Survey: AARP magazine’s top hospitals

There's another reason to leave town: when treatment at home isn't going well.

That's what first prompted Baidwatie Rita Lecoin, 59, a medical surgical technician with diabetes and kidney failure, to transfer more than 300 miles from a Chicago hospital to Minnesota's Mayo Clinic in 2005 when her heart, too, mysteriously began to fail. Mayo fixed that problem with a change of meds and, on subsequent visits, saved one of Lecoin's hands and both of her feet from amputations that had been recommended at various Illinois hospitals. "Had we not traveled out of state, she would have had two below-the-knee amputations," says her daughter Joanna Ammons, 37. Treatment at Mayo saved not only her mother's feet and hand, says Ammons, but also her life.

Frequently patients are the ones driving the decision to seek care out of town. But sometimes a doctor will recommend it. If yours does, advises Sharonne Hayes, director of the Women's Heart Clinic at Mayo, "you should go."

That's how Carlos A. Andrade wound up at M.D. Anderson Cancer Center in Houston, 750 miles east of his El Paso home. Since May 2008, the 70-year-old retired printer and his wife have made eight trips to treat a recurrence of Andrade's esophageal cancer, first diagnosed in 2005. "My doctor told me that there was no other thing they could do for me here in El Paso," Andrade says. Andrade received radiation treatments at Anderson and receives follow-up care at a clinic near his home.

Some patients are reluctant to travel for fear of offending their doctors. While that's understandable, it's important to remember that your doctor's ego will recover, while you may not. And though most doctors have their patients' best interest at heart, other agendas — such as reluctance to part with a challenging case — can occasionally taint their advice. The message: If the facts point toward better care elsewhere, don't stay home just to be nice.

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: Mystery Diagnoses Mayo Clinic, Rochester, MN Cleveland Clinic, Cleveland, OH The Johns Hopkins Hospital, Baltimore, MD Massachusetts General Hospital, Boston, MA Ronald Reagan UCLA Medical Center, Los Angeles, CA Neurosurgery Duke University Hospital, Durham, NC Mayo Clinic, Rochester, MN University of California San Francisco Medical Center, San Francisco, CA Cleveland Clinic, Cleveland, OH The Johns Hopkins Hospital, Baltimore, MD Ronald Reagan UCLA Medical Center, Los Angeles, CA Eyes Bascom Palmer Eye Institute, University of Miami, Miami, FL Wills Eye Institute, Philadelphia, PA Ronald Reagan UCLA Medical Center, Los Angeles, CA Wilmer Eye Institute, The Johns Hopkins Hospital, Baltimore, MD Source: Consumers' Checkbook and AARP The Magazine

Stuart Freedman, 58, a health insurance executive in Seattle, ran into resistance from one of the neurosurgeons he met with after he was diagnosed with a large benign brain tumor. That doctor tried to talk him out of undergoing a novel procedure devised by Amin Kassam, chair of neurosurgery at University of Pittsburgh Medical Center. In certain patients, Freedman had learned, Kassam removes brain tumors via the nose instead of through a hole in the skull. One advantage of this treatment, according to Kassam, is a reduced risk of serious neurological damage.

Freedman talked to Kassam and looked at the data from his procedure. He then compared that with the treatment offered by local neurosurgeons, studying the risks of death, paralysis, and brain damage from each of them. Freedman wanted the treatment, but his insurance company initially denied his request, without giving a reason. They eventually agreed to the Pittsburgh option after Kassam sent them a letter outlining the likelihood of a faster recovery and a shorter — and cheaper — hospital stay.

Freedman's treatment was a success, and it reinforces one of the most important aspects of choosing a hospital: while your doctor's guidance is important, this shouldn't be the only measure. Follow Freedman's example and ask each doctor you're considering for hard numbers on success and complication rates on the treatment he or she is proposing. Also look at the hospitals' statistics-based ratings on sites such as Hospital Compare. As Robert Krughoff, president of CC, points out, a small difference in mortality rates can mean a big difference in the total number of cases. "Two percent sounds like a small number, but if you told me that two out of one hundred people who stayed at a certain hotel died, I wouldn't go to that hotel."

If all this sounds daunting, that's because it can be. Remember that it's a fluid process; you can change your mind. And no one can make the decision better than you can, once you are armed with the facts. When it comes to choosing a hospital, there is no right answer for everyone, only a right answer for you.

For the Consumers' Checkbook complete list of the highest-ranked hospitals in the metro area and to access a database that provides in-depth details about each hospital, visit this AARP the magazine site.

Consumers' Guide to Hospitals, which costs $22, can be ordered by calling 800-213-7283 or by sending a check to Consumers' Checkbook, 1625 K Street, NW, Washington, DC 20006. You can also order it, or subscribe to use the information online, at checkbook.org. Consumers' Checkbook also publishes Guide to Top Doctors.

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