Conflicts of Interest Between Doctors, Hospitals, and Patients Result in Harmful Treatment

OK, I was going to write about the new social caste-system determining how you pay for your health care, but the New York Times article about the errant Dr. Ghandi from Indiana (I kid you not) and his over zealous love of invasive cardiac treatments is too good to pass up. First of all, the full color photo in the New York Times of this woman's scarred chest is a shock. The sleeveless pink floral top (not enough of it to merit calling it a blouse) is the standard rag you find so many many American woman wearing to places they should not. I mean really, this is what you wore for an interview with the New York Times? One could make a case that the cardiac chest-crack surgical scar is more aesthetic than that mom tattoo. I thought you were supposed to put your kids names on your body, not the word mom, isn't that reserved for sailors? Read on to find out how this all went wrong in the midwest.
 Malpractice and Medicare Rip-offs
The woman in the New York Times photo had been treated by Dr. Ghandi for thirty years, originating from the irregular heartbeat diagnosis and devolving into multiple surgeries involving stents,  and other invasive procedures. This plucky female did say no to Dr. Ghandi's insistence on getting a pacemaker (smart move sister) but she was pummeled into the insertion of a heart monitor. Unbeknownst to her, this monitor was linked directly to Dr. Ghandi's bank account. At last count, 293 patients have sued this doctor for installing unnecessary pacemakers, stents, and other cardiac devices. Thanks to Dr. Ghandi and his co-conspirators, little Munster (not to be confused with Muncie), Indiana placed within the top 10% for cardiac defibrillator implants (pacemakers) according to Medicare, which is also investigating. Munster is a town of 23,270 people, so it is pretty difficult to imagine they have that many defective tickers. But please remember, Indiana is pretty close to Wisconsin, where most of the world's cardiac devices are manufactured, so maybe they were being neighborly. However, here is where the story takes an even more twisted turn.
Hospital Administration Conflict of Interest
The hospital administrators knew that Dr. Ghandi and others in his cardiac practice were performing invasive medically unnecessary procedures and they did nothing to stop it. Lest you think this was a for-profit hospital, you'd be wrong. In fact, a nonprofit community hospital, much like any local hospital, such as  Harrison, in Kitsap County, made the decision to ignore the professional complaints brought by Dr. Mark Dixon, whom also practiced at the hospital. The hospital's chief benefactor it seems was a long time patient of  Dr. Ghandi's for his cardiac care, so no conflict there at all. Specifically, Dr. Dixon's complaint was unqualified people were installing some of these cardiac devices and Dr. Ghandi's patients did not meet the medical necessity requirements for some of the treatments.  So, why would the hospital ignore these concerns-because cardiac care is very lucrative and brings in lots of money for the facility. In fact, in hospital administration parlance, this is referred to as a service line, it isn't even called health care. And yes, in hospitals, the doctors who bring in the most money are treated with deference.
What You Can Do
Hold the phone-this is the lesson for all persons reading this article-(1.) ask questions about training and board certification before you consent to any surgery and (2.) get a second opinion. Sure Munster is a small town, but you do not have to have your treatment there, you can go to a bigger city, like Indianapolis or Chicago, or if you are really smart, the Mayo Clinic in Minnesota. Further, if you cannot commute to these locations, you can go to the following web sites to get information which is reliable on cardiac care:
 http://www.mayoclinic.org/departments-centers/cardiovascular-diseases/home/orc-20121930
 http://www.mayoclinic.org/diseases-conditions/heart-murmurs/basics/definition/con-20028706
 http://www.cdc.gov/heartdisease/materials_for_patients.htm
http://my.clevelandclinic.org/services/heart/disorders

Tip of the Iceberg
Lest you think this scenario of over diagnosis and money making through unnecessary medical procedures is an anomoly, it is one of the biggest problems in the U.S. healthcare system. Thankfully, in the last decade, better information has become available to consumers through websites and other resources, which make it easier for the average person to double-check the facts before submitting to a procedure.  The truth is you can't always trust what your community hospital is telling you, nor can the same be said for every doctor. The responsibility is on the patient and their advocate to ferret out all necessary information and make an informed decision. The Lown Care organization is in the midst of its' Right Care Campaign and that is one example of a collective effort of clinicians to curtail abusive practices in healthcare. I have written about health care scenarios and policies for the past eight years, and in 2013, I specifically targeted the layperson in my book, Unraveling U.S. Healthcare-A Personal Guide, of which five chapters were devoted to figuring out how to gauge health care quality.

