Patients at five-star rated hospitals had a 72 percent lower risk of dying when compared with patients at one-star-rated hospitals, according to a new independent study by healthcare ratings organization HealthGrades.

Experts say this is an enormous gap that has held steady over the past years even as overall mortality rates have improved.

The "Thirteenth Annual HealthGrades Hospital Quality in America" study analyzed objective mortality and complication rates at all of the nation's 5,000 nonfederal hospitals using 40 million hospitalization records obtained from the Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services.

The study, the largest of its kind, identified national and state-level trends in hospital care quality and established quality ratings for each hospital, across 26 different procedures and diagnoses. The ratings are now online, allowing individuals to compare their local hospitals.

Looking at overall trends, the HealthGrades study found that hospital mortality rates, on average, have declined by 7.98 percent over the three-year period studied, from 2007 to 2009. Of the 17 mortality-based diagnoses and procedures analyzed, only two bucked the overall trend with increasing mortality rates – gastrointestinal surgeries and coronary intervention procedures.

As part of the study, HealthGrades rated individual hospitals with a one-star, three-star or five-star rating in each of 26 procedures and diagnoses, from bypass surgery to total knee replacements. A one-star rating means that the hospital performed below average, to a statistically significant degree, when compared with the other 5,000 hospitals. A three-star rating means the hospital's performance was average, and a five-star rating means the hospital outperformed the national average to a statistically significant degree.

Five-star rated hospitals had significantly lower risk-adjusted mortality across the three years studied. A typical patient would have a 72.47 percent lower risk of dying in a five-star rated hospital compared to a one-star rated hospital, and a 53.36 percent lower risk of dying by going to five-star rated hospital compared to the U.S. hospital average.

"We are encouraged by the steady improvement in mortality rates among America's hospitals, but there's an unacceptably wide gap that has persisted between the top-performing hospitals and all others in terms of patient outcomes," said Rick May, MD, an author of the study and a vice president with HealthGrades. "For hospital leaders as well as potential patients, it is essential that they understand – and act upon – these findings."

Key findings from the study include:

• The nation's hospitals unadjusted mortality improved on average 7.98 percent from 2007 through 2009 across the 17 diagnoses and procedures studied.
• All but two diagnoses and procedures saw reductions in the unadjusted mortality rates. Gastrointestinal surgeries and procedures and coronary interventional procedures were associated with an increase in unadjusted mortality of 8.76 percent and 9.26 percent respectively.
• The highest unadjusted mortality rates are among sepsis, respiratory failure, and gastrointestinal surgeries and procedures (20.59 percent, 19.45 percent, 10.29 percent, respectively).
• The most improvement in unadjusted mortality was seen in chronic obstructive pulmonary disease (18.73 percent), bowel obstruction (14.72percent), heart attack (13.68 percent), and stroke (13.50 percent).
• If all hospitals performed at the level of a five-star rated hospital, 232,442 Medicare lives could potentially have been saved from 2007 through 2009.
• Approximately 55.91 percent (129,949) of the potentially preventable deaths were associated with just four diagnoses: sepsis (48,809); pneumonia (29,017); respiratory failure (26,361); and heart failure (25,762).
• On average, one in nine patients developed a hospital-acquired condition, across the nine procedures evaluated for in-hospital complications, from 2007 to 2009.
• On average, a typical patient would have an 80.40 percent lower risk of developing one or more in-hospital complications by going to a five-star rated hospital compared to a one-star and a 63.64 percent lower risk of developing one or more in-hospital complications by going to a 5-star compared to the U.S. hospital average.

What are today’s patients looking for? How do they choose a physician? What makes them stay with a healthcare provider?

Once upon a time, healthcare was primarily a physician-driven world. However, the sands have shifted, and now, patients, as consumers, increasingly hold the power. More informed and more inclined to take control of their own healthcare, they have become “pro-sumers” – meaning they are proactive before consuming. These “pro-sumers” read, research, talk, surf and even chat online to gather information before making decisions, including those about their healthcare. They do their “homework” first and want to learn all they can about their health concern, the physicians and treatments available to them, and what others in similar situations have done.

So, practicing medicine today means viewing a patient not just as someone who is ill and needs your help, but as a true consumer making a purchasing decision. That decision just happens to be related to the health and well-being of themselves or a loved one. And as the most successful businesses in other industries already know, the customer should always be your number one priority.

From P’s to A’s

Healthcare today is a business – like it or not.  And any basic business marketing book or course will talk about the “four P’s” – product, price, place and promotion. These elements are still the building blocks of any successful enterprise.

