Wondering how to determine quality health care? Start here

June 20, 2018

This paid piece is sponsored by Avera.

We’re a nation of researching consumers, and we scour websites and read reports, and we might ask friends and family for insight, be it a TV, a home or a new car. Everyone wants a quality purchase, after all.

When it comes to health care, an ocean of abbreviations and a galaxy of rating systems and websites are out there. The definition for “quality health care” could be 40 things if you ask 40 people. Understanding how health systems seek quality and what it means to them can help consumers better gauge their own expectations.

“There are really two universes when it comes to quality and measurement, but at the top is CMS, the Centers for Medicare and Medicaid Services, because ultimately we are accountable to their rating metrics because CMS gives funding or takes it away,” said Stacey Erickson RN and Avera Health vice president of quality and data integration. “But on the other hand, patient experiences – those intimate, personal experiences between patients, families and their health care providers – often are what consumers consider when they think of quality care.”

In this information age, quality in health care is of critical importance, even if its definition might vary from person to person, added Peggy Goos, Avera Heart Hospital director of performance improvement.

“People are used to having tons of information on products, services and almost any place they may wish to go, and having comprehensive ratings, reviews and insight they can consider, all in a few seconds,” Goos said. “Within health care, there are many rating systems, but the CMS one is the most important.”

CMS operates the Hospital Compare website, where it defines quality as how well a provider “of health care keeps its patients healthy or treats them when they are sick.” That definition continues by saying good quality health care means “doing the right thing at the right time, in the right way, for the right person and getting the best possible results.”

While clearly stated in just a pair of sentences, there’s tremendous possible interpretation in those short statements. Erickson said the challenge lies in balancing the “numbers” along with the human “experience of care.”

“The metrics for the CMS evaluation are dense, and there’s a belief that good results will follow when you focus on science-based, patient-centered care,” Erickson said. “Specific programs, such as reduction of readmissions or fighting sepsis, make sense on a level. But the personal experience of care is not as easily quantifiable.”

Erickson provided a simple example with a daughter who brings in her mother for cancer treatments. The family expects exceptional clinical care. When the health team sits with the pair and listens to their fears, this interaction elevates the quality experience.

“That sort of compassion goes a long way toward showing the Avera mission and leaving a lingering idea with them both about the quality of care,” Erickson said.

CMS rating scores are presented in a range from one to five stars. The more stars, the better the rating. In December 2017 of 4,000 hospitals reviewed, 337 earned a five-star rating, and Avera Heart Hospital was among them.

Goos said quality is an ongoing process – not a target – and that process occurs every hour of each day.

“We realize our customers are aware of the ratings, and we work closely with our entire teams so that every person who works for Avera Heart Hospital realizes that quality is an important part of everyone’s day-to-day work,” she said. “What they say and how they treat people really matters.”

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Wondering how to determine quality health care? Start here

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