HOSPITAL GUIDE
Provided by Virginia Health Information.    Website: www.VHI.org

INTRODUCTION


virginia hospitals consumer guideVIRGINIA HOSPITALS: A CONSUMER'S GUIDE is intended to provide consumers and employers with up-to-date information on today's hospitals. The guide includes:

  • a brief history of hospitals along with a close look at Virginia's hospital and health system and how it serves you
  • how hospitals have changed to become more community and patient centered
  • the types of hospitals you will find in Virginia's cities and rural areas
  • a profile of the hospitals' services
  • a checklist of a patient's rights and responsibilities and
  • glossary to help you understand hospital and medical terms
A special four-step section provides work sheets and checklists to help you in your search for the hospital that's right for you.

The regional HOSPITAL SPECIALTY SERVICE TABLES and the statewide PSYCHIATRIC HOSPITAL DIAGNOSTIC TABLES are presented on our website.

  • to provide you with a directory of Virginia's acute care general hospitals, teaching hospitals and psychiatric hospitals
  • to provide information on the primary medical specialty services offered by each of Virginia's hospitals and
  • to provide important experience and cost data in each of the specialty areas listed
These tables do not list specific technical procedures. You may want to inquire about procedures specific to your medical needs if you interview a hospital. The information in the HOSPITAL SPECIALTY SERVICE TABLES and the PSYCHIATRIC HOSPITAL DIAGNOSTIC TABLES is based on data in VIRGINIA HEALTH INFORMATION's patient level database collected under contract to the Commonwealth of Virginia. It is being made available

  • to help consumers and employers choose health care providers and services
  • to enhance the quality of care you receive and
  • to increase the overall serviceability of hospitals to Virginians


THE BEGINNING OF HOSPITALS


Hospitals as healing centers have been part of society since before the first millennium--almost as far back as civilized history takes us! There was even a chain of hospitals (a group of hospitals owned and operated by the same organization) as early as 230 BC. Some of the earliest hospitals existed in ancient Rome in 100 BC as important centers for the emergency care of sick and wounded soldiers. With the spread of Christianity, hospitals grew as part of the church's mission and became part of the community as they tended to health care not only for soldiers but also for all who needed it. During the Middle Ages, European communities began to take responsibility for their citizens' health care by creating voluntary hospitals.

Hospitals in America - In 1524, Cortés, built the first hospital in North America. It is called the Hospital de Jesus Nazareno and it still stands in Mexico City (see map.) The first hospital in the United States was a center created in 1663 to treat injured soldiers in New York. The first incorporated hospital, Pennsylvania Hospital, was established in 1751. It is from these early church-and community-sponsored hospitals that today's hospitals have evolved.

Hospitals In Virginia - A guest house for the ill was established in 1611 at Henricus, a major English settlement near Richmond. Virginia is also home to the oldest medical college building in the South and to the 4th largest university-affiliated teaching hospital in the United States, VCU Medical Center.


TODAY'S HOSPITALS


Much like people, hospitals have a business self and a personal self. The business self of hospitals is their corporate structure; their personal self is reflected through the care they provide to patients - their medical-service structure. In a hospital, the corporate business self keeps things productive and humming smoothly from corporate financial performance to sheets and towels. The personal self, the personality of the hospital that you see as a patient, evolves from the hospital's mission - the commitment to the medical responsibility it has undertaken - and from the attitudes of its employees, administration and medical staff.

As you research your hospital options, the overall personality of the hospital - its corporate self and its personal self - combined with your personal medical and health needs will determine your choice. Knowing something about how a hospital is structured may help you make a more comfortable decision.

CORPORATE PROFILE


Hospitals, like all other businesses, depend on income to stay productive. Hospitals may receive their income from:
  • patients themselves along with the funds paid by insurance carriers for the patients who use the hospital including the government programs Medicare and Medicaid
  • special funding from religious or other organizations or from persons who provide private monetary donations usually made through charitable trusts
  • the fund-raising efforts of volunteers and other auxiliary staff and
  • from various federal, state and community sources in the form of grants and general funding
Most hospitals have an administrative body that reports to a board. The head of independent hospitals, the CEO (chief executive officer), may also be called an administrator or president. If the hospital is owned by a corporation, there may also be a CEO of the corporation. Hospitals, like other businesses, have traditional departments responsible for operating the business side of things - building maintenance, finance and supplies for example. Hospitals can operate as either for profit (proprietary) or as nonprofit (not-for-profit) corporations.

Proprietary Hospitals - Around 25% of Virginia hospitals are owned by corporations that have investors called shareholders. Shareholders invest in the corporation and expect a return on their investment. Some of the profits of these hospitals are distributed to shareholders as dividends. Corporately-owned proprietary hospitals pay federal and state corporate income tax.

Not-for-Profit Hospitals - Most Virginia hospitals are owned by the public at large or by special groups through religious affiliations or by other private or community organizations. These hospitals do not share their profits with shareholders but rather use their profits to further the mission of the organization. Nonprofit hospitals do not pay a corporate income tax to the federal government.

Another form of nonprofit hospital, the public hospital, is operated by a public entity — for example, the federal government, a military hospital or national research center. State and local governments also operate hospitals designed to serve a specific community area or a statewide area. Many state-operated hospitals provide highly specialized acute care, have medical research departments and provide certified medical training to physicians and other medical professionals.

A MEDICAL PROFILE


In addition to their corporate profiles, hospitals have a medical profile. This profile describes the kinds of medical care the hospital is licensed and equipped to provide.

