Heart Health

Honda, Toyota and Alegent Health

November 14, 2011

Honda, Toyota and Alegent Health

I was in an airport a couple months ago, killing time in a gift shop, when I came across the September 2011 issue of Consumer Reports magazine with a cover story entitled “Protect Your Heart.”  Always on the look-out for grist for my blog I snapped up the issue (at a ridiculous price of $5.99—I can almost get a Grisham paperback for that amount.  But, hey, no price is too high to get through the time between entering the airplane and the moment they announce you can finally turn on your iPad.)  To my surprise I came across a story that not only discussed the quality of cardiovascular programs around the country but went so far as to grade each one.

Naturally I skipped through the “A” states (Alabama, Arizona . . .) and quickly found my way to “N” where I was pleased to see that my own group earned highest marks.  Alegent Health of Omaha, and in particular the heart program at Bergan Mercy Medical Center, was rewarded with three stars for all the work we’ve done in improving patient outcomes and providing quality care.  I immediately shared this with the guy sitting next to me, who was less than impressed and seemed to be more focused on the flight attendant’s safety briefing than on trying to figure out where he should get his next bypass surgery.  I briefly entertained the idea of reminding him that he stands a far greater chance in his lifetime of coming under the heart surgeon’s knife than ever needing to use his seat cushion as a flotation device on a flight from Omaha to Denver, but I just let it go.

I find it kind of funny that Consumer Reports is now in the business of reviewing medical care.  While I’ve never had a subscription to this magazine I’m quite familiar with its layout and purpose.  Their editors buy up a sampling of some type of product (appliances and electrical devices are favorites) and run them through a series of tests in an attempt to find out which particular model is the most reliable, functional, and worth the money.  A typical issue will tell you, for example, which toaster is the best value for your buck and whether a Honda is really more reliable than a Hyundai.  They also take into account feedback from their thousands of loyal subscribers, especially when it comes to big-ticket items like automobiles.

I’ve never had much need for Consumer Reports’ advice, since my method of choosing a new car or appliance mostly comes down to which one looks the coolest or accelerates the fastest (cars, not appliances), but it’s somehow reassuring to me that their unbiased editors agree with my own assessment of my practice’s performance.

Consumer Reports’ foray into health care (other articles in that issue: “How to keep it young,” “Risky tests to avoid,” “Angioplasty: What your doctor might not tell you”) seems to be part of a bigger movement by the lay press to get a handle on the rating of health care, a trend that includes Angie’s List’s recent addition of physicians to their catalog of reviewed professions.  I have previous written on the explosion of doctor-rating web sites and concluded that they leave something to be desired.  This particular issue of Consumer Reports is, however, a bit novel in that it takes a more scientific approach to evaluating the product we provide.  The information they base their rankings on comes from a large database collected by the Society of Thoracic Surgeons and takes into account hospital length of stay, complications, and requirement for readmission and repeat procedures.

Unfortunately, such data doesn’t really exist for other parts of our specialty.  No one tracks how well I implant pacemakers or do heart catheterizations.  There is no database that provides feedback about how well I’ve chosen medications to treat high blood pressure or whether I correctly differentiate between true cardiac chest pain and heartburn.  We track a few things in the clinic and hospital that we call “quality measures,” such as how well we comply with current guidelines for treatment of congestive heart failure and atrial fibrillation, but these parameters just scratch the surface when it comes to the many decisions we make with each patient.

And what about parameters that are most meaningful to patients?  To many people, a one percent difference in heart surgery survival (which, by the way, is often all that separates the good from the great programs) may not mean as much as how well the doctor communicates with the patient and family.  Heart attack victims understand the importance of getting therapy quickly, but probably care more about their ICU nurse’s level of attentiveness than whether I get them into the cath lab within 90 minutes (one of the few parameters that is actually closely tracked and another area where our local doctors and hospitals excel).

