Healthcare Quality: 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 a highly recommended plumber, or go to the restaurant with the best reviews. But healthcare is complicated, and the results aren’t always certain. Still, there is some information you can look to before you choose a healthcare provider.

Quality measures are created by the government, nonprofit groups and for-profit firms. They look at the treatment patients get and the results of that care.

Choosing a Provider
Choose a healthcare provider who has the qualities most important to you. For instance, you might want a provider who speaks your language. You may want one who is located close to your home or workplace. You can also look for a provider with special training in treating your condition.

Some providers cost more than others. Providers may charge more because they’ve been practicing for a long time or have special training. Going to a provider who doesn’t take your insurance may also cost you more. Only you can decide if seeing the provider is worth the extra cost.

To compare providers, you can look at:

  • Provider practice information;
  • Quality measures; and
  • Websites that let you search for providers.

Provider Practice Information
Provider credentials. These tell you about a provider’s medical education and specialty training as well as graduation date. Different healthcare professionals earn different types of degrees and licenses.

Provider’s primary specialty. After they get their medical degree, doctors may get more training in a special type of medicine. For instance, doctors who complete extra training in heart conditions are cardiologists.

Provider’s secondary specialty. You may want to look into the provider’s secondary specialty if you or your family have special medical needs. For example, your family might have a history of diabetes. In that case, you might look for a doctor who specializes in both family medicine and endocrinology.

Hospital affiliations. This is the hospital or hospitals where the doctor can provide care. If you might need hospital care, make sure the doctor is affiliated with a hospital that you like or that’s in your plan’s network.

Quality Measures
The Centers for Medicare & Medicaid Services (CMS) collect quality measure information from providers. These will tell you if the provider:

  • Uses electronic health records (EHRs). EHRs are online records of patients’ medical histories. They make it easier to share your medical information with other providers. EHRs also make it easier for you to gain access to your records.

  • Is part of the e-Prescribing (eRx) Program. With eRx, your provider can send your prescription to your pharmacy over the internet.

  • Is part of the Physician Quality Reporting System (PQRS). Only providers who accept Medicare are part of PQRS. Providers in this program agree to report quality measures more often than other providers.

  • Is part of the Million Hearts® Program. Providers in this program help their patients avoid heart attacks and strokes. They do this by motivating their patients to take medications and have a healthy lifestyle.

Websites with Quality Information
Many websites have quality measures for providers and hospitals.

U.S. News & World Report.1 You can use this site to search for a doctor or hospital by specialty, geographic location or name. Information includes:

  • Years in practice;
  • Board certifications;
  • Hospital affiliations;
  • Insurance plans accepted;
  • Specialties;
  • Education and medical training;
  • Certifications and licensure; and
  • Awards, honors and recognitions.

New York State Physician Profile. Here you can search for a doctor licensed in New York State by name. You can get information about education, board certifications, practice information and legal actions.

National Committee for Quality Assurance (NCQA). Use this website to search for healthcare providers and health plans that have been highly rated by NCQA.

For more information, see the FH® Healthcare Quality Toolkit.

1. “U.S. News & World Report” and its logo are registered trademarks of U.S. News & World Report, L.P.