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Category: Selecting a Hospital

Quality Reports for Hospitals and Doctors: Interesting but Flawed

By Mark A. Kelley, MD |10/18/17
Founder, HealthWeb Navigator

Every patient eventually asks the same question: “How can I find the best hospitals and doctors?”

The solution might seem easy, since we live in world where information is readily available on the internet. In a few clicks we can shop for goods, review consumer products, market ourselves on social media, and complete financial transactions instantly. You would think that health care, which accounts for 17% of the GDP, would have all these same features.

Think again. Healthcare information for consumers is woefully unsophisticated compared to other industries. Ask anyone who has ever attempted to find prices for healthcare services, interpret a medical bill, or schedule an appointment online.

Healthcare information is primitive because it focuses on finances rather than customers—that is, the patients. As a result, hospital and physician offices are skilled at sending bills but often can’t help patients with much else.

Federal regulations have helped improve online medical records and lab results. But information about healthcare quality is still lacking. The lack of standardization about what is important, credible, and measurable leads to confusion.

HealthWeb Navigator lists the most common online hospital rating websites. Unfortunately for patients, there is no consistency among these many rating tools. Research shows that hospitals ranked highly in one system often score poorly in another…and vice versa.

The reason? These rating systems all use different measurement criteria, as well as different statistics to compute results. Some are heavily influenced by reputation rather than clinical outcomes. Even Medicare’s rating system—Hospital Compare—isn’t very helpful since it’s hard to navigate and most hospitals come out “OK”. Many patients choose not to use these “quality” tools due to the inconsistency among them.

Report cards about doctors are not much better. Medicare’s Physician Compare suffers from the same problems as its hospital-focused counterpart. The average visitor has difficulty sorting out the information most valuable to them. Some websites promote doctors who pay to be listed on the website. Others feature those doctors with regional and/or national reputation. This approach is common in regional publications magazines like Boston Magazine that list the “best” local specialists.

Finally, the newest “report card” for hospitals and doctors is the popular website Yelp. Reports featured on Yelp remain controversial, as they are based on consumer opinions rather than a more data-driven methodology. Despite the flaws, Yelp reviews are extremely popular among consumers.

In the midst of all this confusion, how can someone find a good hospital or doctor?

Most physicians, including me, think that the best source is still a recommendation from a trusted friend, preferably a health professional. Those in health care usually have a network of helpful contacts. Of course many other factors can influence patient choice. Most patients prefer medical care that is conveniently close to home. Others, especially those with complex conditions, may prefer to see a specialist in a large medical center far from home.

Once a hospital recommendation is made, the patient and their family can examine the hospital’s website to evaluate its staff and their credentials. Some hospitals publish their staff’s expertise and experience in certain specialties. Such voluntary public reporting is becoming more common among hospitals that perform at a high level. If a hospital does not list such metrics, it is worth asking for them.

As for doctors, you can check out their background on several websites featured in our “Physicians” section. Most hospitals list the educational credentials of their medical staff, including board certification.

Clinical experience is highly important when choosing a physician. That information may not be listed on a website, but every physician can and should be able to summarize their experience to interested patients. HealthWeb Navigator covers how to choose a doctor in more depth on a previous post.

In summary, publicly reported hospital and physician “scorecards” are interesting and sometimes helpful—but not necessarily authoritative. We have a long way to go before “public reporting” in health care represents an accurate reflection of clinical performance in ways that consumers can understand.

In the meantime, the best approach is to contact a trusted source, especially a physician or nurse. Ask them where or to whom they would send their loved ones in times of need. That recommendation is bound to be reliable.

Rising Costs: The Greatest Threat to Health Reform

By Mark A. Kelley, MD |9/21/17
Founder, HealthWeb Navigator

The main character in the popular film Groundhog Day is caught in a time loop where he must repeat the same day over and over again.