Acute Care General Hospitals are equipped and staffed to provide short- term, inpatient medical and surgical services for many different conditions and illnesses and provide continuous nursing services. When staffed, equipped and licensed to handle acute episodes of various illnesses and conditions, accidents or other traumas, which may or may not involve intensive care, these facilities are also classified as acute care hospitals. Therefore, hospitals that are licensed to provide various acute levels of care are known as acute care general hospitals.

Today's acute care general hospitals are open 24 hours a day, 365 days a year to provide around-the-clock emergency care, day-to-day medically necessary services and, in many cases, wellness services and other specialty services such as transplant surgery and research-based studies.

Community and Regional Hospitals - With a staff and physical facility appropriate to the patient population it serves, today's acute care general hospitals have become ready and able community-oriented medical facilities. With this newer community focus, most acute care general hospitals are being referred to as community or regional hospitals.

Over 90 percent of community hospitals have emergency facilities and are licensed as acute care hospitals. Some of these acute care general hospitals include the word 'community' in their name. A community-based acute care general hospital may be an urban (city) facility, a rural facility or may be designed and staffed to serve both urban and rural populations, thereby becoming a regional hospital. A community or regional hospital can be large - as many as 500 licensed or staffed beds (that is, they can treat 500 patients at one time) - or it can be small, having as few as 10 licensed or staffed beds. Many community hospitals today may offer highly specialized services such as organ transplants. Community hospitals may be privately or publicly owned and may operate as proprietary or as nonprofit corporations.

Critical Access Hospitals (CAH) The Critical Access Hospital (CAH) program is a federal program to help rural communities keep their health care facilities. The program was established through legislation enacted as part of the Balanced Budget Act (BBA) of 1997 through the State Medicare Rural Hospital Flexibility Program (Flex). The advantages of this program are to “offer adequate health care services that meet the needs of the community citizens (such as radiology, laboratory services, outpatient rehab and surgery; and assist in ensuring financial viability of small rural hospitals through enhanced reimbursements.”

The Critical Access Hospital program allows smaller rural hospitals to maintain quality access to primary and emergency health care services. Critical Access hospitals provide 24-hour emergency care services; but have no more than 25 inpatient beds and the length of patients’ hospitals stays averages no more than 96 hours. If a patient needs more care, they may be transferred to another hospital. Virginia currently has seven (7) designated CAH facilities:
  • Bath County Community Hospital in Hot Springs
  • Carilion Giles Memorial Hospital in Pearisburg
  • Dickenson Community Hospital in Clintwood
  • R.J. Reynolds-Patrick County Memorial Hospital in Stuart
  • Page Memorial Hospital in Luray
  • Shenandoah Memorial Hospital in Woodstock
  • Carilion Stonewall Jackson Hospital in Lexington

Specialty Acute Care Hospitals - Another type of acute care hospital, a specialty acute care hospital, offers highly specialized care for a particular group of patients, such as children, long-term acute, psychiatric or rehabilitation hospital.

Teaching Hospitals - An acute care general hospital may also be accredited to teach and be classified as a teaching hospital. Teaching hospitals provide medical education facilities and training to future health care professionals. Most teaching hospitals also serve as community or regional hospitals. A teaching and/or research hospital usually has many specialty units and is able to handle state medical disasters. Virginia has both formal and informal teaching hospitals.

Formal teaching facilities are usually those that are affiliated with an accredited undergraduate medical school or university and are structured and staffed to provide both an undergraduate and postgraduate accredited medical curriculum. Postgraduate accreditation of courses is through the Accreditation Council for Graduate Medical Education (ACGME.)

Other teaching hospitals may have a less formal teaching structure because they are not directly affiliated with an undergraduate medical school or university. However, through an affiliation with an accredited medical school, these less formal teaching facilities can offer valuable clinical experience to medical interns, residents, nursing students, and other health care professionals.

Typically all teaching facilities - like almost all other acute care hospitals - are accredited by the Joint Commission on Accreditation for Health Care Organizations (JCAHO.) Many teaching hospitals are also active in the Council of Teaching Hospitals and Health Systems (COTH) of the Association of American Medical Colleges.

Research Hospitals - Through special research departments, teaching hospitals may also perform a vital research function. A research hospital studies ways to reduce disease and medical disability and improve medical conditions. A hospital can be both a teaching hospital and a research hospital.

HOSPITAL SERVICES


Today, through specialized departments and equipment manned by trained staff, acute care hospitals deliver not only acute inpatient care services but also fulfill a rapidly growing area of health care service - outpatient care.

Inpatient Care - When medical services are performed for a patient who has been admitted for a minimum of 24 hours, it is generally considered inpatient care. Primarily, inpatient services cover any general acute care medical need including:
  • the diagnosis and treatment of illnesses, injuries and some chronic conditions or diseases
  • surgical procedures that require post-surgery, medically supervised care of at least 24 hours;
  • the management of childbirth and
  • housing during these treatments and procedures
When an emergency dictates and when, in the physician's opinion, a minimum of 24 hours of medical care is warranted, inpatient care can be authorized by an admitting physician or by an on-call physician who is affiliated with the hospital.

Outpatient Care - Due to dramatic advances in medicine, many medical and surgical procedures that used to require inpatient care can now be performed on an outpatient basis. Outpatient services generally include medically necessary treatments or procedures that do not require overnight, medically supervised care. Hence, outpatient care allows patients to return home while recovering. Services that help us stay healthy have also added to the growing outpatient service need.

