How often have I said: “There is no Consumer Reports guide to healthcare—and with good reason”? Often I add that “rating refrigerators is a lot easier than measuring the quality of care provided by a hospital or doctor.”

Guess what?

Consumer Reports has just launched a new online “compare your hospital” tool  (Thanks to Gary Schwitzer, who reported this on Schwitzer Health News Blog over the week-end.)

And where did Consumer Reports get their information?  They’ve taken it from the Dartmouth research on treatment, overtreatment and outcomes that I cite so frequently.

I have always liked Consumer Reports–ever since I was a young bride buying my first air-conditioner. It didn’t let me down then, and, I’m glad to say, it hasn’t let me down now.

Consumer Reports’ health website
doesn’t claim that this is the “report card” that can give you the
skinny on the hospitals where you will receive the “best care.”
Instead, it cautions readers:  “This tool gives you one way to compare
hospitals, but it’s not designed as a quality indicator.”

If you’re looking for charts that rank quality, it sends you to the Federal government’s “Healthcare Compare” website
where you will find some helpful information. But since research that
looks at the quality of health care is still quite new, the indicators
are fairly thin. They measure what can be measured, leaving out many of
the most important and more subtle measures of good care.

Today these indicators may tell us whether the patient received
antibiotics after the operation. But ultimately, we need to ask “Did he
need the operation in the first place?” And if the patient died, one
would like to know whether he was in pain. Did he receive palliative
care?

But while Consumer Reports doesn’t claim that it has
developed the ultimate “quality report card” that we’ve all been
waiting for, it makes very clear that the Dartmouth research on
individual hospitals offers priceless information:

“Most Americans die in old age of serious chronic conditions that
worsen over months or years, such as diabetes, heart failure, dementia,
or many types of cancer,” the report on hospitals explains. “With
careful medical management, patients with these diseases can spend most
of these months or years outside the hospital, with their symptoms
under control.”

Conservative vs. aggressive care

“The data you’ll see here, from The Dartmouth Atlas of Health Care,
shows that not every hospital practices conservative care,” the Report
continues. “Many patients with these long-term serious illnesses are
repeatedly hospitalized and seen by many different physicians. The
Dartmouth research has shown that aggressive care does not necessarily
improve patient outcomes and can sometimes shorten life. That’s because
it exposes people to a greater risk of hospital-acquired infections and
the medical errors that can occur when too many doctors test and treat
patients in an uncoordinated way.”

Consumer Reports stresses that “It’s important to understand
that the distinction between aggressive and conservative care does not
apply to medical emergencies such as a heart attack, stroke, broken
hip, or inflamed appendix. All hospitals everywhere address these
conditions immediately and with the full arsenal of treatments at their
command.”

The Report then offers a very helpful table:

10 Overused Tests and Treatments

Here, Consumer Reports lists what it calls “medical rip-offs.”
This doesn’t mean that no one should undergo these tests or treatments.
But often, they are over-used, and in some cases there is little or no
evidence that they are more effective than less invasive, less
expensive strategies.

1
BACK SURGERY. Don’t rush to surgery for a simple slipped disk. In 90
percent of cases, the pain goes away on its own within six weeks. In
stubborn cases, surgery, which can cost $20,000 plus physician’s fees,
can relieve pain somewhat faster than physical therapy and medication,
a recent study showed. But it also found that both groups of patients
wound up with similar improvements after two years.

2
HEARTBURN SURGERY. Doctors surgically tighten a sphincter muscle that
blocks stomach acid from backing up into the esophagus. But research
shows the operation, which costs $14,600 or more, provides no better
long-term relief than taking a proton-pump-inhibitor drug such as
omeprazole (Prilosec OTC), which costs less than $1 a day.

3
PROSTATE TREATMENTS. Prostate cancer is often overtreated by surgery
that costs $17,000, or by radiation therapy for $20,700 or more, plus
physician’s fees, without adequate discussion of the alternatives or
the high risk of distressing side effects such as incontinence or
impotence. Because prostate cancer can grow slowly, sometimes the best
approach is “watchful waiting.”

4
IMPLANTED DEFIBRILLATORS. These devices, which automatically shock the
heart back to normal rhythm, cost some $90,000 over a lifetime. Yet
one-third of people who get them might not really need them, according
to research reported in 2007. This year Medicare will pay for an
estimated 50,000 of the devices.

5
CORONARY STENTS. Billions are spent each year inserting tiny mesh tubes
to prop open coronary arteries. The procedure plus heart drugs turns
out not to work any better to prevent future heart attacks than heart
drugs alone for patients with stable coronary artery disease,
researchers reported in 2007.

6
CESAREAN SECTIONS. They cost almost $7,000, about 55 percent more than
a natural delivery, and constituted a record high of 30.2 percent of
births in 2005. Most are performed because labor is progressing too
slowly. But several less-invasive approaches might be enough to speed
up labor.

7
WHOLE-BODY SCREENS. These CT scans, which can cost $1,000 or more, are
promoted for spotting early signs of cancer, heart disease, and other
abnormalities. There are no proven benefits for healthy people, the
Food and Drug Administration has concluded. Plus CT scans expose
patients to far more radiation than X-rays. A few CT scans a year can
increase your lifetime risk of cancer.

8
HIGH-TECH ANGIOGRAPHY. Using a CT scan to noninvasively check coronary
arteries for narrowing costs an average of $450, according to data from
HealthMarkets, which sells health and life insurance through
subsidiaries in 44 states. But standard angiography is sometimes still
needed to confirm blockages that might require aggressive treatment.

9
HIGH-TECH MAMMOGRAPHY. Using software to flag suspicious breast X-rays
would add $550 million a year to national costs if used for all
mammograms. But a 2007 study found that this technique failed to
improve the cancer-detection rate significantly, yet resulted in more
needless biopsies.

10
VIRTUAL COLONOSCOPY. These CT scans are being used to detect signs of
cancer without inserting a tube into the colon. But a study of virtual
colonoscopy reported in 2007 concluded that standard colonoscopy is
better at spotting smaller suspicious polyps. Though less costly than a
standard colonoscopy, the virtual test isn’t cost-effective because any
suspicious finding requires retesting with the real thing.

Comparative-Effectiveness Research

We need unbiased head-to-head research comparing new drugs, devices and procedures to existing treatments.  As the Report points out: “Many developed
nations have some kind of national agency that objectively evaluates
new treatments and technology and determines coverage policy, such as
Britain’s National Institute for Health and Clinical Excellence. Though
insurers and medical specialty societies, among others, do such
evaluations in the U.S., payment and coverage decisions here are driven
mainly by pressure from manufacturers, doctors, and consumers,
according to a study published in the November/December 2004 issue of Health Affairs. No one wants to be ‘the one on the block who doesn’t know the new technique,’ a physician told the researchers.

“Some health-policy experts are advocating the creation of a national
center devoted to research directly comparing different medical
treatments, an idea that Consumers Union, the nonprofit publisher of Consumer Reports, strongly supports.”

If you are concerned about being over-treated and want more
conservative care, it’s important to know where you will find it. Check
out the Consumer Reports website by clicking here.
Then, at the beginning of the second paragraph, click on The Dartmouth
Atlas of Health Care (highlighted in blue.)  On the left-hand side of
the first page, you’ll find “Data Access Tools.” Scroll down, and click
on “Help.” Follow the instructions and you’ll be able to compare
hospitals in your region.