The U.S. Senate is now having its own “Groundhog Day” moment as it debates (yet again) a law to replace the Affordable Care Act. To add to the drama, Senator Bernie Sanders (I-Vt.) is promoting his single payer alternative popularly branded as “Medicare for All.” In a recent TV interview he raises many of the same points I raised in my previous post.

Meanwhile, the average person watches their health care costs spiral out of sight, something our elected officials seldom discuss. How did that happen? Who is to blame?

The answer is no one…and everyone. Human history is full of examples when humans exhausted their resources. This is believed to be the reason why Easter Island’s inhabitants disappeared, eradicated by their own unchecked “ecocide.”

In North America, humans wiped out 50% of the large animal population in the geologic blink of an eye. Of course no one planned these extinctions. But we humans seem to have trouble learning that excessive demand eventually devours resources.

We have the same problem when it comes to health care. Over the last 40 years, health care has become one of the most innovative and profitable sectors of our economy. However, its costs are now taking big bites from the budgets of government, industry, and private citizens.

Until recently, this toxic effect was hidden behind spectacular successes in medicine: new technologies and cures, improved public health, better quality of care, etc.

For businesses, the success has been equally impressive. Health care has been profitable for insurance companies, hospitals, device manufacturers, and the pharmaceutical industry. These sectors thrived because the government and employers could afford to pay the costs, very little of which was passed on to patients.

But those “good times” ended a decade ago when health costs pushed the U.S. auto industry into bankruptcy. After the
Great Recession of 2008, most companies faced the same challenge and were forced to cut their health benefits to stay afloat.

As a result, employees now pay more for health care out of pocket, while the average worker’s income has flatlined. You don’t have to be a math major to figure out that health care will soon be too expensive for most people. Meanwhile, the big business of health care has shown few signs of slowing down. Nearly all companies remain profitable.

However, there are some cracks in the armor. The profits of some hospitals and systems have dropped off, and several have closed as a result. Physician incomes are stable, but the pressures of practice are becoming intolerable. Many physicians are suffering from burnout, causing them to leave practice.

Health care is a major sector of the economy, accounting for 17% of the GDP. It is a field with many powerful constituents who support—and wield substantial influence over—members of Congress. That fact alone makes legislative reform difficult.

How will change occur? Possibly, though not ideally, from America’s most common instrument of change—a national crisis.

Despite what many experts believe, health care is not “too big to fail.” It has few price controls and bears no resemblance to a free market. The industry cannot survive without employer and government subsidies. As a nation, we have become gluttons for health care that is inefficient and becoming prohibitively expensive. There is no clearer path toward extinction.

Left unchecked, healthcare prices will continue to rise. Unless those costs are subsidized or controlled, more consumers will choose to be uninsured and seek care in hospital emergency rooms, leaving other patients to foot the bill.

If employers retreat from health insurance, the consequences will be catastrophic. The uninsured will flood the country’s delivery system of doctors and hospitals. Without federal bailouts, the system will bleed itself dry and suffer a full-blown meltdown.

That may happen no matter what Congress decides in the coming months. If Congress reduces current federal subsidies, more Americans will find themselves instantly uninsured, triggering a political and financial crisis. But even if the subsidies survive, costs will continue to rise, eventually resulting in catastrophe for all.

Unwittingly, with health care we have created a game that the public simply cannot win. The time has come to change the rules in our favor.

How to Effectively Manage Appointments with Your Doctor

By Mark A. Kelley, MD |7/12/17

Everyone in health care is busy these days. Most doctors have full schedules and patients often can’t afford to take time off from work.

Neither patients nor doctors are satisfied with this situation. However, once you and your doctor get together, there are ways you can make the visit more valuable.

Doctor appointments fall into two different categories:

• Urgent visits: For true emergencies, you should seek immediate medical attention. For a problem that is not an emergency but worries you,  the best approach is to contact your doctor’s office. Your doctor may be able to solve the problem by phone or work you quickly into the office schedule.

• Routine planned visits: These visits are usually for a new consultation or a follow-up for a known condition. You can get more from these scheduled visits if you do some preparation.