Some of the outpatient services provided by most acute care general hospitals usually include:
  • surgical department services and facilities
  • emergency room facilities and services
  • diagnostic services such as x-ray, ultrasound and laboratory services
  • some respiratory services and
  • wellness services
Many acute care community hospitals also offer a wide variety of outpatient rehabilitative services such as occupational, cardiac, radiation, substance abuse and recreational or sports medicine therapies.

THE HEALTH CARE DELIVERY SYSTEM IN VIRGINIA
LEVELS OF CARE

Health Care Delivery System in VirginiaToday's modern acute care general hospitals deliver health and medical services through networks of physicians, hospitals, public and private clinics, public health professionals and health insurance companies. Care can be obtained within this system for a wide variety of medical needs. The kind or extent of the treatment or procedure a patient receives - coupled with who is responsible for the care - is what medical professionals refer to as a level of care.

The Medical Referral - A medical referral is a form of recommendation that takes place in medical services. A medical referral recommends appropriate care and refers patients to the level of care needed to fulfill the recommendation.

NOTE: The type of medical referrals discussed here are not to be confused with the physician referral programs offered to consumers through local hospitals and other consumer referral services discussed in the Finding a Physician Section.

THE HEALTH CARE DELIVERY SYSTEM IN VIRGINIA
MEDICAL LEVELS OF CARE AND MEDICAL REFERRALS

This diagram shows in a non-technical way how each level of care can move the patient to the next level of care.

LEVEL ONE: PRIMARY CARE Most of us have become familiar with the term primary care physician. The primary or first level of care - for example, those health and medical needs treated by your family physician in an office - usually only requires your personal or family physician. Primary Care Physician, Family Physician or Public Health Clinic
LEVEL TWO: SPECIALTY PHYSICIAN CARE Sometimes a primary care physician will seek the opinion of a specialist concerning treatment. Your primary care physician may refer you to a medical specialist in the medical field that is needed. Specialist Physician
LEVEL THREE: HOSPITAL CARE The medical opinions of the specialist and the primary care physician can form the basis for a referral to a third level of care - outpatient hospital services or an ambulatory (outpatient) surgical center. Should 24-hour care be needed, you could be referred for inpatient care. Acute Care General Hospital or Ambulatory Surgical Center
LEVEL FOUR: SPECIALTY HOSPITAL CARE Sometimes special equipment or highly specialized physicians are needed to return a patient to health. The fourth level of care may require a specialty acute care hospital. It may be a teaching or research hospital or other specialty unit or facility. Specialty Acute Care Hospital


VIRGINIA'S HOSPITALS

Virginia currently licenses over 70* acute care general hospitals. They are located to serve Virginia's communities in major metropolitan areas, in the suburbs and in midsize and small towns across the state. Virginia's acute care general hospitals vary in mission, in their corporate profiles, as well as in their size. For example, some acute care general hospitals in Virginia have as few as 25 licensed beds and others - large regional facilities - can accommodate upwards to 1,000 patients if necessary. Some are nonprofit and some are proprietary.

*Based on data available at time of publication of this guide.

OUR REGIONAL AND COMMUNITY HOSPITALS


Size and ownership may not determine value or quality of care. For many conditions and illnesses, a midsize or small acute care hospital is quite sufficient. In fact, many hospitals in Virginia's smaller towns have a long-standing record for successfully serving family medical needs from birth to elder care. These are the hospitals on which most Virginian's depend for their acute care needs. When or if there is a potential need for critical or specialty care that reaches beyond a particular hospital's capability, your physician will guide you to the appropriate expanded care choice.

Small Acute Care General Community Hospitals
Many small community hospitals provide a range of inpatient and outpatient services necessary to diagnose and treat many acute care needs that may include in addition to general medical care:

  • emergency room services
  • intensive care
  • surgical care
  • obstetrics (OB) (or maternity care including birthing rooms)
  • diagnostic services such as laboratory procedures, x-ray or other diagnostic radiological procedures and ultrasound procedures
  • some rehabilitation therapies
  • inpatient pharmacy services
  • geriatric services and
  • consumer physician referral services

Some rural community hospitals have become Critical Access Hospitals (CAH) hospitals. A CAH receives a different type of funding from Medicare and is designed to help reduce closures of small rural hospitals. CAH hospitals have a maximum of 25 beds and must provide 24-hour emergency services. CAHs are required to develop agreements with an acute care hospital related to patient referral and transfer, communication, emergency and non-emergency patient transportation. CAH hospitals have flexibility to tailor their staff and services to meet their communities needs. community hospital virginia

Large Acute Care General Community Hospitals and Health Centers When considering your hospital options, you will find that most of the services listed for small community acute care hospitals will be available at the larger facilities. In addition, these larger, typically regional hospitals and health centers may have specialized departments such as women's centers, home health services and hospice services.
They can also provide other specialty services that may include
  • infectious diseases
  • pediatrics
  • cardiology
  • oncology, including chemotherapy
  • nuclear medicine
  • radiation therapy
  • neurology and neurological surgery
  • dental surgery
  • ophthalmic surgery and other ophthalmological service; and
  • ear, nose and throat (ENT) - or otorhinolaryngology - services

You may also find these large facilities staffed and equipped to provide
  • premature baby care
  • nephrology and urology services as well as urological surgery
  • transplant surgery and,
  • inhalation therapy and respiratory therapy

They may also have
  • an intensive care unit (ICU) and cardiac care unit (CCU)
  • inpatient and outpatient psychiatric care and substance abuse services
  • burn and trauma centers and, in some cases,
  • heliport services


For more information on hospitals in Virginia please visit www.vhi.org/hospital_region.asp



THE HEALTH CARE DELIVERY SYSTEM IN VIRGINIA
OUR TEACHING HOSPITALS

virginia teaching hospitalsIn addition to serving our acute care general hospital needs, Virginia's teaching hospitals have also earned regional and national recognition for
  • special service to their communities
  • innovations in research and
  • procedural medical innovations
that have been adopted nationwide

Acute care general teaching and/or research facilities not only provide a wide range of services but also frequently receive patients from community and other general hospitals for specialized critical care. These large facilities - though perhaps not as close to home or as intimate - may be the first choice when a trauma, infectious disease or complicated disorder dictates.

