Opinion Extra

Smith: How does your hospital rate, and how much does that matter?

Dr. Timothy Pansegrau performs heart surgery with the the help of Wayne Durbin at Palmetto Richland Memorial Hospital.
Dr. Timothy Pansegrau performs heart surgery with the the help of Wayne Durbin at Palmetto Richland Memorial Hospital.

When I needed surgery seven years ago, my wife and friends took the time to identify surgeons most highly recommended by their peers. One surgeon’s name came up often.

I visited his office in San Antonio. He made a formal presentation to us about surgical and other options and recommended several surgeons in the Southeast. I needed to take time to select a surgeon, he said.

After three months and visits with other surgeons, I asked the Texas doctor to do the operation. I had no idea what hospital he would use. The surgeon, not the hospital, was the deciding factor.

Do we have a reasonable choice of health-care providers today?

There are now only three major national health-insurance providers, Anthem, Aetna and United Healthcare.

In South Carolina, large hospital systems are buying smaller hospitals, resulting in fewer systems.

Surgeons and physicians used to be independent professionals; today many are employees of hospital systems.

Consolidation may result in higher costs, especially for people with high deductibles on health insurance or no insurance at all.

The good news is that there’s a world of information available about health-care providers. But you have to look for it.

You can find out how much hospitals charge for a procedure, not including surgeon charges, at scPricePoint.org. Charges shown are just list prices, which no one pays. If we want to know our out-of-pocket costs for the hospital and surgeon, our insurance provider, if we have one, should be able to tell us.

You can identify surgeons, by hospital, who have the lowest rates of complications, at ProPublica.org.

ConsumerReports.org shows that two hospitals in Richland and Lexington counties are in the lowest-ranked category for “avoiding death” from surgery. One hospital is just average on avoiding death. Providence Hospital is the only rated hospital anywhere in South Carolina with a better-than-average rating on avoiding death from surgical procedures.

How often surgical patients die in the hospital after developing a serious treatable complication is one of the few measures we have for evaluating a hospital and its surgeons.

Insurance providers have the best data on both costs and surgeons’ outcomes. But you can also ask your primary care physician for recommendations, including several in-state and out-of-state surgeons. Ask friends who have had a recent experience, good or bad, before, during and after surgery. Ask a nurse. Review the web sites on best rated surgeons.

We have to work to get cost and quality information. Little is transparent. Many people do more research on a car or house purchase than they do on the purchase of a surgical procedure.

But even with the rapid consolidation of health care and fewer local choices, there are choices of surgeons and physicians around the country and abroad.

Companion Global, here in Columbia, advises patients about surgeons in such places as Thailand or Ireland who specialize in certain surgical procedures, have low complication rates and have out-of-pocket costs much lower than most U.S. hospitals.

Few patients and family members really want to travel for surgery; most would rather stay home if they know that they will have affordable out-of-pocket costs and a surgeon with low complication rates and good long-term outcomes. But if patients cannot find out the total cost and the performance record of surgeons at home, it is reasonable to look elsewhere.

It does not seem right to say that the search for an affordable, high-quality surgical procedure is like the search for a reasonably priced, high-quality car. But maybe that’s how we should look at it.

When I heard that I needed surgery, my wife stepped forward quickly to lead the research process while I worried about my body having a problem that I thought needed fixing without delay, at any cost.

Research was done. Rational decisions were made. And my outcome was very good. While the process took time and effort, it was worth it for a decision that would affect the rest of my life.

Dr. Smith is a sociologist and president of Metromark Market Research in Columbia; contact him at emsmith@metromark.net.

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