The New Consultation

You can take a few steps to ensure a new consultation goes as smoothly as possible.

Educate yourself beforehand: Understand the reason for the consultation from your referring doctor. Have you read up on your particular problem? Have you checked the credentials and experience of the new doctor? Is this new doctor affiliated with a hospital that you like? Does the doctor accept your insurance?

Bring your medical records, drug list, and results of any lab/radiology studies: This step can make a major difference in your first visit. Medical records provide a clear picture of your health history. The doctor can read faster than you can talk, and this written information frees up time for the doctor to have a better conversation with you. The information may also reduce the need for more tests, allowing the doctor to focus on a diagnosis and treatment plan.

Prepare a list of questions in advance: Make a list that you can share with the doctor. This conversation will help you to understand the medical issues involved, as well as help the doctor understand your concerns.

Ask a close relative or friend to accompany you on the visit: This has several advantages. Your relative may remember something about your medical history that you forgot to mention. They may also be helpful in remembering specific details that the doctor mentions. Additionally, it is always comforting to have a close companion with you to provide support.

Ask the doctor to summarize their findings and recommendations for you: Then, in your own words, repeat the summary back to the doctor. This will help you remember details and ensure that you and your doctor are on the same page regarding your problem and action plan. Don’t be shy about asking questions. Doctors want their patients to be well informed.

Understand the plan and goals before the next visit: These may include any new medications, tests, procedures, or therapies. For each one, consider asking the following questions: How does this test or therapy work? Why do I need it? How long will I need it? What are its benefits? What are its risks? For a new medication, what side effects should I look for? Will it interfere with my current medication? If I have a problem, who should I contact?

Ask for a printout: Request hardcopies of any diagnosis, medications (especially new ones), or tests before you leave the office. You can also ask the doctor to send you a written summary of the visit for your records. By law, you are entitled to this information, and physicians are usually glad to provide it.

Learn more about your condition: Although you may have read about the subject beforehand, your doctor may direct you to other helpful resources. The information may come in the form of written materials or online resources. HealthWeb Navigator can direct you to the most trustworthy, independently reviewed health websites online today.

The Follow-Up

Follow-up visits are scheduled so that the doctor and patient can monitor progress together. You should expect to discuss the following issues with your doctor:

• Are you feeling better or worse?

• Are there any problems to report? If so, let the doctor know early in the visit. They can evaluate whether this issue is serious and/or related to other conditions.

• Are you taking your medicines as prescribed?

• Have you had any new tests or other doctor visits recently? The doctor may not have the results but should be able to get them quickly.

• Do you have any questions about your condition?

• Do you understand the treatment plan? Before you leave the appointment, be sure you receive written summaries and instructions.

Based on my decades of practice, this preparation makes the office visit more productive for doctor and patient alike.

Final Tip

Sometimes routine follow-up visits become “too routine.” Physicians know that patients spend a lot of time and money on medications and doctor visits. If you are doing well and everything has been under control, you may want to pose the following questions to your doctor:

• Can I cut back on any of my medicines (or even stop them)?

• Can I reduce the number of routine follow-up visits?

• Can some of these follow-ups be done by phone or email?

Physicians are modernizing their practices to suit your needs. I suspect that most are more than willing to discuss these requests.

Choosing Your Primary Care Physician

By Nathan Blake |12/19/16
Updated |10/20/17

When my partner and I relocated from Virginia to Massachusetts, neither of us had a gameplan for what we would do once we got there. A partial list of things we didn’t have included: an apartment, jobs, state driver’s licenses, a local bank, and health insurance.

Fortunately we were able to cross off everything from that list within a month. But the last item—securing health insurance—was only the first step in health maintenance. I knew eventually I would want a medical professional I could trust to help me make my healthcare decisions, both big and small.

What I was needed was a primary care physician, or PCP.

What’s a Primary Care Physician? And Why Should I Have One?