Teaching hospitals also stand ready to accept the overflow from other general hospitals when regional disasters or large community emergency needs arise. These units have heliports for receiving critical care patients from other hospitals and from accidents and community disasters.

For more information on hospitals in Virginia please visit www.vhi.org/hospital_region.asp

CHANGES IN HOSPITAL CARE
Medical Advances

Hospital care as we know it today has evolved rapidly. Physician expansion into specialties and the new equipment that goes with those specialties has pushed hospital growth. Physicians and hospitals working together have moved to center the hospital as a widely based treatment facility.

changes in hospital careCost Containment - With rapid growth came the increased cost of expanded technology - equipment that costs millions of dollars, specialists who have earned the right to charge for their abilities and the price tag on the state-of-the-art facilities built to house it all. Government, businesses and consumers were affected by the initial surge in costs. Beginning in 1984, a serious attempt was made by our government, insurers and medical service providers to put some cost controls in place.

Led by Medicare and Medicaid programs, the health care system began its move from a fee-for-service schedule of payments -"we'll pay the bill"- to a regionalized fixed-fee -"we'll pay what we figure it's worth"- system of reimbursement. Health care insurance companies quickly followed. Over time these changes in the system brought about a need for hospitals to become more efficient, to provide their patients with the most appropriate medical services and to return their patients to health as quickly as possible. In doing so, hospitals became more productive. Many hospitals found other answers to cost reduction challenges. Merger with or acquisition of companies or groups of professionals - like insurance companies or physician groups - that could provide some of the services hospitals needed to increase efficiencies was one of them. With these business-oriented changes, standard business distribution methods were also put in place. Physicians and managed care plans became the "distributors" for hospital products and services. And, realizing their distributors needed some help in approaching the consumer with new services, hospitals began to advertise their facilities, staff and services directly to their ultimate consumer - the patient.

The most recent significant change is related to patient safety and quality beginning in the 1990s with the Institute of Medicine's (IOM) report on medication errors. The Joint Commission, the IOM, the Institute of Healthcare Improvement and the Centers for Medicare and Medicaid (CMS) made efforts towards increasing quality and safer care for patients. With the Patient Quality and Safety Initiatives--effective in October 2008 CMS will not pay hospitals more for care complicated by certain hospital acquired conditions. These conditions will likely change over time but initially include infections, objects left in during surgery and pressure ulcers (bed sores).

CHANGES IN HOSPITAL CARE
Consumer-Driven Changes

consumer-driven changes in hospital care Hospital Centered Care - Other changes in hospital structure and service have occurred as a result of consumer feedback and new levels of demand for information and assistance. Today's consumer wants to maintain health. When ill, they want to return to health quickly, and they want a say-so in how this is accomplished. Because, on a daily basis, the demands exceed the average physician's ability to provide all the services we want, the community hospital has become the center for today's expanded health care needs.

More Information, Better Information - Consumers have increased accessibility to information that helps them make good decisions about who delivers their health care and where they go to receive it. As the data becomes easier to understand and act on, consumers will be more able to communicate their needs and desires back to the providers. As many already do, hospitals will respond by providing what consumers have defined as quality health care. Through rapid advancements in computers and telecommunications and advanced medical imaging, hospital services will reach more people.

Outcomes - Though not all consumers think alike about health care, there is one thing that frequently is part of our definition of quality hospital health care: They were returned to health. To better ensure patient satisfaction and meet quality requirements in health care, today's consumers are choosing hospitals that have experience in a needed procedure and can demonstrate their successes.

Respect - There may be other emotionally based attitudes and opinions held by consumers when assessing the quality of the hospital care they receive. They expect continuity and coordination in their care, smooth transitions from illness to health, better emotional support that includes the involvement of family and friends and staff sensitivity to the inconveniences a hospitalization can create. Patients also expect to feel respected and their hospital will enforce patient information confidentiality policies. Patients want to know that their problems will be taken seriously and want sufficient time with their physician. And, they want attention shown to their personal needs. When they leave the hospital, they want clear instructions that include information about their health, that alert them to danger signals and that advise them about the resumption of normal activities.

CHANGES IN HOSPITAL CARE
THE PATIENT'S BILL OF RIGHTS

patient's bill of rights The expectations of quality care are supported for every patient treated in an American Hospital Association (AHA) member hospital. In 1973, AHA member hospitals voted to adopt a Patient's Bill of Rights and revised it in 1992. In 2001, AHA hospitals replaced “A Patient’s Bill of Rights” with “The Patient Care Partnership: Understanding Expectations, Rights and Responsibilities.” The new statement “a straightforward, plain language statement that clearly outlines what patients should expect during their hospital visit.” ©2003 American Hospital Association. All rights reserved

A copy of the full version may be obtained through an AHA member hospital in your area or from the AHA (see FOR MORE INFORMATION in this guide) http://www.aha.org/aha/issues/Communicating-With-Patients/pt-care-partnership.html. Rights and responsibilities - both are important to your hospital care. Be sure to ask for a copy of this commitment during a hospital admission process.