Stay healthy by choosing wisely and this is the healthpolicymaven signing off, encouraging you to share this article widely. Roberta E. Winter is a graduate of the University of Washington School of Public Health and the University of Washington Evans School of Public Affairs and publishes under the trademark healthpolicymaven.
1. http://www.nytimes.com/2015/10/18/business/a-small-indiana-town-scarred-by-a-trusted-doctor.html?smprod=nytcore-iphone&smid=nytcore-iphone-share&_r=1
2.  http://www.rightcaredeclaration.org/
3. http://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

Insurance Exchange Triage

Insurance Exchange Triage

Long wait times, changes in coverage for those covered under high risk pools, and changes in provider networks are some of the problems which have occurred with the national insurance exchange implementation. This article provides pragmatic advice for those seeking insurance through an exchange, working with an agency who has to implement some of the mandates, and who want straight talk on how to accomplish your mission. First and foremost, apart from the standardization of insurance coverage and national role out of a quasi national health care policy, much of the griping over the exchange implementation is merely a ramped up “open enrollment process” which occurs annually for those covered by private insurance plans. To help allay some of the misconceptions, each of the concerns are addressed below.

Timely Processing of Insurance Exchange Applications

Firstly, we can all acknowledge that the federal exchange roll-out has been problematic and now let’s move on to the concern of a delayed application, which is-will I still have medical coverage. If you applied timely, provided all of the documentation, such as proof of income, address, family information, and plan selection your application will be processed with the date you requested. The federal law isn’t effective until January 1, 2014 which is the earliest your exchange plan will be effective. If you miss the December 15^th enrollment deadline, you can still enroll for a plan with an effective date of February or March of 2014. Since the majority of the people purchasing insurance on the exchanges are uninsured, this is not a crisis as these people do not have insurance now.  Secondly, if you are having trouble getting through on the phone or the web site for exchange enrollment, get a paper enrollment form and attend one of the free sessions at local libraries on how to enroll on the insurance exchange.

Limitations on Provider Networks

Health care clinics or hospitals in the insurance exchange offerings may not be the same as other private sector plans outside the exchange. The reason for this is the insurance companies had to meet both price and strict benefit guidelines to participate in the exchanges and the way they were able to achieve this is to negotiate with hospitals and other providers. Provider limitations or changes Is nothing new in the insurance industry, as there are contract changes every year. For example, Premera has aligned with Virginia Mason as its main hospital for their Washington State Insurance Exchange Plans in Seattle. For me, this is not a negative as Virginia Mason has annually had one of the best patient safety records of all Washington State hospitals, based on publicly available data.

 It is the insurance applicant’s job to review the provider/insurer network information and discern whether it is adequate for their needs. And hold the phone, if you doctor doesn’t have privileges at your in-network hospital, you can obtain a referral to someone who does. The primary concern shouldn’t be that you may have a different hospital network, it should be about having the safest facility.