Primary care physicians provide general medical services to specific patient populations. A pediatrician manages the health of infants and children. Internists provide care to adults, diagnosing the nonsurgical treatment of diseases. A gynecologist specializes in pregnancy, childbirth, and the postpartum period. Each is a primary care physician.

PCPs, unlike many other health specialists, get to know their patients intimately and over a longer period of time. The ongoing nature of the PCP-patient relationship means the doctor can better assess what’s considered “normal” (and what isn’t) for each patient.

But those aren’t the only benefits of having a primary care physician.

The PCP often serves as a patient’s go-to medical resource. No more Dr. Google—with a primary care physician, you can voice any medical concern you have and expect to be treated with respect by an actual health expert. It’s the primary care physician’s job to provide the patient with the very best care available, whether that care is in-house or through a referral to another specialist.

Primary care physicians and patients engage in what is called “continuity of care,” which means building a personal relationship that develops year after year. Keeping a close watch over a patient’s health allows PCPs to better intervene with disease prevention, patient education, health maintenance, and the diagnosis and treatment of both acute and chronic illnesses.

Lastly, the ease of access and communication involved with visiting a primary care physician is unrivaled. Longstanding doctor-patient relationships afford patients the opportunity to truly understand and participate in decisions that affect their health.

Once I settled down in Massachusetts, I knew I would need a primary care physician in my corner if I wanted to stay on top of my health. Turns out I had no idea how to actually go about choosing a primary care physician.

How Do I Choose a Primary Care Physician?

Choosing a primary care physician is sort of like dating: there’s a large pool to choose from, and finding the right “fit” may take some trial and error. Here are some tips I picked up that may help you find the doctor who best fits your personal needs. Let us know in the comments if they help!

Know your insurance plan. Contact your health insurer or check your policy’s benefits to find out which doctors are considered “in-network.” These doctors will offer you discounted rates that have been negotiated by your health plan. Doctors considered “out-of-network,” on the other hand, often require patients to pay for their services up-front and in full. Do yourself a favor and choose a PCP who is willing to work with your health insurance. We have an entire post focused on how to work with a doctor who doesn’t accept your health insurance.

Ask around. Consider asking for recommendations from friends, family, and coworkers. Most people feel more comfortable visiting doctors who have been recommended by someone they trust. Another benefit is that other people (or websites if you’re looking online) can help you pinpoint exactly what you want in a healthcare provider. Are they male or female? Old or young? Laid-back or over-serious? The more you know about a doctor increases the chances that you’ll find one you like.

Look for compatibility. Many patients schedule preliminary interviews with potential doctors to determine “fit.” Imagine the first visit as a trial run, and don’t rule out your gut-feeling. Does the doctor explain things clearly? Do they listen without interrupting? Is the doctor relatable or more formal than your liking? Can you tell if the doctor prefers aggressive treatment or a more prolonged “wait-and-see” approach? All of these questions will help you in your search for a primary care physician.

Plan logistically. If you have a specific health condition like diabetes, you should choose a PCP who has specialized training or experience in endocrinology to receive the best care for your needs. Other logistical considerations include the distance required to travel to the doctor’s office, schedule flexibility, and whether or not the doctor can understand you preferred language. Make a list of your “wants” and “needs,” which you can then use to narrow down the pool.

Understand availability. Not all primary care physicians accept new patients. Even doctors with availability may have hours that conflict with your schedule. Some PCPs have dozens of patients, and those with more responsibilities require longer wait times to schedule an appointment. Reach out to the doctor to get a better idea of their availability before you commit. You may be able to find someone who is a better fit for your schedule.

Check for qualifications. A doctor is tasked with matters of literal life and death. Of course you’re not going to take advice from someone who isn’t qualified to give that advice. You want your health advisor to be an authority in their field, with an education and professional background that reflects expertise. Check online or through the doctor’s office to see if the doctor is board-certified in the field(s) that you are visiting them for.

Are you ready to find your own primary care physician? Check out the “Physicians” tab on our homepage to browse resources we recommend for locating a doctor online. Happy hunting!

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