What to expect during your hospital stay:
  • High quality hospital care
  • A clean and safe environment
  • Involvement in your care
  • Protection of your privacy
  • Help when leaving the hospital
  • Help with your billing claims

“Patient safety is one of the Nation's most pressing health care challenges. A 1999 report by the Institute of Medicine estimates that as many as 44,000 to 98,000 people die in U.S. hospitals each year as the result of lapses in patient safety.” The AHRQ consumer fact sheet “Five Steps to Safer Health Care Patient Fact Sheet” tells what you can do to get safer health care. It was developed by the U.S. Department of Health and Human Services in partnership with the American Hospital Association and the American Medical Association. http://www.ahrq.gov/consumer/5steps.htm AHRQ Publication No. 04-M005 Current as of February 2004.

Medicare Patients have additional rights including a review of your hospital discharge by the Quality Improvement Organization. You have the right to ask a Quality Improvement Organization (QIO) to review whether you are being discharged too soon. To view these rights go to www.cms.gov/medicare/appeals-and-grievances/mmcag/downloads/rightsandprotections.pdf

CHANGES IN HOSPITAL CARE
THE PATIENT'S BILL OF RIGHTS


http://www.aha.org/aha/issues/Communicating-With-Patients/pt-care-partnership.html

Below is a checklist, abbreviated from the AHA Statement “The Patient Care Partnership: Understanding Expectations, Rights and Responsibilities”

Tell your caregivers if you have concerns about your care or if you have pain.

You have the right to know the identity of doctors, nurses and others involved in your care, including if they are students, residents or other trainees.

If anything unexpected and significant happens during your hospital stay, you will be told what happened, and any resulting changes in your care will be discussed with you. Discussing your medical condition and information about medically appropriate treatment choices.

The benefits and risks of each treatment.

Whether your treatment is experimental or part of a research study.

What you can reasonably expect from your treatment and any long-term effects it might have on your quality of life.

What you and your family will need to do after you leave the hospital.

The financial consequences of using uncovered services or out-of-network providers.

Please tell your caregivers if you need more information about treatment choices.

Consenting to treatment such as surgery or experimental treatment to confirm in writing that you understand what is planned and agree to it.

You have the right to consent to or refuse a treatment and an explanation from your doctor about the medical consequences of refusing recommended treatment.

It is your right to decide if you want to participate in a research study.

If you or your family need help making difficult decisions, counselors, chaplains and others are available to help.

You will receive a Notice of Privacy Practices that describes the ways that the hospital can use, disclose and safeguard patient information and that explains how you can obtain a copy of information from their records about your care.

You can expect the hospital staff to help you identify sources of follow-up care and to let you know if the hospital has a financial interest in any referrals.

As long as you agree that the hospital can share information about your care with referral sources, they will coordinate their activities with your caregivers outside the hospital.

You can also expect to receive information and, where possible, training about the self-care you will need when you go home.

You can expect help with billing information and what to do if you do not have insurance.



What Your Caregivers Needs From You.

Complete and correct information about your health and coverage so that they can make good decisions about your care.

Past illnesses, surgeries or hospital stays.

Past allergic reactions.

Any medicines or dietary supplements (such as vitamins and herbs) that you are taking.

Any network or admission requirements under your health plan.

Make sure your doctor, your family and your care team know your wishes related to health care goals, spiritual beliefs and values.

If you have signed a health care power of attorney stating who should speak for you if you become unable to make health care decisions for yourself, or a “living will” or “advance directive” that states your wishes about end-of-life care; give copies to your doctor, your family and your care team.



If you have Medicare or Medicaid, you have additional rights, including an appeal process if you think you are being asked to leave the hospital too soon or are not receiving a service you think you should. For more information, view Medicare Publication ID: 10050

The information below was developed by the U.S. Department of Health and Human Services in partnership with the American Hospital Association and the American Medical Association.
  1. Ask questions if you have doubts or concerns. Ask questions and make sure you understand the answers. Choose a doctor you feel comfortable talking to. Take a relative or friend with you to help you ask questions and understand the answers.
  2. Keep and bring a list of ALL the medicines you take. Give your doctor and pharmacist a list of all the medicines that you take, including non-prescription medicines. Tell them about any drug allergies you have. Ask about side effects and what to avoid while taking the medicine. Read the label when you get your medicine, including all warnings. Make sure your medicine is what the doctor ordered and know how to use it. Ask the pharmacist about your medicine if it looks different than you expected.
  3. Get the results of any test or procedure. Ask when and how you will get the results of tests or procedures. Don't assume the results are fine if you do not get them when expected, be it in person, by phone, or by mail. Call your doctor and ask for your results. Ask what the results mean for your care.
  4. Talk to your doctor about which hospital is best for your health needs. Ask your doctor about which hospital has the best care and results for your condition if you have more than one hospital to choose from. Be sure you understand the instructions you get about follow-up care when you leave the hospital.
  5. Make sure you understand what will happen if you need surgery. Make sure you, your doctor, and your surgeon all agree on exactly what will be done during the operation. Ask your doctor, "Who will manage my care when I am in the hospital?"
Ask your surgeon:

Exactly what will you be doing?

About how long will it take?

What will happen after the surgery?

How can I expect to feel during recovery?