Here is a list of the latest patient safety rankings by the LeapFrog Group, a nonprofit patient safety advocacy and research group that conducts an annual hospital survey on patient safety, as mentioned in Unraveling U.S. Health Care-A Personal Guide. Leapfrog Group identifies five patient safety criteria for prevention of medical errors including: prevention of medication errors, appropriate intensive care unit staffing, steps to avoid harm to patients (ex. falls), managing serious errors (ex. surgical site mistakes), and safety focused scheduling (ex. post discharge follow-up). There were only four hospitals in the entire State of Washington that met all of these criteria 100% of the time for the 2012[1] reporting period and these stellar performers are:

Swedish Hospital-Issaquah

Swedish Hospital-Cherry Hill

Swedish Hospital-First Hill

Virginia Mason Medical Center

Access to Doctors

One of the primary concerns with the implementation of the insurance exchanges has been how this newly insured population will access health care since many do not have a doctor. This is a huge issue and is also one of the reasons the federally qualified health centers known as community health plans have taken a lead in enrolling folks without insurance. Group practices are better able to integrate new patient populations. Also, most clinics these days employ an array of health care professionals, from nurse practitioners, to physician assistants, and licensed practical nurses, so seeing a doctor doesn’t necessarily mean an M.D. Being under the care of a good group practice will mean the organization has oversight and adheres to guidelines for primary health care treatments. And finally, since many of these people have not been insured at all, having access to a clinic is still an improvement in the potential for care. So, if in doubt on where to find a health care provider, look for a community health clinic or a group practice, like Group Health Cooperative or Virginia Mason as an initial point of entry.

Cost of Health Care and Individual Responsibility

Though the grousing about premiums has been somewhat minimized, U.S. health care is the most expensive in the world because we tolerate over charging and tremendous system inefficiencies. Because of these factors we have to pay taxes and premiums to finance our health care system, which is primarily based on user fees. Medicare recipients pay copayments and premiums for their plans, just like the private sector insured. This will not change in this country, you will have to pay for your insurance (unless you are very poor). So please consider whether you are better off paying for a higher insurance premium for a more comprehensive medical plan or a low premium for catastrophic coverage. In essence you are making a philosophical decision about how you want to spend your money and how much risk you are willing to take up front.

In the United States if you want health care, you must pay for it, via an insurance plan and/or at the point of service. To make this manifest you may actually have to do something, like read a brochure, complete an application, go to a free seminar at the library (which have had sparse turnouts), and make a decision to enroll. Failure to do so will result in a tax penalty in 2015, unexpected medical expenses, or the inability to obtain care. For those of you who still have questions on the 2014 health care mandates or the Gordian knot of U.S. health care system, pick up a copy of my book, Unraveling U.S. Health Care-A Personal Guide, published by Rowman & Littlefield in July. http://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972 And if you can’t afford to buy it, your local library may have a copy to borrow.

And this is the healthpolicymaven signing off wishing you a safe and merry holiday season-lights up and on!

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[1] http://www.leapfroggroup.org/cp?frmbmd=cp_listings&find_by=state&city=&state=WA

Leapfroggroup.org Washington State Hospital Survey 2012 results

Hold the Phone an Understandable Book About Resourcing Health Care

For all of the grousing about health care, reforms or not, we still need to figure out how to resource our needs in the bifurcated U.S. delivery system and to that end, I wrote Unraveling U.S. Health Care-A Personal Guide, for the average Joe and Joanne. This easy to read guidebook for the U.S. health care system and some global centers for health care, is available on Amazon and elsewhere now.
http://www.amazon.com/books/dp/1442222972
https://rowman.com/ISBN/9781442222977

I will be presenting material from the book on these dates:
August 5th-6:00PM-Bremerton Public Library
August 22nd-5:00PM-Book Release Event-La Toscanella
September 4th-7:00PM-University Book Store
October 15th-6:00PM-Seattle Public Library Main Branch

And into the deep we swim-working on my strokes.

Author-Roberta E. Winter AKA the healthpolicymaven

Implications of Health Care Reforms on U.S. Trauma System

Up close and personal with the U.S. Health Care Trauma System

October 16, 5:17 P.M. I received the call, “Your son has been hit by a car. “At this point everything slowed down inside my head and all noise from the outside world was muffled. First, I breathe and then ask, is he conscious? Thankfully, he was alert according to the paramedic on the scene. He was being transferred to the local hospital emergency room for further treatment. By this time it is too late to make it down to the 5:30 ferry, so I was relegated to the 6:45, which means I wasn’t on the beach to see my son until 7:45P.M. I gave the paramedic my information and called the hospital giving them my E.T.A.

