Hospital web site archeology

When “googling” for hospital information we often wind up at hospital web sites.

Hospital web sites are marketing based so how does one find and aggregate key elements and then do comparative analysis?

You can use these web sites for this exercise, all hospitals I have been involved with

Jersey City Medical Center (I was President & CEO from 1989-2006)   http://www.barnabashealth.org/Jersey-City-Medical-Center/About-Us.aspx

Mount Sinai Hospital (various positions at the medical school and medical center from 1979-1989, leaving as an SVP)   http://www.mountsinai.org/?lastName=O

CarePoint Health/ Hoboken (I was on the Board of the Hoboken Municipal Hospital Authority for three years)   https://www.carepointhealth.org/hoboken-university-medical-center#xDk1A

Meadowlands Hospital Medical Center (was part of LibertyHealth with Jersey City Medical Center) http://meadowlandshospital.org/

Ok, let’s get started:

Find ABOUT US. This is the picture painting how the hospital wants to be envisioned.

Find the MISSION STATEMENT, a formal summary of the aims and values of the hospital, as approved by the Board of Trustees and required for accreditation.

Compare ABOUT US and the MISSION STATEMENT. Are they clear and consistent?

Find ACCREDITATION. This gets trickier. A long list of certifications is not in of itself important. What is important is are they evidenced-based, completed by an arms-length review, and for a fixed period of time then must be renewed. You can google the agency and find the methodology used.

Find QUALITY. Again quality recognition awards should be evidenced-based, completed by an arms-length review, and for a fixed period of time then must be renewed. You can google the agency and find the methodology used.

Find AFFILIATIONS. A medical school affiliation is an excellent benchmark, however is it robust or ceremonial?

Go to LEADERSHIP/ BOARD OF TRUSTEES. Are Board member recognized community leaders?

And then go to

HOSPITAL COMPARE https://www.medicare.gov/hospitalcompare/search.html At this MEDICARE site you can compare hospital performance metrics.

THE LEAPFROG GROUP http://www.leapfroggroup.org/compare-hospitals an independent organization where you can compare hospital quality metrics

AGENCY FOR HEALTHCARE RESEARCH AND QUALITY http://archive.ahrq.gov/consumer/qnt/qnthosp.htm “How can you choose the best quality hospital for the care you need?”

AVOID for-profit “hospital quality” web sites which sell marketing packages to hospitals which pay to be surveyed!

 

 

 

 

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Stress Tests for super-size NFP hospital systems already too big to fail!

When I was growing up in Queens in the late mid-1950s the two “go-to” hospitals were Long Island Jewish and Booth Memorial.

In the early 1970’s the hospital system in the NYC metropolitan area was anchored and dominated by internationally renowned academic medical centers (then defined as a medical school and its primary teaching hospital on the same campus) – e.g., Columbia Presbyterian, Mount Sinai, NYU and Cornell. Academic affiliations were in place with area hospitals for teaching medical students and training residents.

Probably triggered by the North Shore/ LIJ merger in 1997 (North Shore was already a regional system with 10 hospitals) we have seen a rapidly accelerating merger trajectory from regional hospital systems focusing on becoming integrated health care delivery systems, to mega systems focusing on geographic reach, to super-size systems which have started or taken over medical schools, functioning almost like insurance companies and investment banks.

Some examples of the scale of super size systems:

North Shore, recently rebranded itself as Northwell Health, has annual revenue of $7.0 billion.  The LIJ name is history. http://medicine.hofstra.edu/about/history/history_nslij.html

The Mount Sinai Health System * has 3,535 beds on 7 hospital campuses.http://www.mountsinaihealth.org/about-the-health-system/facts-and-figures

New York Presbyterian includes two medical schools. Booth Memorial is now NYP Queens. http://www.nyp.org/about-us

RWJBarnabas Health, created last month by the merger of two mega systems, serves a geographic area that covers 5 million people, or more than half of New Jersey’s population. http://www.mycentraljersey.com/story/money/business/consumer/2016/03/31/robert-wood-johnson-barnabas-health/82489800/

To be followed imminently by the merger of Hackensack and Meridian https://www.meridianhealth.com/media/press-releases/2016/hackensack-university-health-network-and-meridian-health-announce-board-members.aspx

Geisinger, the powerhouse in central, south-central and northeast Pennsylvania now includes AtlantiCare in New Jersey http://www.geisinger.org/pages/about-geisinger/index.html  A number of New Jersey hospitals have academic and programmatic affiliations with NYC and Philadelphia medical schools.