However, what patients believe they want, deserve and expect has really become the driving force in healthcare purchasing decisions. Over the years, service has become an increasingly important part of the “product” physicians provide. Healthcare has become a competitive marketplace. You can have stellar credentials and provide the highest level of care available, but if you can’t keep your patients happy, many will simply leave and find someone who will.

As a result, the true key to any physician’s survival and success in 2010 and beyond is what I call the “four A’s:”

• Access
• Availability
• Accountability
• Accommodation

Access

Patients want to be able to easily reach the highest level of care available when they need it, where they need it. And they want the freedom to choose and be involved in decisions about their care. Access is the primary reason behind the explosion in “walk-in” clinics that can be found in familiar community locations throughout the country, including inside pharmacies, grocery stores and big-box retailers. These businesses have capitalized on the simple fact that many patients could not get access to their regular physicians in a time they felt was reasonable. And many of these businesses are booming.  While most patients would prefer to see their personal physician, many are willing to give this up in exchange for access to care.

Availability

Closely related to access, patients want availability. They want convenient appointment times, and they don’t want to wait. They also expect their physicians and other healthcare providers to be approachable and readily communicate with them about their condition and treatment options. They want both phone and face-to-face exchanges to be unhurried and compassionate. To address patient demand for availability, many forward-thinking practices now offer non-traditional appointments times, including early in the morning, at lunchtime, evenings and even Saturdays based on the needs of their specific patient population. And others offer express or fast-track walk-in care during certain times of the day.

Accountability

Patients want accountability.  They are looking for someone who will take responsibility and provide accurate answers and explanations. Typically, patients are already anxious and under stress when they turn to you. Often, they are experiencing a health problem. They have questions and concerns, and are looking to you and your staff for answers and solutions. They don’t want to get passed from one person to another. They expect leadership, assistance and guidance in navigating what can be a complex maze.

One example of how many healthcare providers are addressing this need for accountability is the rise in care coordinators or care teams. This approach provides each patient with a single point person in your office who handles all questions related to their care. And it also helps to put patients at ease because they see the same familiar face and hear the same familiar voice each time they interact with your office. By doing this, you are building relationships and loyalty because you are providing a more personal level of care. This can make even large, multi-physician or multi-specialty practices feel “small.”

Accommodation

Finally, today’s patients expect that you will accommodate them.  They want convenience and genuine concern for their well-being – someone who understands their unique, individual challenges and makes it easy to get the care they need. They don’t want cookie-cutter care.  They want customization and personalization. They want to feel engaged and personally recognized during the time they are connected with your practice.

So how can you incorporate the “four A’s” into your practice? Spend some time walking in your patient’s footsteps. Really listen to their needs and learn from their situations. What do they need? What do they want? What do they like and dislike about your practice? Then, examine your current systems, identify potential opportunities and be sure to engage your staff in developing creative solutions to providing exceptional service.

Though EMR costs can vary greatly (BAC Medical Marketing/Mitochon Systems is offering a free EMR system), most practitioners believe that reputable EMR systems will pay for themselves over time and lead to increased revenues. Still, many physicians worry about the time it will take to recoup their initial investments. Here are some things to look for when considering an EMR system for your practice:

EMRs can improve your office’s efficiency

EMRs make charting faster and easier. A comprehensive EMR system’s functionality should include appointment setting, billing links, coding tools, chart evaluation, email and messaging, patient tracking, reporting, template management and more, all in one fully integrated system. Even though an EMR investment can be costly, over time this investment will result in greater savings for both clinicians and health insurance companies. Remember that EMRs also saves physical space. Instead of big, thick paper files cluttering the walls and shelves of your office, all patient data is easily accessible by computer.

EMRs can increase your profits

EMRs should eliminate the high costs of medical transcription fees, saving you thousands of dollars. Good EMR software should improve your office productivity through easier access to patient information and improved workflow. EMRs should enable you to support your billing and claims processing with complete, accurate documentation. A more efficient office enables you to see more patients, thanks to easy access to patients’ medical history and easier charting.

EMRs should deliver a real return on your investment

With the right combination of powerful and easy-to-use features, a good EMR system will make your practice more efficient at an affordable price. Under these conditions, most practices can see a positive return on their investment within months after their initial implementation.

EMRs should be supportive, easy to use and flexible

The right EMR system should support today’s latest technologies. These include wireless networking, voice and handwriting recognition, remote access and running on commonly available computer platforms such as Windows®, Mac®, Linux® and other networks. The right EMR system should also mesh well with other EMR systems to facilitate the fast, accurate exchange of information between practices, hospitals, imaging centers and labs.

With the right computer system and EMR software, you can make your practice more efficient and see a continuous return on your investment.