Choosing Where to Have Surgery

In the era of Facebook, Yelp and online surveys on every topic imaginable, it makes sense that we’d turn to patient satisfaction scores to help us decide at what hospital we — or a family member — will have surgery. After all, who better to tell us about the patient experience than other people?
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Unfortunately, a study by Johns Hopkins University School of Medicine researchers found that there was a big disconnect between the quality of what happens in surgery and the perception of patients about a hospital. The study was published in 2013 in JAMA Surgery.

Surgical patients who reported they had a positive experience in the hospital did not necessarily get high-quality surgical care, according to the research.

In other words, don’t let thumbs-up on a Facebook page or even a hospital’s awards or reports about patient satisfaction serve as key factors in deciding where to go for surgery. The researchers found little evidence there was any correlation between patient satisfaction and quality.

There are certain factors — typically not seen by a patient — that contribute to high quality care. They don’t sound very exciting, but research has shown that having certain routine procedures and safety factors in place make a big difference in how healthy you’ll be after the surgery. Those factors include, for example, how well the hospital prevents potential complications like infections and blood clots, and how extensively staff are committed to and educated about  providing safe, error-free care.

Quality Issues 

The researchers looked at quality measures and patient satisfaction data at 31 urban hospitals in 10 states. Medicare patient experience surveys were reviewed to identify the level of patient satisfaction. Quality was determined by how closely physicians and staff followed recommended standards of care.

Martin Markey, M.D., the lead author of the study, said satisfaction scores will mislead patients since they’re going to feel that the “hospital with the best lobby and the best parking and customer service is going to have the best heart surgery.”

The researchers looked at quality factors that have been shown to improve surgical outcomes, such as the use of antibiotics to prevent infections; prevention of deep vein thrombosis (such as blood clots in the legs); prompt removal of bladder catheters; and the hospital’s commitment to safety.

They said  that while patient assessments may tell you something about the overall patient experience at a hospital, don’t count on them to give you guidance about the quality of care related to surgery.

Financial Problems

And then there are financial questions to ask. An article recently published in Reporting on Health raised the issue of surprise, out-of-network billing that frequently occurs with procedures and surgeries in hospitals. A physician from Los Altos, Calif., chose an in-network hospital for a cardiac procedure he needed, based in part on his surgeon’s confirmation that he was indeed “in network.” But surprise! The anesthesiologist was not in his network, and so he was responsible for the complete $6,000 bill for anesthesia.

“It’s upsetting,” the physician told reporter Kellie Schmitt. “It’s the additional service that most patients don’t think about. They enter a hospital that’s in-network and just don’t think the possibility exists.”

Schmitt says just this year, Consumers Union found that nearly 25% of privately insured Californians received unexpected medical bills. And the issue isn’t unique to Californians; it’s national.

What This Means For You

  • When your surgeon tells you what hospital you’ll be going to for surgery, ask whether you have a choice. You may not. Some surgeons only do surgery at one facility. If you do have another option, ask about the pros and cons of each facility, especially in terms of surgical outcomes.
  • If you don’t like the surgeon’s answers or if you have concerns about the recommended hospital, consider getting a second opinion from another surgeon.
  • Don’t be impressed with frills like valet parking or free Wi-Fi. Understand that quality surgery care is a little like air travel: no matter how good  (or bad) the in-flight entertainment or the mileage bonuses may be, your ultimaFeatured imagete goal is to get where you want to go safely and with a minimum of drama.
  • Be wary of hospital advertisements and reports about patient satisfaction. Ask for hard data about key safety factors, including not just the ones the researchers used in this study (as noted above), but readmission rates, infection rates, adverse events, and average length of hospital stay for the surgery you’re getting  (longer stays are often correlated with complications).
  • Be sure to ask questions about whether you will be  “in network” when you receive services from not just your surgeon, but anesthesiologists and any other physicians, or tests or services that may be part of your health care while you’re in the hospital. Don’t trust the surgeon to know for certain whether the full range of care you would receive at a given hospital will be covered by your insurance provider.

The Bottom Line

When you’re having surgery, you’re not just choosing the surgeon. Other very important factors related to how you will ultimately fare include the quality of the nursing and other hospital staff,  the hospital’s routine policies and procedures, and the organization’s commitment to patient safety.

Knowing whether you’ll be hit with surprise out-of-network costs is important, t00, if not for your physical outcomes, for your mental and financial health, for sure.

And while some things  may be difficult to know with certainty, asking some questions beforehand may make a big difference for you and the people you love.

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About Barbara Bronson Gray, RN, MN

I'm an experienced healthcare and science editor and journalist. But most of all, I'm a registered nurse with many years of experience working in hospitals. I've learned what patients and families need first hand. But I've also worked to improve hospitals and educate people about their health. I'm committed to helping people take charge of their health care and get what they need from a complex and often discouraging healthcare system.
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