A recent article by Georgia Health News reports on the patient safety ratings for Georgia hospitals. According to the article, the intent of the hospital safety report is to aid consumers in their selection of hospitals based on a very important measure of care: “the ability of hospitals to prevent errors, injuries and infections.” They should have added “deaths” to the list.
The article cites a statistic that is quite alarming: “More than 1000 people die each day in the United States because of preventable hospital errors”. Because that statistic is so alarming, I investigated a little and found that some very large, reputable news sources published the same information — so this isn’t a stat pulled from a fringe alternative health outfit. I haven’t confirmed this, but the number of deaths was estimated by the U.S. Senate in a committee while discussing this very serious issue in July, 2014.
Even if just ten percent of that figure is correct, that’s still more than 36,000 deaths each year due to hospital errors! To read more about the report published by the Leapfrog Group and the measures they used in their safety ratings, go to their website: http://www.hospitalsafetyscore.org/
So, it really is important to be proactive about your health and not assume all doctors — especially overworked ones at hospitals — are going to make decisions in your best interest. Some hospitals are extremely busy and understaffed, so it’s not hard to believe that their safety ratings are on the low side. For example, Grady Memorial Hospital in downtown Atlanta received a ‘D’. I was, however, surprised to see that Piedmont Hospital in Atlanta earned a ‘D’ also.
For a full report on all the hospitals in Georgia and other states, please go here.
This report is timely because many people will be making decisions soon during Open Enrollment for the 2015 plan year for many group plans, personal plans and Medicare Advantage plans. Reviewing provider networks (including doctors AND hospitals) is an important consideration when comparing options.
The HMO Trend — Your Hospital may be excluded
One of the trends we are seeing is a movement back towards the HMO (health maintenance organization) model. One of the primary ways health insurance carriers are able to mitigate against rising costs is by narrowing their provider networks. A few carriers in Georgia — Blue Cross Blue Shield, Coventry and Cigna — have drastically reduced their HMO networks. So, it is more important than ever to make sure your preferred hospitals are “in-network”. For those who don’t have a preferred hospital or are new to Georgia, checking out hospital and doctor ratings can be a big help in selecting quality providers to receive care.
Just because a carrier offers a narrow HMO network doesn’t mean it’s a poor choice. For example, Coventry’s HMO networks includes Northside Hospital, but excludes some prominent hospitals in the greater Atlanta area such as Kennestone and Emory. Some folks are content if their doctors and favorite hospital(s) are in an HMO network. Also, some people prefer the coordination of care offered by HMO plans. They like the fact that their primary care doctor is on the same page as their other doctors.
Kaiser Permanente in Georgia has consistently received top ratings in most categories over the years. I have found people really like their experience with Kaiser’s HMO model. On the other hand…
There is a Strong Dislike for HMOs
Many people steer clear of HMOs due to their lack of flexibility. Most of my clients want the choice to see providers out of network. If they were to be diagnosed with a serious illness, they want the choice of seeing a highly regarded specialist out-of-state and not have to worry about paying for it themselves. Choosing a national PPO or POS network is essential for these people.
Most carriers offer a choice of plan types: HMO, POS, or PPO. Some HMO networks are “open access”, meaning you are not required to see your primary care doctor to get a referral to a specialist. Again some people like having a “gatekeeper”, while others strongly oppose this.
When I help my clients select the right plan, discussing provider networks is a very important part of the decision-making process. Health insurance carriers offer a link to look up doctors and hospitals on their websites. Most quote comparison sites for personal plans include links to carriers’ provider networks. If you’re shopping for a new personal, Medicare or group plan in Georgia, please click here. If you’re looking for personal coverage on the Marketplace (with subsidies), please click here.
The report on hospital safety is a good reminder that selecting the right doctors and hospitals is certainly one of the important ways to be proactive about your health.
Greg Sanders Peachtree Insurance Advisors 678-236-1600