Tell the surgeon, anesthesiologist, and nurses about any allergies, bad reaction to anesthesia, and any medications you are taking.

CHOOSING A HOSPITAL

choosing a hospital Determining which hospital is best for you and your family may require some planning and thought
  • about your and your family's expectations for health care
  • about your health care plan coverage and options
  • about the different kinds of services you will want and use to maintain health and serve present medical needs and
  • about any foreseeable or predictable future medical needs such as maternity care
In defining your needs and expectations concerning hospital care
  1. Take your concern for the choice of a hospital seriously and don't apologize to yourself - or others - for your insistence in doing so. The work sheets in this guide are designed to help you focus on the qualities and services about which you care the most when it comes to a hospital choice.
  2. Review the lists of important services and quality care needs with your family. Include their priorities where you can.
  3. If possible, visit and make your choice when you are healthy. When you are ill, you are probably more tired than usual and often anxious. If you know you are going to need a hospital in the near future, try to visit the one you have selected prior to being admitted. Doing so will help reduce one of the potential stresses of illness - unfamiliar surroundings.
Hospital First? Physician First?
Many consumers choose a hospital first and then select an affiliated physician. Other people may feel more comfortable selecting a physician first and including his or her input in their hospital choice.

If you make a hospital choice first, to then select a physician you may want to use the physician referral services offered by the hospitals you have identified in your search. The four steps that follow provide
  • guidelines for finding a hospital and a physician and
  • work sheets for recording and assessing your options.
PLEASE CLICK ON ONE OF THE STEPS BELOW.

STEP ONE: FINDING A PHYSICIAN
STEP TWO:LOCATING HOSPITALS TO CONSIDER
STEP THREE:GETTING THE FACTS WORK SHEET
STEP FOUR:RATING YOUR HOSPITAL OPTIONS WORK SHEET

CHOOSING A HOSPITAL
GETTING AN OVERVIEW OF YOUR OPTIONS

STEP ONE: FINDING A PHYSICIAN

Virginia Health Provider Virginia's DHP website www.vahealthprovider.com is a good source of information when searching for a physician. Using a physician referral service offered by one of your local hospitals can be another helpful tool to find an appropriate physician - and a hospital!

physian referrral system You can find physician referral services by calling a hospital to ask if they offer a consumer physician referral service. If they do, you can access the information you need during the call. Or, you can find a referral service by checking a hospital's yellow page advertisement for a physician referral service phone number. Also, hospitals will often feature referral services in newspaper advertising.

Once you have identified a physician you would like to consider you can contact the physician or add the information to the physician information you find
  • by looking through your telephone book
  • by asking friends and relatives for their recommendations based on their experience with a particular physician or
  • by talking with a local or state medical society that offers physician referral services
choosing physiciansHospital physician referral services typically offer the name and phone number of one or more physicians that have an affiliation with the hospital you called. Most hospitals will also be able to give you information on the physician's board certification, putting you one step closer to a final choice.

If your health insurance is a managed care plan (an HMO, a PPO and/or a POS feature in a health plan) another source of physician referral is available to you through the plan's pre-approved lists of health care providers. Since hospitals are also listed, your approved provider list is also a good way to begin your search for the hospital that best suits your needs.

All are good ways to begin a search for a primary or family physician or for a specialist. And all are as close as your computer or telephone!

CHOOSING A HOSPITAL
GETTING AN OVERVIEW OF YOUR OPTIONS

STEP TWO: LOCATING HOSPITALS TO CONSIDER

If you have time to research and plan your hospital selection, the following is a checklist of things you may want to do first to develop a working list of hospitals to consider.

Discuss the list of hospitals with your physician or specialist you have identified as ones that meet your and your family’s needs.

During a regular visit or annual checkup, ask your primary care physician or a specialist you see on a regular basis — a gynecologist for example — to give you his or her views on the hospitals they routinely recommend. Also take this opportunity to discuss the services you would like to receive at a hospital over and above special medical care, such as wellness programs or health-related seminars. Ask about the advantages or special characteristics of each hospital where he or she practices. Your physician’s input is important because your medical history and/or present medical condition may affect your hospital choice. For a comprehensive personal evaluation, visiting the hospital will give you a better view of its practices and personality.
Important to Note: If you make a special appointment with a physician to review your hospital options, you may be expected to pay for it as an uncovered expense. Ask about the physician’s policy concerning charges for consultative visits when you call to make the appointment.

Check your health insurance plan. Traditional health insurance plans, indemnity or fee-for-service for example, do not usually limit your hospital choices to a pre-agreed-upon list of hospitals or physicians. If you are covered by a traditional plan, a call to your plan administrator will confirm coverage for a particular hospital choice.

If you are covered by a managed care plan - HMO, PPO, or an HMO or plan with a POS feature - you may already have a list of the hospitals that participate in your plan. You will want to review this list against the hospitals you are considering or choose hospitals to review from those that participate in your plan. With managed care coverage, you may elect a non-participating hospital but there may be additional costs. If you feel strongly about a particular facility, contact your plan administrator before ruling it out. Or include all of the hospitals you want to consider - those in and out of the plan - and decide after your review if your beliefs and opinions about your choice are strong enough to offset potential additional costs.

Take a class or attend a seminar offered by one or more of the hospitals on your list.

You will usually find these advertised in your local paper or may receive notice of them in the mail. If not, call the hospital you are considering and ask for information on upcoming community classes and seminars. Some may be free or there may be a minimal charge.

Ask for a tour of the hospitals you are considering.

