Getting the Right Care at the Right Price
How do you know if you’re getting good-quality healthcare? There is no easy answer. With other types of services, you can simply look for the cheapest plumber, or the restaurant with the best reviews. Healthcare is not as simple, but some types of information can still help when you choose a healthcare provider.
Quality measures offer many types of information about healthcare providers. These measures were created by government, nonprofits and for-profit companies to show which healthcare providers give the best care. What are quality measures based on? They may be based on the experiences of other patients, clinical results and whether the provider follows a usual standard of care.
Choose a healthcare provider based on what you value most. 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. You also might need to visit a doctor who has special training in treating your health issue.
The provider who is best for you may be more or less costly than others. Only you can decide if the extra cost is okay to you. Some providers charge more because they have been practicing for a long time. Or, they may have special training or certifications. Going to a provider who does not take your insurance plan may also cost you more.
The choice is yours. Just make sure it is an informed choice.
FH® Healthcare Quality Toolkit
What should you keep in mind when choosing a healthcare provider, like a doctor or hospital? Use this toolkit to learn about the types of information you can use to compare the quality of doctors and hospitals. For example, you may want to know about:
- Provider practice (location), education, training and hospital affiliations;
- Some measures used to describe quality, such as e-prescribing;
- Websites that allow you to search for providers based on specific quality measures; and
- Questions to ask healthcare providers to help keep you in the know and healthy.
As you read the information below, take notes so you can compare your choices later. Download and keep this toolkit to look at later.
Practice and Contact Information
This is basic facts about a provider or facility, such as:
- Name of healthcare provider;
- Practice address;
- Phone number/fax number; and
- Provider’s credentials.
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.
How can this be helpful? If you know you’ll need a prescription drug, you may need 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 if the healthcare provider has the experience and training needed in a specific type of care. For example, physicians who finish extra training in heart conditions specialize in cardiology.
Provider’s Secondary Specialty
This tells you if a healthcare provider (most often a physician) has training in more than one type of care. This information may be helpful in some cases. If you’re looking for a primary care physician for your family, but you know you have a family history of diabetes, you might look for a physician who has training in both family medicine and endocrinology.
The Centers for Medicare & Medicaid Services (CMS) collect information from healthcare providers about “quality” metrics. Some metrics include whether a provider has electronic health records or takes part in a program that asks him or her to report on quality measures. Below are some CMS quality metrics that you may want to keep in mind when choosing a healthcare provider. Our FH® Medical Cost Lookup lists some of these metrics for some providers in New York State.
Participates in Electronic Health Records
This tells you whether a healthcare provider uses online records to keep track of your medical history. Providers can share these electronic health records, or EHRs, with other providers. This makes it easy for everyone involved in your care to have the information needed to give you the right care. EHRs also make it easy to access your own medical records.
Participates in E-prescribing*,**
This tells you whether your provider can send your prescription to the pharmacy over the web. Electronic prescribing (eRx) can help make sure you get the right medicine. It also makes it easier to fill your prescription. Learn more about .
Participates in Million Hearts® Program
This tells you whether a provider is part of the Million Hearts® program. Providers in this program have to meet certain goals to stop heart attacks and strokes. This may involve helping their patients take medicines as prescribed or keep track of their cholesterol levels. Or, they may help patients quit smoking and other habits that affect their health. Learn more about the Million Hearts® Initiative.
You also can use the Care Compare website to find and compare doctors, hospitals, nursing homes and other types of facilities where you live.
Other Sources of Quality Information
Many websites offer quality measures for doctors, hospitals and other healthcare providers. These websites may measure patient safety and the types of care offered. They also may measure how providers speak with their patients, or wait times. Some of these websites are listed below. FAIR Health is not linked with and doesn’t endorse these websites, their methods or results.
U.S. News & World
You can use this tool to search for a physician or hospital by specialty, where they are or their name. Information about physicians 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; and
- Publications and Presentations.
Information about hospitals (including children’s hospitals) on the website includes ranking, recognition and performance linked to types of procedures. Hospital rankings are based on data for 15 specialties.
