Getting the Right Care at the Right Price
How do you know if you´re getting good healthcare? There´s no easy answer. With other types of services, you can look for the cheapest plumber, or go to the restaurant with the best reviews. But healthcare is complicated, and the outcomes aren´t always certain. However, there is some information you can look to before you choose a healthcare provider.
Quality measures, which are created by government, non-profits and for-profit companies, offer many different types of information about healthcare providers. They may reflect the patient experience, clinical outcomes and whether the provider follows a routine standard of care.
Choose a healthcare provider based on those qualities that are most important to you. Keep in mind that issues you feel are important may not be the same as those of your friends or family members. For example, you might want to see a provider who speaks your language or who uses electronic health records (EHRs). Or, you might be willing to pay more to visit a provider who is closer to your home or work, or has special training in treating your condition.
The provider who is best for you may turn out to be more or less expensive than others—only you can decide if the extra expense is acceptable to you. Some providers charge more because they have been practicing for a long time, or have special training or certifications. Going to a provider who does not accept your insurance plan may also cost you more.
Remember, the choice is yours –
just make sure it´s an informed choice.
FH® Healthcare Quality Toolkit
There are many ways to understand and compare the quality of different healthcare providers (such as physicians, other types of healthcare professionals and facilities).
The toolkit below gives a snapshot of just some things to consider when choosing a provider, such as:
- Provider practice (location), education, training and hospital affiliations;
- Some measures that are used to describe quality, such as e-prescribing**;
- Websites that allow you to search for providers based on specific quality measures; and
- Suggested questions to ask healthcare providers to help keep you informed and healthy.
As you look for doctors and other healthcare professionals, think about the factors below, and take notes so you can compare your choices later.
You can also download and keep the toolkit handy for easy reference!
Practice and Contact Information
*Name of Healthcare Professional
*Phone Number/Fax Number
*Provider Credentials (e.g., MD, DO, PhD)
This tells you about your healthcare provider´s training and education. Different healthcare professionals earn different types of degrees and licenses. For example, physicians might earn a Doctor of Medicine (MD) or Doctor of Osteopathy (DO) degree. This information may be helpful in certain cases. For example, if you know that you will need a prescription drug, you may want to go to the type of provider who is licensed to prescribe that medicine in your state.
Other healthcare providers like acupuncturists, social workers, psychologists, physical therapists and nurse practitioners may have their own set of credentialing rules. You can visit their professional associations to learn more about these types of providers.
*Provider's Primary Specialty
This tells you whether the healthcare provider has the required experience or training in a specific type of care. For example, physicians who complete extra training in heart conditions specialize in cardiology.
This tells you if a healthcare provider—most commonly a physician—specializes in more than one type of care. You may want to know whether a physician has a secondary specialty in certain cases. For example, if you are looking for a primary care physician for your family, but you know that you have a family history of diabetes, you might look for a physician who specializes in both family medicine and endocrinology.
*Medical School and Graduation Year
This tells you where the provider went to school or received training, and when he or she graduated.
These are the hospitals where a doctor can provide care or admit patients who need to be hospitalized. Doctors may be affiliated with more than one hospital. If you think you will need hospital care, you´ll want to make sure your doctor is affiliated with the hospital you prefer or the hospital(s) in your plan´s network.
The Centers for Medicare and Medicaid Services (CMS) collect information from physicians and other types of healthcare providers about specific “quality” metrics, such as whether a provider has electronic health records or participates in a program that requires reporting on specific quality measures. We have included the following CMS quality metrics for providers on our site, where available. You may want to consider these when making a decision about a healthcare provider.
*Participates in Electronic Health Records
This tells you whether a healthcare professional uses online records to keep track of patients´ medical history. Providers can share these electronic health records, or EHRs, with other providers, which may make it easier and faster for everyone involved in your care to share the information they need to give you the right treatment. EHRs also make it easier to have access to your own medical records.
*Participates in e-Prescribing Program
This tells you whether your provider can send your prescription to the pharmacy over the internet. Electronic Prescribing (eRx) can help make sure you get the right medicine and also adds to the ease and convenience of filling your prescription.
*Participates in the Provider Quality Reporting System (PQRS) and Received PQRS Certification
This tells you whether your provider participates in the Provider Quality Reporting System (PQRS) “Maintenance of Certification Program”. Only doctors that accept Medicare participate in PQRS. All doctors have to report quality measures regularly, but providers in this program agree to report them more often, and to evaluate the care they provide in their practices.
*Participates in Million Hearts® Program
This tells you whether a provider has joined the Million Hearts® program. Providers in this program have to meet certain goals to prevent heart attacks and strokes by helping their patients take medications regularly, manage their cholesterol, quit smoking, and other steps.
Other Sources of Quality Information
Many websites offer quality measures for doctors, hospitals and other healthcare providers. These websites may measure providers based on patient safety, communication with their patients and the types of care they provide. FAIR Health is not affiliated with and does not endorse these websites, their methodologies, or results.
U.S. News & World
You can use this tool to search for a physician or hospital by specialty, geographic location or name. Information about physicians listed on this website includes:
- Contact information
- Years in practice
- Board Certifications
- Hospital Affiliations
- Insurance Plans Accepted
- Education and Medical Training
- Certifications and Licensure
- Awards, Honors and Recognitions
- Publications and Presentations
Information about hospitals (including children’s hospitals) listed on the website include ranking, recognition and performance related to different procedures. Hospital rankings, are based on data for 16 specialties.