Traumatic Brain Injury

8:00 P.M. I arrive at the local hospital, a 262 bed facility with a Level III Trauma Center, and immediately found my teenager in the E.R. The treating physician informed me that he had multiple fractures, on his head and leg, the most worrisome of which was the skull fracture. (My son had just bought his new skateboard and did not have his helmet at the time of the accident.) The first thing Nathan says when he sees me is “I’m sorry Mom,” and then he starts asking for pain medication, yet he was calm, and composed. The doctor informs me the head trauma has caused a brain bleed, and Nathan needs to be transferred to a pediatric trauma center. At this point, I requested Seattle Children’s Hospital for the transfer, but it turned out that Harborview Medical Center had the pediatric –neuro-rotation for that night.  So off we went in the ambulance to the Level I Trauma Center, which is funded by the State through the University of Washington.

If you haven’t experienced the controlled chaos of an urban trauma center, it is reminiscent of a mental health ward, serves as a repository for the homeless in varying degrees of inebriated battle-weary skirmishes, and of course, is the collecting point for trauma victims. Some patients were on gurneys in the hallway while more urgent cases were treated in the E.R. suites, which were divided only by a curtain which runs two feet above the ground, and circles the bed like a shower curtain. Consequently you can hear everything in the ward, which can be somewhat disturbing.

Patient Safety Observations

Nathan was admitted to Harborview at 11:10P.M. October 16th. Throughout the night teams of specialists came in to examine him and he was not allowed to sleep until he could be fully evaluated, after the C.T. scan(s). Teams included pediatric neurological surgeons, general care pediatricians, orthopedic surgeons, and ortho/maxillofacial  surgeons.  Procedures which he endured included putting a cast on his leg and a second cast on his arm, which was later removed after it was discovered there was no arm fracture, and lots of tests. Unfortunately whoever installed the I.V. line did not removed the tourniquet after finding a vein and it was allowed to linger on his arm until the next day. This included some nurse actually attempting to put a blood pressure cuff over the tourniquet, which was high up on his arm and slipped under the cap sleeved gown. The tension of the tourniquet left a circular barbed-wire-tattoo on his arm. If he had circulatory problems this safety lapse may have caused severe problems. During his hospital stay, the phlebotomist came in to draw blood and asked if he was the patient in Bed A or Bed B, and I said I don’t know what bed this is, but he is my son and his name is Nathan. Again, isn’t it a better verification to use a patient’s name rather than the bed insignia?

Shortage of Beds for Patients

October 17, 5:30A.M. Nathan was transferred to the Intensive Care Unit where he spent two days for observation of his brain bleed, which had doubled in size but was stabilized. Yes, we spent the night in the E.R., with him on the gurney and me in a straight-backed chair, because we were waiting for a bed to become available anywhere in the hospital. This is not an unusual phenomenon for urban trauma centers, as they received referrals from all regional hospitals, for Traumatic Brain Injury (TBI) cases, burns, and other traumas. Children of course get top priority, so a bed was found. Literally, this trauma center does not have enough beds for its patients.  The Intensive Care Unit (I.C.U.) floor featured a shared ward with the burn victims and as it turns out, one mental health patient in the midst of an episode. Though the room was private and it actually had views of the harbor, the hallway between all of the other “rooms” in the ward was an open design, separated from the patient’s area only by a curtain. This meant that sound carried throughout the ward. Thankfully Nathan was loaded up on some pain medication and I crashed out on one of those folding bed/chairs.

Who Pays the Bill?