Take the opportunity to talk to the nursing staff during your visit. And take a copy of this guide's assessment checklist (STEP THREE) with you so you can rate your options later.

Put VHI's hospital information to work.

If you know you will be entering a hospital in the future for a particular procedure, such as childbirth or surgery, and want information about a particular hospital's experience in the specialty you will need, VHI's service line and other hospital information can help you learn more about how often they provide certain care and, for some conditions, the quality of care they provide. VHI also provides links to other trusted sources of quality.

Ask for a copy of the hospital's consumer satisfaction survey results or a report card on their facility.

Many hospitals conduct consumer or patient satisfaction surveys to determine how well they perform in the patient's view. Many hospitals are proud of the results and share them with prospective patients. Ask for a copy and compare the survey results with other information you have collected. Also, some hospitals prepare report cards on their facility, including the outcomes of many procedures. You may also want to ask for a copy of this report as well.


CMS also has patient satisfaction information at www.hospitalcompare.hhs.gov

CHOOSING A HOSPITAL
GETTING AN OVERVIEW OF YOUR OPTIONS

STEP THREE: GETTING THE FACTS - WORKSHEET

Since there is basic data to gather for each hospital you are considering, you may want to copy this two page assessment tool and fill one out for each hospital visited.

NAME OF HOSPITAL:
LOCATION:


WHEN YOU VISIT, ASK FOR...

A copy of the hospital’s Patient’s Bill of Rights document

A Patient Information Packet

A written description of the hospital’s services and fees

An annual report or statement of organization

A hospital report card on general performance issues or the results of hospital’s latest patient satisfaction survey



HOSPITAL QUALITY ATTRIBUTES

Accredited by the Joint Commission on Accreditation of Health Care Organizations (JCAHO)

Percentage of physicians with privileges at the hospital (and/or staff physicians) who are Board Certified*  

Number of Registered Nurses to each patient overall  

Number of Nurse Specialists (master’s degree) in hospital units  

Ratio of Licensed Practical Nurses to each patient overall  

Ratio of graduate nurses and licensed practical nurses to each patient in specialty area: 1 nurse to:
to 10 patients       to 15 patients       to 20 patients      

Participates in clinical trials

Services and specialties provided by the hospital meet your specific health goals and potential medical needs

Financial aid services available
Interest-free financing of co-payments/deductibles

Assistance in filing insurance claims
Medicare and Supplemental Coverage   Medicaid

Social Services assistance in hospital as well as post-discharge follow up

*For other ways to ascertain board certifications for specialists see American Board of Medical Specialties in the FOR MORE INFORMATION section of this guide.


HOSPITAL TOUR CHECKPOINTS

Hospital conveniently located

Ample/Convenient parking

Courtesy Van service available

Hospital presents a clean appearance and pleasant air

Lobby greeting warm, friendly, relaxed

Comfortable waiting room

Vending machines nearby

Visitor phone in the waiting room

Patient rooms inviting and cheery, conducive to recovery

Patient rooms have comfortable chairs for visitors

Privacy considered in the room design

Television, internet, radio service

Television, internet service at extra cost. Paid by day/week



DISCHARGE POLICY

Discharge plan is developed for you before you leave the hospital

Provides patient/caretaker with necessary training to continue care at home

Includes training in
changing dressings,
taking medications
using special medical devices

Provides patient/family with written instructions on at-home care

Provides written plan for return to health (normal activity)



ABOUT THE PHYSICIAN/SURGEON

Physician/surgeon who will perform the procedure is Board Certified
has continued specialty education

Particular procedure is performed frequently (annual basis) by physician

Has success rate in a specific medical procedure you need

Has responsibility for maintaining your personal care plan
during hospitalization
during home recovery period

CHOOSING A HOSPITAL
GETTING AN OVERVIEW OF YOUR OPTIONS

STEP FOUR: RATING THE HOSPITALS - WORKSHEET

This is a scorecard designed to help you compare your hospital options. There is space to compare three hospitals. You may want to copy these pages to use as your work sheets.

HOW TO RATE
By Using Points: Assign 3 points if the benefit is very important to you, 2 points if the benefit is moderately important, 1 point if the benefit is not important, and 0 if the hospital does not have the feature or benefit.
or
By Using Check Marks: The hospital with the most check marks rates highest. See “Other” to add personal items to consider or special services you may need.

NAME OF HOSPITAL 1:  2:  3:
Covered by my insurance   
My physician(s) has/have privileges   
Nationallly accredited   
Best and latest equipment   
Certified teaching hospital   
Reputation for:   
  ·   Best Physicians in Area   
  ·   Best Nurses in Area   
Nurse to Patient Ratio 1:10 or Better   
Most Physicians Board Certified   
Good Emergency Department   
Experience:   
  ·   Best Experience in Major Specialties   
  ·   Significant Experience in My Procedure   
Women’s Specialty Department   
Recommended by:   
  ·   Physician   
  ·   Another Employee Says Good   
  ·   Employer Recommends   
  ·   Been to Hospital/Satisfied   
Advertises Seminars/Classes   
Advertises Free Diagnostics   
TOTAL SCORES THIS PAGE   

NAME OF HOSPITAL
(From first page)
 1:  2:  3:
Caring Reputation   
Warm/Friendly Staff   
Same Religious Affiliation as Family   
Conveniently Located   
Modern Facilities   
Has Health Center/Wellness Program   
Good Educational Programs   
Free TV   
Has Rooming-In for Relatives   
Good Visiting Hours/Flexible   
Has Patient Transition Plan   
Good Food/Flexible Menus   
Respects Patients Preferences/Privacy   
Best Value/Lower Costs   
Clinical Trial Participation Available   
Physician Coordination Plan   
Pharmacy Coordination Plan   
Private Rooms Available   
Safe for Valuables   
Allows Personal Toiletry Items   
Schedules Diagnostics w/Physician for Me   
Other:   
    