You also can search for health plans based on whether your physician is part of the health plan’s network.Go to U.S. News & World Report “U.S. News & World Report” and its logo are registered trademarks of U.S. News & World Report, L.P.
The National Committee for Quality Assurance (NCQA)
is a nonprofit that accredits healthcare providers, organizations and health plans. Use the website to search for healthcare providers who meet NCQA’s quality standards such as patient care planning, and treating patients with diabetes, heart disease or those who have had a stroke.
Sources of Quality Information for New York State
New York State Physician Profile
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
You can find and compare quality, safety and inspections information about all hospitals in New York State. This information looks at:
- Patient satisfaction and emergency department timeliness;
- Number of procedures and surgeries performed;
- Childbirth practices;
- Care complications;
- Use of recommended practices;
- Hospital-acquired infection rates;
- Death rates and readmissions; and
- Inspection and complaint results.
Questions to Ask a Healthcare Provider
Use this list of questions when choosing a healthcare provider. In many cases, it may be best to speak with the provider´s billing staff.
Take notes of your conversation, the name of the person to whom you spoke and the date.
- Are you in network for my health plan?
If my plan does not cover a service:
- Do you offer payment plans, discounts or financial support or negotiate prices?
- Can I get financial support?
- Can I reach you by email, web portal, phone and/or text?
Do you take part in any of these programs?
- Electronic health records;
- Electronic prescribing;
- Provider Quality Reporting System (PQRS); and
- Million Hearts® Initiative.
- Are you affiliated with any hospitals near where I live? If I need hospital care, which hospital should I use?
- Do you or someone from your staff speak [your language of choice]?
- Does your office offer support for people with disabilities?
- Can you treat my condition or illness? If not, can you suggest someone who does?
Getting recommended tests and screenings can help you stay healthy. But how do you know if you’re 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. Learn more about these services by reading our article Preventive Care and Wellness Services: Coverage and Costs.
Most health plans must cover these preventive services for free if you get 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 offers questions and resources from many 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 does on certain quality measures. For example, you may want to know how many patients get sick in the hospital. Or, how quickly a hospital gives care in an emergency.
Below are the quality measures featured on our site. There also are links that talk more about them. Learn more about these quality metrics by going to 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 describes how these data are collected and measured here. Our website offers information about quality metrics for some hospitals in Albany, Buffalo, Syracuse and Westchester.
This tells you the number of complications that patients had after surgery (per 1,000 patients), compared with the common number of complications. Complications are new problems that result from a sickness or treatment. A hospital that gives proper care will have a lower number. That means there were fewer complications.
This website shows information on hospital central venous catheter-related bloodstream infections, which are common complications in surgery. A central venous catheter is an intravenous tube often used to give medicine, fluids and nutrients to patients over a long period of time. It is also called a “central line.”
Emergency Room Timeliness
This is the normal time that patients spend waiting in the ER (or ED, emergency department) before they are taken into the hospital. It gives you a sense of how quickly a hospital can give care in an emergency. A hospital that does well will have shorter wait times.Measures include:
- Median time from ED arrival to ED departure for discharged patients - Some patients are seen and/or treated in the ED. A doctor then decides to discharge them, most often to their homes. This measures 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 taken to some other part of the hospital for inpatient treatment. This measures the median time 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 taken into 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 vital information. A hospital that does well will have fewer infections.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 hospital that does well will have fewer readmissions. Hospitals with a lot of readmissions might not be giving patients the care they need. Or, they 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 patients who are less able to care for themselves at home for other reasons.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).*
Copyright 2022, FAIR Health, Inc. All rights reserved.
The content on this site is provided for informational purposes only. FAIR Health has not evaluated and doesn’t endorse the websites, quality measures or sources included or linked to on this page, and isn’t responsible for the outcomes that may result from using these guidelines.
*This website offers this information for some healthcare providers who offer certain medical services. In some cases, this website will also display the provider´s prices for those services.
** E-prescribing is mandatory in many states, with certain exceptions.