Choosing the right hospital for you can be a complex decision. There are many factors to consider, everything from financials to your own comfort level.
Health New England leaders, Dr. Vishal Tiwari and Dr. Ira Klein, weigh in on some important aspects to consider.
Talking to your Primary Care Doctor
Dr. Vishal Tiwari, Interim Senior Director Medical Management at Health New England, recommends discussing your needs with your primary care doctor.
“There can be more than one hospital in network providing similar services, but referral from a primary care doctor or specialist with whom you have been following in network can direct you to the right care,” he says.
They’ll likely have a recommendation for you based on your specific health history and condition.
In their Guide to Choosing a Hospital (pdf), the Department of Health and Human Services (HHS) suggests asking your doctor these questions:
- Which hospitals do they work with? – Some doctors have special privileges or have more experience at certain hospitals.
- Which hospital can best care for your condition? – Some hospitals specialize in certain surgeries or treatments. There are others who are especially organized at providing a coordinated care plan.
- Should you consider a specific hospital type? – Your doctor may think it best you go to a specialty hospital, a community hospital, a hospital that has clinical trials, etc.
- Who would be responsible for your care while you’re in the hospital? – You’ll want to find out whether your doctor will be in contact with someone throughout your stay.
- Will you need special care after leaving the hospital? – Some health systems may have a more coordinated approach to your after care.
- Do you actually need to go to the hospital? – Your doctor may find you don’t need to be hospitalized. Your doctor can help you decide whether to go to the emergency room or an urgent care location.
Dr. Tiwari says if you have questions, you can always call the number for member services located on the back of your insurance card.
You’ll also want to research whether your visit to the hospital would be covered under your health insurance.
Dr. Ira Klein, Health New England’s Chief Medical Officer, says a particular health insurance plan often has a formal relationship with a hospital and health system.
“This usually allows for more coordination in planned admissions and added effort in assuring a complete plan at time of discharge. Your doctor will almost always know about these relationships, so be sure to ask,” he says.
Dr. Tiwari says you should look at your insurance card for help checking your coverage.
“If it states HMO plan on your card, it means there is a restricted hospital network in plan that you can get care at the lowest cost but still high quality. If you go out of network, you will incur high out of pocket costs,” he says.
Call your insurance provider to understand your plan and avoid surprises when the bill comes.
Consumer Reports advises getting the information in writing – or at least taking notes and writing down the date, name, and contact number of the person you spoke with. This may help if there are payments disputes later.
You can also request an estimate of your fees from your healthcare provider before you receive care.
The HHS suggests looking into the following questions:
Do you need a referral or preauthorization? – Your plan may require this before you’re admitted into a hospital.
- Do you need to be in network? – In non-emergency situations, you may need to use certain hospitals, specialists, or surgeons. In some cases, you may have to pay more if you receive care out of network (deductibles and coinsurance).
- Are there certain requirements for getting care after your hospital stay? – What will be covered after you leave the hospital?
Consumer Reports notes that even if a hospital is in the network, doctors who practice there may not be.
The HHS suggests researching hospitals for yourself as well. There are many ways to measure the quality of a hospital.
Use 'Care Compare'
Medicare provides a tool, Care Compare (formerly Hospital Compare), which allows you to search through data for individual hospitals, providers, and nursing homes.
Look at patient survey results to see how previous patients felt about their hospital experience (you can also see Baystate patient reviews on Find a Provider)
- Compare measures of quality that show how well these hospitals treat patients with certain conditions
Word of Mouth
Ask your family and friends if they’re willing to share their own hospital experiences. They may have point out things like advanced care methods or how kind their nurse was to them.
Awards and Recognitions
Although awards aren’t the "end all, be all" measure of quality, they offer a window into the care a hospital is known for.
There are many different types of awards, such as:
Awards based on care for certain conditions (ex. Stroke, joint replacement surgery, care for newborns)
- Awards based on how employees are treated
- Awards based on high nursing standards
Hospitals are also inspected by the Joint Commission, which makes sure hospitals abide by rigorous standards.
Your comfort level
You should also consider whether you’d be comfortable at a certain hospital.
Location: Is the hospital located close to family or friends? (See Baystate's hospital list to find out what is closest to you)
- Visiting hours: Make sure you know a hospital’s visitor policy before a non-emergency visit. Knowing what to expect ahead of time will cut down on stress when your friends or family try to come see you.
- What policies and practices are in place for safety and infection control during a pandemic?
The important thing to remember is you can always call your doctor or your insurance company with questions.
“Health insurance coverage can be complicated,” Dr. Tiwari says. “Many out there do not understand their coverage plan.”
You don’t have to make this decision on your own.
Learn more about resources for patients and visitors and quality and safety ratings at Baystate Health.