Survey: AARP magazine’s top hospitals

When Kate Probst learned she needed surgery to remove a brain tumor, she launched a nationwide search for the best medical care. Probst, an environmental policy analyst who lives in McLean, Va., consulted doctors in nearby Washington, D.C. She telephoned specialists at Duke University Medical Center in North Carolina and sent her records to experts at Massachusetts General Hospital in Boston and the Barrow Neurological Institute in Phoenix. Ultimately, Probst chose the second of two neurosurgeons she interviewed at Johns Hopkins Hospital in Baltimore. Her operation to remove the benign tumor was a success.

But a year earlier, in 2006, when Probst received a diagnosis of early breast cancer, she looked no farther away than a community hospital a few miles from her home. That time, her condition was so common, and treatment so uniform, that there was no compelling reason to leave town. "I was told there were ten doctors here who could do it," said Probst, 52, who underwent a lumpectomy followed by radiation and has not had a recurrence.

A generation ago most ailing Americans received treatment in their hometown hospitals, no matter how rare the illness or grave the diagnosis. Today it is increasingly common to venture hundreds or thousands of miles for care. Although statistics are elusive, several of the largest U.S. hospitals report significant increases in out-of-state patients during the past decade. M.D. Anderson Cancer Center in Houston, for example, recorded a 69 percent jump between 1999 and 2007.

Americans are more mobile these days, but that's not the only factor fueling the trend. Some large insurance companies are steering patients with unusual or complex medical problems to specialized institutions. These facilities, sometimes dubbed "centers of excellence" by health experts, have more experience and better results at such difficult tasks as performing transplants or treating rare cancers. They can significantly change a patient's outlook by offering treatments that local physicians may not have been aware of. Says oncologist John Glaspy of UCLA's Jonsson Comprehensive Cancer Center: "What happens at least once a week is that someone comes here and finds there are new treatment options that work."

Another change is that it's easier to study the success rates of different hospitals than it used to be. The federal government has taken a leading role in making such information available to consumers through its Hospital Compare Web site. The site lets you look up a particular hospital's success at treating heart attacks, pneumonia, heart failure, and other conditions. It also reports the results of patient surveys, telling you everything from whether the hallways are quiet at night to whether nurses respond quickly to calls. Private organizations such as the nonprofit Consumers' Checkbook (CC) in Washington, D.C., use government statistics along with their own research to compare and rank hospitals. For example, CC surveys doctors nationwide about the quality of hospitals in their area, and adds that data to its calculations. On this page, at right, you can see which out-of-town specialty hospitals were recommended most frequently in CC's doctor survey.

Top hospitals in America When Consumers' Checkbook asked docs where they were most likely to send patients with extremely difficult cases, these are the hospitals they named: Heart, General Cleveland Clinic, Cleveland, OH Mayo Clinic, Rochester, MN Children’s Hospital Boston, Boston, MA New York-Presbyterian/Columbia, New York, NY Massachusetts General Hospital, Boston, MA Brigham and Women’s Hospital, Boston, MA The Johns Hopkins Hospital, Baltimore, MD Stanford University Medical Center, Palo Alto, CA Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston, TX Cancer, General The University of Texas M.D. Anderson Cancer Center, Houston, TX Memorial Sloan-Kettering Cancer Center, New York, NY Dana-Farber Cancer Institute, Boston, MA Mayo Clinic, Rochester, MN City of Hope, Duarte, CA The Johns Hopkins Hospital, Baltimore, MD Duke University Hospital, Durham, NC Roswell Park Cancer Institute, Buffalo, NY Source: Consumers' Checkbook and AARP The Magazine

But just because a particular hospital appears to be the most successful at treating your disorder doesn't mean you should go there. Deciding whether to travel for care can involve weighing difficult trade-offs. Travel costs money, even if insurance covers the cost of treatment. (For more on costs, see "Can You Afford to Travel?" below.) And it's impossible to put a price tag on the advantages of being in familiar surroundings, cocooned by family and friends who can stay by your side and ask questions.

So how do you know when to travel? Clearly, any emergency such as a stroke or heart attack requires a prompt visit to the closest hospital. But many illnesses, including most cancers, do not require immediate treatment, giving patients time to consider their options. Your own doctor can tell you how urgent your need for care really is.

Even though it can literally be a life-and-death decision, "there are no hard and fast guidelines" about when or whether to leave home for treatment, says Arthur A. Levin, who directs the Center for Medical Consumers, a New York City-based patient-advocacy group. One key step, Levin says, is simply to ask local hospitals how frequently they see patients with your illness. If one hospital has a specialized program for patients like you, it is likely to have more familiarity with the latest research findings.

The rarity and severity of your disease also make a difference: for patients diagnosed with common malignancies, such as early breast or prostate cancer, experienced physicians can be found in many communities, Levin says. But for those with rare or hard-to-treat illnesses, such as pancreatic or esophageal cancer, "it's less likely you're going to get the best advice and treatment" nearby, unless you live near a teaching hospital. Doctors don't see enough cases.

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