At both the local hospital and the regional trauma center, I was queried on where I worked, if I had full-time or part-time employment, and other insurance payment questions. Incidentally, evidence of employment in the United States does not mean that medical insurance is available to the employee or her family, as only about half of all businesses offer any type of group medical insurance. This payment interrogation is part of the follow-the-money-trail of all health care providers in the United States. Even though my son had insurance and I presented his insurance card, there is still the secondary payer inquiry, to allocate fault or payment somewhere else. Speaking of fault, the ambulance company billed me immediately and assumed that because my son was hit by a car that it was an auto insurance claim and asked for that information.  Of course these questions are routine and did not drive my son’s health care, but they serve as a constant reminder that our health care system is always about the money trail. Because the United States lacks a national health care program, we must concern ourselves with the ugly word, subrogation, which is an insurance industry term for assigning blame in order to obtain payment or reimbursement. In fact, at 12:04P.M., on October 18^th, I received a call from the man who drove the car which hit my child, asking for money to fix his truck. Aside from the ghoulishness and timing of the request, it too reflects on a predominant driver in the U.S. health care system, which is getting paid.

Follow-up Care

Fortunately our follow-up care at Children’s Hospital was a marvel, with concierge-type service from department to department, making fast work of the registration and verifying patient identity quickly, and with humor. Another marvel was the complete lack of any measurable wait time at Children’s Hospital as compared to the follow-up  care we also completed at the trauma center. While at the latter a hospital volunteer retrieved an unconscious man who was unable to speak from the “drive-up” and wheeled him to the X-ray and imaging department. Though I have difficulty imagining what family member would leave someone this vulnerable without an advocate, I was reassured when I saw him alert later in the day when he was waiting for his ride home. In conclusion, a patient advocate is always a good idea during a traumatic event as the family member and the patient may be too upset to make good decisions.

Implications for the Hospital Safety Net

With the implementation of the Affordable Care Act in 2014, more employees will have access to affordable health insurance through federal subsidies and insurance exchanges, regardless of what their employers are doing, so the full-time or part-time work question will become less important. But what remains is an acute shortage of hospital beds, especially in urban trauma centers and this will require an infusion of cash to overcome. Though Disproportionate Share or DSH hospitals like Harborview do receive additional funding from the federal government, it is not enough to finance a building expansion. The resourcing of health care falls to the local hospital district which will have to raise the money through a bond issue or some other means. We cannot afford to staff every hospital with the neurological and other specialty personnel required for Level I Trauma Centers, so surely we must do everything we can to preserve the ones we have. Since 2013 will focus on the budget crisis I hope lawmakers will consider the hospital safety net when they make their cuts.

And this is the healthpolicymaven signing off in real time.

This article was written by Roberta E. Winter, MHA, MPA, a health care journalist, consultant, and mother.