All of the super-size systems are not-for-profits.

The NFP corporate veil has been weakened by the Atlantic Health System, owners of the Morristown Medical Center, agreeing to pay the town $15.5 million over the next 10 years in a property tax settlement based on its for-profit subsidiary profits. http://www.nj.com/morris/index.ssf/2015/11/atlantic_health_to_pay_morristown_155m_to_settle_t.html This is a template for all NFP hospitals in New Jersey and nationwide.

In New Jersey for-profit systems have been created or bought previously NFP hospitals. While “prohibited” in New York, recently there was talk of allowing for-profits demonstration projects particularly focused on rebuilding the hospital system with “other people’s money.”

In April “The Federal Reserve and the Federal Deposit Insurance Corporation said on Wednesday that five of the nation’s eight largest banks — including JPMorgan Chase and Bank of America — did not have “credible” plans for how they would wind themselves down in a crisis without sowing panic.” http://www.nytimes.com/2016/04/14/business/dealbook/living-wills-of-5-banks-fail-to-pass-muster.html

Are NFP super size hospital systems structured to handle a “bubble”? Are we ready for some to become “for-profits” to have access to capital?

The FTC opposed the 1997 North Shore/ LIJ merger, which was “approved” through litigation. Now in New Jersey and New York Certificates of Need for super-size mergers are awarded in a few months time.

Maybe it’s time for STRESS TESTS!

 

 

* Disclosure: I have been on the faculty at Mount Sinai for over forty years.

 

 

 

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Every clinician with a doctoral degree has earned the respect to be called doctor.

Over the past five years teaching in a health care MBA program, I had a number of students who were physical therapists. They had DPT (Doctor of Physical Therapy) degrees, worked at prestigious academic medical centers in NYC, but did not want to be, or were not called Doctor at work.

At one of the community hospitals in our system when I was a CEO, orthopedic surgeons (M.D.s) and podiatrists (DPMs) shared on-call for ankle (trauma) surgery. It was never clear enough for me that the patients were appropriately informed.

I went to the VA Hospital for a hearing test and was seen by Dr. Jones, an audiologist (Au.D)

The discussion became a kerfuffle by an article in the New York Times: “HI. I’m Dr. Patti McCarver, and I’m your nurse,” she said. And with that, Dr. McCarver stuck a scope in Ms. Cassidy’s ear, noticed a buildup of fluid and prescribed an allergy medicine. It was something that will become increasingly routine for patients: a someone who is not a physician using the title of doctor. Dr. McCarver calls herself a doctor because she returned to school to earn a doctorate last year, one of thousands of nurses doing the same recently. Doctorates are popping up all over the health professions, and the result is a quiet battle over not only the title “doctor,” but also the money, power and prestige that often come with it.” *

We are familiar with M.D. and D.O. (physicians). Many other clinicians are called doctor such as your dentist (D.M.D.), chiropractor (D.C.), and optometrist (OD), occasionally confused with ophthalmologists (M.D.).

Now many disciplines have doctoral degrees.

A patient (and family) on an acute rehabilitation medicine unit at a teaching hospital might be treated by a team of doctors including: a physiatrist (M.D.); a nurse manager (D.N.P., Ph.D, or Ed.D); a pharmacist (Pharm.D); a physical therapist (D.P.T.); a social worker (D.S.W.); a  psychologist (Psy.D.); an audiologist (Au.D.); an occupational therapist (DrOT); and a speech pathologist (SLP.D).