    
    
    
TOTAL SCORES THIS PAGE   
TOTAL SCORES FROM FIRST PAGE   
TOTAL SCORE FROM BOTH PAGES INDICATING BEST CHOICE   

FOR MORE INFORMATION
IN VIRGINIA

Virginia Department of Health Office of Licensure and Certification

The office of Licensure and Certification of the Virginia Department of Health ( http://www.vdh.state.va.us/OLC/contacts.htm) has the responsibility to investigate any complaints regarding alleged violations of regulation or applicable law regarding the following facilities and services:

  • Inpatient and Outpatient Hospitals
  • Nursing Facilities
  • Home Care and Home Health Organizations
  • Hospice Programs
  • The quality of care provided by managed care health insurance plans

    Complaints can be made in writing at
    Virginia Department of Health
    The Office of Licensure and Certification
    9960 Mayland Dr., Suite 401
    Richmond, VA 23233-1463
    Toll Free: 1-800-955-1819
    Local: 1-804-367-2106
    via email at OLC-Complaints@vdh.virginia.gov

    The Acute Care division is responsible for the licensing of hospitals, home care and hospice programs. The division monitors managed care health insurance plans and private review agents and, under CLIA, conducts the certification inspections for clinical laboratories. This division is also responsible for the Medicare certification of hospitals, home health agencies and hospice programs as well as a variety of medical services and facilities.

    Virginia Health Quality Center (VHQC) Investigates Medicare quality of care facility complaints concerning Medicare patients.
    On the Web: vhqc.org
      Virginia Health Quality Center
      9830 Mayland Drive, Suite J
      Richmond, VA 23233
      Toll Free: 1-800-545-3814
      Fax: 804-289-5324
      Main Office: 804-289-5320


    MEDICARE INFORMATION: 1-800-MEDICARE (1-800-633-4227)
    BENEFICIARY HELPLINE: 1-800-MEDICARE (1-800-633-4227)
    PROVIDER HELPLINE: 1-800-854-5244 OR 1-804-289-5303

    Virginia Hospital and Healthcare Association represents Virginia hospitals and publishes information on health care providers in Virginia.
    On the Web: vhha.com
      Virginia Hospital and Healthcare Association
      4200 Innslake Drive
      Glen Allen, VA 23060
      Phone: 804-965-1210
      Mailing Address:
      P.O. Box 31394
      Richmond, VA 23294-1394

    NATIONALLY

    American Board of Medical Specialties® Certified Doctor Locator and Verification Services allows the public to verify the board certification status of any physician who is certified by one or more of the 24 member boards of the ABMS and who has subscribed to be listed. This service also allows the public to locate a board certified physician in his or her area (by zip code.)
    On the web: https://www.abms.org
      Or questions may be directed to:
      American Board of Medical Specialties
      1007 Church Street, Suite 404
      Evanston, IL 60201-5913
      PH: 847-491-9091
      Toll Free: 1-866-ASK-ABMS (1-866-275-2267)
    American Hospital Association (AHA) The national organization that represents and serves all types of hospitals, health care networks, their patients and communities. Developed Patient's Bill of Rights for use by hospital members.
    On the web: www.aha.org
      American Hospital Association
      Chicago Headquarters
      One North Franklin
      Chicago, Illinois 60606
      PH: 312-422-3000
      Toll Free: 1-800-424-4301
      American Hospital Association
      Washington DC Office
      325 7th St. NW
      Washington, DC 20004-2802
      PH: 202-638-1100
    Association of American Medical Colleges (AAMC) A nonprofit association comprised of 125 accredited U.S. medical schools and over 400 teaching hospitals.
    On the web: www.aamc.org
      Association of American Medical Colleges
      2450 N Street, NW
      Washington, DC 20037-1126
      Phone: 1-202-828-0400
    Center for Medicare and Medicaid (CMS) The federal agency that administers the Medicare, Medicaid, and Child Health Insurance programs. Also performs a number of quality-of-care-related activities, including certification and quality improvement. Provides information under the Freedom of Information Act. On the web: http://www.cms.hhs.gov/aboutwebsite/04_foia.asp

      Center for Medicare and Medicaid
      Office of Information Services
      Division of Freedom of Information and Privacy
      Room N2-20-16
      7500 Security Boulevard
      Baltimore, MD 21244-1850
      Phone: 1-410-786-5353 or 410-786-0474

    For further information, contact the Administrator at

    Center for Medicare and Medicaid
    Department of Health and Human Services
    200 Independence Avenue SW.
    Washington, DC 20201
    PH: 410-786-3000

    Joint Commission on Accreditation of Healthcare Organizations accredits hospitals/healthcare organizations for administrative, medical, facility and quality of care issues. Has an active complaint department to assist consumers/patients with concerns. On the web: www.jointcommission.org
      The Joint Commission
      One Renaissance Boulevard
      Oakbrook Terrace, Illinois 60181
      Phone: 1-800-994-6610
    on the web: www.jointcommission.org/GeneralPublic/Complaint
    email: complaint@jointcommission.org
    Office of Quality Monitoring/Complaint Operations Unit:
    fax: 1-630-792-5642

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