Consumer Tips for Surgery

One of the chapters in my book, Unraveling U.S. Health Care, which is a guide to the health care system, addresses surgery and tips on how to vet your surgeon and find the optimal facility.
Finding a Surgeon
The best web site for researching surgical specialties is the American College of Surgeons, which allows consumers to look up surgeons by specialty and location. The web site for this is: www.facs.org. For instance if you need a neurosurgeon, you can enter that and voila, the universe of neurosurgeons is revealed. These specialists are typically associated with university medical centers and large trauma centers. However, it is amazing that some health care consumers still think that neurosurgeons are available at rural 25 bed hospitals. Even if they were, why would you want to have this type of surgery done at that kind of facility?
Hospital Safety Rankings
Secondarily, it is worth your while to review hospital patient safety ratings before deciding on the facility. Methods to discern patient safety ratings of hospitals include reviewing the published information on www.leapfroggroup.org, by going to the 2010 hospital survey and looking up your state and the targeted hospital. Another method is to go to the federal Health & Human Services Agency web site for comparing hospital performance. It allows you to look at multiple hospitals at once. The web address for this is http://www.hospitalcompare.hhs.gov. and the site was recently updated to make it easier for consumers to use.
Reporting of Hospital Medical Errors
Another important aspect of doing your due diligence before undergoing surgery is reviewing patient medical errors and whether or not your state shares this information with the general public. Let me save you the time on this one, as I have reviewed all fifty states and the District of Columbia and the only states which required public reporting of hospital medical errors impacting patient safety were: Minnesota,Connecticut, and Indiana, The following states collect the data but do not necessarily make it readily available to the public or the data is not facility specific: Colorado, Illinois, Maryland, Massachusetts, Michigan, Missouri, New Jersey, Oklahoma, Oregon, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont, Washington, and Wyoming. I will also mention California, but they have been criticized for not complying with a state law on the reporting of hospital patient safety data. Scarier still is the 2005 Montana Law that has been dubbed the "I'm Sorry Law" giving health care providers additional protections for adverse patient safety events. Though Montana is rural and retention of some clinicians may be an issue, it is still of concern when in 2003, they repealed the requirement for a statewide health database and now clinicians are given more protections than patients.
In terms of preparing for any surgical procedure, it is most important to select the surgeon and the facility, but also to verify the accuracy of the diagnosis, so getting second opinions are a good method if you have any doubt. However, given today's digital imaging, it is much easier to see clear images of tumors and other issues than in 1993 when I had my first big surgical event. So verification of the diagnosis is key.
Once the diagnosis is determined,the treatment plan needs to be discussed and planned. Adverse events, post surgical recovery, and rehabilitation need to be considered in any plan. I suggest using a healthy level of detachment and planning your surgery like a project.
Presently an agent is reviewing my consumer opus: Unraveling U.S. Health Care: A Guidebook to the Complex and Confounding U.S. Health System. I hope to have the publishing path decided soon and of course, I will keep you posted.
Ending with my usual penache the healthpolicymaven suggests that having surgery done at a local facility, one where it is easier for friends to visit, or with a clinician you like are not enough evidence to support a decision potentially involving your health and well being. Take the time to look up the data, as reviewed by independent third party nonprofit organizations or a government agency under the Health & Human Services arm.
And finally, to the douchebag patients who criticize surgeons for not giving them a back rub and serving as their psychologist, that is not his or her job. They are skilled at cutting you up and putting you back together quickly and with low margin for error, so forgive them if they took the cram course in bedside manner. For oncologists, whose relationship with patients is typically long-term the consultative manner of the M.D. is more important. Having had a few surgeries myself, I do not go into the operating theater thinking I am special, but I realize I am one of many in the sea of humanity and many whiny consumers would do well to consider this perspective. It doesn't mean you take less care in your research, preparation, or recovery from your surgery, it just means, have a little consideration for the brilliant hard working medical staff, especially the surgeons.
For an advanced peek at my guide to the health care system, you can read part of it on:http://www.authonomy.com/books/24823/unraveling-u-s-health-care-everything-you-always-wanted-to-know-about-health-care-but-were-afraid-to-ask/
And this is your healthpolicymaven signing off.