Some of this is already done, but to a limited degree.  Alegent Health gathers “customer feedback” by calling a small percentage of my patients to ask about their interaction with me (note to my patients: I’m willing to pay a small bribe if you conveniently forget all my faults when you get that phone call) and actually bases part of my pay on my bedside manner (hence my application this year for food stamps).

Someday I suspect we’ll see magazines like Consumer Reports publishing detailed rankings of doctors that include markers that matter to both patients and medical epidemiologists.  They’ll probably be able to incorporate monetary value in their calculations as well.  Does your doctor stick with generic medications when possible or order the most cost-effective test when the opportunity presents itself? Does your doctor adequately emphasize health maintenance and prevention?  Which clinic provides you the most comprehensive care for the money?

For now, the Consumer Reports’ review of cardiac surgery centers is based on such a limited data set that a critique on the subject would be akin to an automobile review that provides information about engine durability but pays no attention to comfort, ride, accessories, or performance.  Someday that might be different:

Dr. Van De Graaff, Cardiologist, Omaha NE

1 star out of 4
A satisfactory doctor with a fair knowledge base and a reasonable work ethic.  The bedside manner is less that what you might expect in this class of medical professionals, but is serviceable.  Procedural complication rates are a bit higher than average but 5-year mortality among reviewed cases is within acceptable limits.  Knowledge of cardiac physiology is low and writing skills are mostly nonexistent.

Pros:  Has the ability to produce two pages of nonsense every week.

Cons: Poor sartorial insight, weak sense of humor, cold stethoscope.  Never learned how to use seat cushion as a flotation device.

12 Comments
  1. Cheryl Vandegraaff

    Good thing I'm paying attention to how to use a seat cushion as flotation device.......sheesh

  2. Tara Whitmire

    I can't believe you only got 1 star!? You get at least 2 1/2 in my book!! =)

  3. Jeff Carstens

    Another great blog that helps to point out the good and the bad in these rating systems. The government is also starting to collect a lot of this patient satisfaction information as part of a grading system for hospitals that will also be tied to reimbursement from Medicare. I am happy to say that Alegent ranks very highly here as well. This information is increasingly available on the internet as well at www.hospitalcompare.hhs.gov

  4. Dianne Strobel

    Five Stars for Wonderful Writing...Very Informative and Humorous. Great Job!

  5. Gwen Larsen

    This was a wonderful blog! You have a great sense of humor on this but yet so real and common sense! And yes $5.99 is worth it while waiting until you can turn on your "electronic devices!"

  6. Michelle Zuerlein

    I just want to say that just reading your blog can make my day! Unfortunately, because of the serious nature of the work we do in healthcare, sometimes people forget that humor can be the best medicine. Thank You :)

  7. "pre"

    As competition amongst doctors inreases for patients,many will be referring to how they scored on the latest survey. Maybe a retail model may be in the future, maybe a punch card..like at subway....see me 5 times and you get a free prostate exam....

  8. Naomi Kamoro

    You just made my day!!!!!! Love your blogs. Did you hear of the man on Good morning America that went to ER and the doc asked him what he wanted on his orbituary? The man turned his life around, is half his previous size and has moved his family to get healthier! Sometimes the bedside manners are overrated and health care providers should be able to tell as it is to save lives!

  9. Tammy

    Literally laughed out loud!! I am most positive your bedside manner is top notch. I love it when my doctor has a sense of humor. I don't really give a lot of attention to consumer reports, I have a problem with people that have that much time on their hands, word of mouth is where it's at and is what people really listening too. Hope I never need your expertise, but if I do I'm book marking your name.

  10. Gayle Barnett

    As a former employee of Heart and Vascular, I am sorry that I do not get to work with you! You are just too funny and I love your writings and sense of humour! What a way to practice to practice a vision not only for employees, but patients as well. Keep up the wonderful writings and thank you!

  11. Just

    i never knew doctors could be so laughable. Your Nonsense, just Makes Sense!

  12. Nancy Welch

    Thank You for an interesting and informative article that was fun to read.

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