You also can search for health plans based on whether your physician is part of the health plan’s network.“U.S. News & World Report” and its logo are registered trademarks of U.S. News & World Report, L.P. Go to the Site
New York State
You can search for a physician licensed in New York State by name and receive information about a physician´s education, board certifications, practice information and legal actions that have been taken against the physician (e.g., restrictions on practicing).Go to the Site
The National Committee for Quality Assurance (NCQA)
is a non-profit that accredits healthcare providers, organizations and health plans.
Use the website to search for healthcare providers who have been recognized by the NCQA in areas such as coordinating patient care and treating patients with diabetes, cardiovascular disease or those who have had a stroke.Go to the Site
Questions to Ask a Healthcare Provider
Use this list of questions when choosing a physician or another healthcare provider, such as a physical therapist or chiropractor. In many cases, it may be best to speak with your provider´s billing office staff.
Remember to take notes of your conversation, the name of the person you spoke to and the date!
- Do you accept my health plan?
- If my plan doesn´t cover a service, do you offer payment plans, discounts, financial assistance or negotiate prices? Do I qualify for financial assistance or financing?
- Can I communicate with you by e-mail or online? By cell phone or text messaging?
Do you participate in any of the following programs…?
- Electronic health records
- Electronic prescribing
- Provider Quality Reporting System (PQRS)
- Million Hearts™ Program
- Which hospitals are you affiliated with in my area? If I need hospital care, do you have a preference for which hospital I use?
- Do you or a member of your staff speak [your language of choice]?
- Does your office accommodate people with disabilities?
- Do you specialize in treating my condition or illness? If not, can you recommend someone who does?
Getting recommended tests and screenings is an important part of staying healthy. But how do you know if you are getting all the tests you need?
Ask your primary care physician whether you need any of these preventive services based on your age and health status
Most health plans must cover these preventive services for free if you receive them from a provider who is in-network. Learn more by reading our article on preventive care.
What about tests and procedures that you may not need? The Choosing Wisely® campaign has compiled questions and resources from different medical specialties that you can use when speaking with your physician about testing options.
Hospital Quality Measures
When choosing a hospital, you may want to learn more about how the hospital performs on certain quality measures. For example, you may want to know how many patients get infections in the hospital, or how quickly a hospital provides care in an emergency.
Below are the quality measures featured on our site, and links that explain more about them. Learn more about these quality metrics by visiting the website of the New York State Department of Health (NYS Health Profiles) and the Centers for Medicare & Medicaid Services Hospital Compare website. The New York State Department of Health explains how these data are collected and measured here. This website offers information about quality metrics for specific hospitals in Albany, Buffalo, Syracuse and Westchester.
This tells you the number of complications that patients experienced after surgery (per 1,000 patients), compared with the number of complications typically expected. Complications are new problems that result from an illness or treatment. A high-performing hospital will have a lower number, meaning fewer complications.
This website shows information on hospital central venous catheter-related bloodstream infections, which are common complications in surgery. A central venous catheter, also called a “central line,” is an intravenous tube often used to provide medicine, fluids and nutrients over a long period of time.
Emergency Room Timeliness
This is the average time that patients spend waiting in the ER (or ED, emergency department) before they are admitted to the hospital. It gives you an idea of how quickly a hospital can provide care in an emergency. A high-performing hospital will have shorter wait times.Specific measures include:
- Median time from ED arrival to ED departure for discharged patients - Some patients are seen and/or treated in the ED, and the doctor decides to discharge them, usually to their homes. This measure is the median time those patients spent in the ED, from the time they arrive until they leave the hospital.
- Time from ED arrival to ED departure for admitted ED patients - For some patients, the doctor decides the patient should be “admitted” to another part of the hospital for inpatient treatment. This measure is the median time those patients spent in the ED, from the time they arrive until they leave the ED for their inpatient rooms.
- Admit decision time to ED departure time for admitted patients - This measure is also for patients admitted to the hospital for inpatient treatment. It is the median time patients spent in the ED, but from the time the doctor decided to admit them until they leave the ED for their inpatient rooms.
Hospital-Acquired Infections—Surgical Site
This tells you how many patients got sick with an infection in the hospital after a surgery. If you’re having surgery, this could be important information. A high-performing hospital will have fewer infections.Specific measures include:
Heart Attack Readmissions within 30 Days
This tells you how many heart attack patients had to go back to the hospital within a month after they went home. A high-performing hospital will have fewer readmissions. Hospitals with a lot of readmissions might not be giving patients the care they need, or might be sending them home too early, without the support they need to get better. Sometimes, though, the hospital could have patients who are sicker, or are less able to care for themselves at home.Specific measures include:
- Heart attack (acute myocardial infarction, or AMI) patients readmitted to hospital within 30 days
- Heart surgery (coronary artery bypass grant, or CABG) patients readmitted to hospital (from the Centers for Medicare & Medicaid Services)*
- Hip surgery/knee surgery patients readmitted to hospital (from the Centers for Medicare & Medicaid Services)*
*CMS Measures and current data collection periods on Hospital Compare
© FAIR Health, Inc. 2017. “U.S. News & World Report” and its logo are registered trademarks of U.S. News & World Report, L.P.
The content on this site is provided for informational purposes only. FAIR Health has not evaluated and does not endorse the websites, quality measures or sources included or linked to on this page, and is not responsible for the outcomes that may result from using these guidelines.
* For certain medical services, this website offers this information for some healthcare providers who perform certain medical services. In some cases, this website will also display the provider´s prices for those services.
** In New York, Maine and Minnesota, e-prescribing is mandatory with certain exceptions.