Hospital Quality-Checks & Balances

Discerning Hospital Quality
The Center for Medicare and Medicaid Services(CMS) now requires health quality measures for specific clinical services, in order to recognize and encourage the best patient outcomes. Recognition will include greater financial reimbursement for those medical practices which conform to the CMS standards for clinical outcomes. This is yet another step in the right direction toward patient-centered-care as identified by the International Order of Medicine. This article highlights the primary hospital quality watchdogs in the United States and consumer tips on how to assess your hospital.
Organizations Measuring Hospital Quality
There are a number of ways to gauge your hospital’s quality, including accessing information from public sites, such as the Center for Disease Control, the Center for Medicare and Medicaid Services and the Health & Human Services Agency. There are also nonprofit organizations devoted to measuring hospital quality including; the Joint Commission for Hospital Accreditation Organization, National Quality Forum,Then LeapFrog Group and the Quality & Patient Safety Organization. Here are the crib notes for these organizations.
Private Sector Quality Watchdogs
Joint Commission
The Joint Commission for Hospital Accreditation is the pre-eminent organization for auditing and certifying hospital services in the United States. Obtaining its’ certification is an essential requirement for hospitals, which may lose reimbursement contracts and patients without the JCO recognition. The Joint Commission recognizes twenty-two hospital medical errors, which it has been tracking for patient safety purposes for 15 years.
National Quality Forum
The National Quality Forum is a non-profit group created by thirty-two health care organizations to develop consensus about hospital quality indicators and reporting. The NQF reviews twenty-seven patient safety metrics, but the information is not shared with the public.
Quality & Patient Safety Organization
The non-profit Quality and Patient Safety Organization or QuPS provides state-by-state analysis of patient safety initiatives by state governments. You can go to the site and see what your state has done to make your hospital safer.
Public Agency Quality Police
Agency for Health Research and Quality
The Agency of Health Research and Quality or AHRQ was created in 1999 to promote methods for improving health care quality in the United States. Though it doesn’t have any enforcement provisions, it does conduct research, award grants, and recognize health care groups with excellent performance.
Center for Disease Control
The federal Center for Disease Control established the National Health Safety Network in 2005. As of 2010, twenty-two states had adopted this method for reporting patient safety errors in hospitals and other inpatient facilities. Presently, 3,000 hospitals use this system, which make it the largest database for hospital errors in the United States. The data is collected for scientific review and specific facilities are not disclosed.
Center for Medicare & Medicaid Services
The Center for Medicare & Medicaid Services polices patient quality outcomes and publishes statistics, like patient mortality from pneumonia, heart failure, and acute myocardial infarction (AMI). However, mortality information alone is not a good measure of hospital quality or patient safety, because you would have to know the patient volumes as well as the morbidity or overall patient health. This information may be found at:
http://www.cms.gov/HospitalQualityInits/20_OutcomeMeasures.asp
One of the CMS sites that is helpful is the listing for certified organ transplant centers at: www.cms.gov/CertificationandComplianc/Downloads/ApprovedTransplantPrograms.pdf

Health & Human Services
The Health & Human Services Agency or HHS has a web site where you can find your hospital and compare clinical outcomes by diagnosis, to other facilities. This is a useful tool if you live in an urban area with multiple facilities, because you will literally be able to check their performance before your procedure. The link to this site is: www.hospitalcompare.hhs.gov

Other Public Sources for Hospital Certification Information
The American College of Surgeons publishes an on-line guide to Trauma Center Certification which is quite detailed because it explains the criteria for Level I Trauma Status. Also, university hospitals are teaching facilities and they typically have the highest status for trauma injuries. Information on your university hospital is available on its web site or through the State Department of Health.
Local Look
Washington State Hospitals which scored high in quality measures for 2009 data include: Virginia Mason, all of the Swedish Hospitals, University of Washington Medical Center, Harborview, Northwest Hospital, Seattle Children’s Hospital, Kadlec Hospital, St. Claire Hospital, and Mary Bridge Children’s Hospital. For information on how hospitals fared in your area, contact the healthpolicymaven by scrolling down to the comment tool or complete the form at: roberta@healthpolicymaven.com
Consumer Tips
The healthpolicymaven’s advice is to know-before-you-go for your surgical procedure and here are some helpful tips to figure out your hospital's quality score:
1.Look for public reporting of hospital medical errors as this is the highest degree of transparency and commitment to improve patient safety.
2.Hospitals which use a national model like the CDC’s National Health Safety Network are using a rigorously tested assessment model.
3.Find out if your state mandates public disclosure of patient safety errors and if it is available by facility.
4.The Center for Medicare & Medicaid publishes information on hospital performance, including infections, surgical errors, and discharge information.
5.Ask questions and do some research.

Closing Thoughts
This patient safety article may not seem that germane now that the country is in its third war and on its knees fiscally. However, the Chinese are paying our light bill, having mastered science and math and access to birth control. Meanwhile folks in the United States continue to debate teaching the science of evolution versus the dogma of religion in public schools. Is it any wonder the US doesn’t measure up to global standards for primary education?