare or JCAHO. Many insurers will rank a hospital in their top tier but not tell you much about why.
Finally, if you do need surgery, you might want to get some general information on heart disease and its treatment. There are plenty of good, informative Web resources, including the American Heart Assn. (americanheart.org), WebMD (webmd.com), and the National Institutes of Health (medlineplus.gov).
Rating hospitals for heart care is still an imperfect process. And informed patients may want to know a lot more about the facilities and the staff than they can learn on the Web. But check out these sites before you see the cardiologist. Then you'll be prepared to start asking your specialist questions.
By Howard Gleckman