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Choosing a Provider

There are more tools than ever available to help you find a hospital or provider.

Choosing a Hospital

Many patients rely on their doctor when choosing a hospital, who will usually steer them to the facility where he or she has affiliations. Recommendation from family or friends and community reputation are also traditional methods used when making a decision.

When there is time to plan ahead, there are resources to help you judge the quality of hospital care.

Hospital Compare, set up jointly by the federal Centers for Medicare and Medicaid Services (CMS), hospitals and other groups, lets consumers search by city, state or other criteria, and look up a variety of statistics comparing more than 5,000 hospitals against one another and to state and federal averages. You can see how often a hospital’s patients receive timely and effective care for certain conditions and how often certain serious conditions could have been prevented. National survey results from patients are included, such as what they said about their hospital stay, like how well pain was managed and how well the doctors and nurses communicated.

As part of the initiative to add five-star quality ratings to its Compare sites, CMS publishes HCAHPS Star Ratings to the Hospital Compare Web site. Star ratings make it easier for consumers to use the information on the Compare websites and spotlight excellence in healthcare quality.

Other available comparison sites:

Nursing Home Compare features an overall star rating for each nursing home based on health inspections, certain quality measures, and hours of care provided per resident by staff performing nursing care tasks.

Home Health Compare features an overall star rating that summarizes home health agencies’ performance on nine quality measures that indicate how well they assist their patients in regaining or maintaining important functional abilities and how frequently they adhere to evidence-based processes of care.

Don’t rely only on a star rating to make a final decision.

 

Choosing A Physician

Choosing a doctor is an important decision, but it is ultimately your choice. Asking for a referral from a trusted advisor (a family member, friend, coworker, or neighbor) is a great way to start. Always check the terms of your insurance coverage to find out whether the plan will cover visits to the physician you are considering. If he or she does not participate in your health plan, how much will you pay out-of-pocket for visits to this provider?
 

Primary Care vs. Specialist

Everybody needs a doctor to perform a yearly exam and treat everyday issues that pop up, like the flu. Such primary-care doctors should also coordinate the care you get from specialists for severe or complicated problems.

Credentials

Doctors are increasingly being scrutinized and not just on treatment outcomes. Consumers are increasing able to access information to judge for themselves where they accept their treatment.

You can find out whether a doctor is in good standing with state licensing agencies through a website run by administrators of several state medical licensure boards. The site Administrators In Medicine can provide information about licensing background and disciplinary information of physicians and other health care practitioners in addition to physician profile information from states that have passed physician profile laws.

Some health-insurance also plans provide information for members on the educational and professional background and specialty certification of participating physicians.

 

Ratings

Physician Compare uses star ratings to display ratings for several meaningful measures for group practices.
 

Questions to ask the doctor/Practice

  • How often does the doctor treat a specific condition (if you have condition)?
  • How long you will have to wait for an appointment?
  • Who will see you if the doctor isn’t available?
  • Which hospital does the doctor use?
  • What is the office’s cancellation policy?

 
Questions to ask yourself

  • Is office staff friendly and helpful?
  • Is it easy to reach the provider?
  • Do you prefer a provider whose communication style is friendly or formal?
  • Does the provider refer to other specialists frequently or infrequently?
  • Does the provider invite you to participate in your care?