Every clinician with a doctoral degree has earned the respect to be called doctor but should be wearing a name tag that includes name, degree, and clinical profession such as: Mary Green, M.D., Neurology Resident; Stan Brown, D.N.P., Nurse Practitioner; or Chris Magenta, Psy.D., Clinical Psychologist.

If you are not certain who is treating you, ASK!!!

 

*When the Nurse Wants to Be Called ‘Doctor’

http://www.nytimes.com/2011/10/02/health/policy/02docs.html?pagewanted=all&_r=0

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We don’t know what we don’t know” (1) The challenge to emergency preparedness…..

The recent news that ZIKA is on a more rapidly spreading trajectory than previously predicted and the confirmed link between ZIKA and microcephaly has led me to reflect on my professional hospital administrator experience with “disasters”.

My first experience was in 1975; I was 30 years old, the Mount Sinai Administrator at Elmhurst Hospital. “A powerful bomb ripped through a baggage area crowded with holiday travelers at LaGuardia Airport….. killing 12 persons and injuring at least 75 others.” (2) The most seriously injured were transported to nearby EH, a trauma center. I manned a security post keeping family members and press out of the E.R., observed much but learned little.

The first World Trade Center bombing was in 1993, four years into my tenure as President and CEO of Jersey City Medical Center. (3)  As the nearby EMS service we sent all our ambulances through the Holland Tunnel into Manhattan. They got caught in the gridlock, were useless, and we didn’t get them back for three days and had to rely on Mutual Assist to cover our home turf.

In the mid 1990’s we had a 4-alarm arson fire in the hospital. The extraordinary efforts of the JCFD saved the day and 400 patients as we were evacuating the smoke-filled hospital, hampered by archaic elevators and narrow, dark stairways.   

My focus on LESSONS LEARNED started on September 11th, 2001 when as President and CEO of Jersey City Medical Center we were a lead responder to the World Trade Center attacks. A confidential LESSONS LEARNED memorandum to the New Jersey Commissioner of Health became public when the Mayor of Jersey, who was out of the country on Sept 11th and was planning a run for governor, leaked the report “Schundler Assails New Jersey’s Response to Terrorist Attack.” (4) The Governor’s Office was not happy.  

In 2004 I was visited by a Secret Service agent who told me that JCMC had been one of two hospitals designated as the primary back-up facilities for the Republican National Convention in Madison Square Garden and that we had to be fully staffed during the week before Labor Day, one of the slowest weeks of the year – and I couldn’t tell anyone why. 

In 2009 I suggested to the new Acting Mayor of Hoboken that the Swine Flu maps showed it pointing to the NYC/ Hoboken metropolitan area. This led to ““Hoboken Creates Swine Flu Task Force.” (5) Interestingly Swine Flu did not reach epidemic proportions most probably due to “herd” immunity (6) from the prior year’s sub-clinical outbreak.  

I monitored the Ebola outbreak starting in 2014 and advocated for the designation of regional centers as even as community hospitals “marketed” their preparedness. (7)

While I was not involved in Super Storm Sandy in 2015, the new Jersey City Medical Center opened in 2004 was hard hit even though it had been built to withstand the “100 year flood plain.” The hospitals in Hoboken and nearby North Bergen were totally evacuated.  

Which brings us to ZIKA.  ZIKA is a complex problem where participants have to reach agreement on goals while simultaneously evaluating options, in the context of “unknown unknowns.” Previous experience, even with Ebola, are not necessarily templates for ZIKA and the many existing and emerging mosquito-borne viruses. 

While it may be true that “no battle plan ever survives the first encounter with the enemy” (8), a plan is needed.  

I taught an MBA/ MPA/ MPHA course “Project Management. The hardest part about getting started……is getting started.” The public needs confidence that ZIKA planning is underway. 

 

 

  

1.  Donald Rumsfeld. “There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don’t know. But there are also unknown unknowns. There are things we don’t know we don’t know.”

2.  http://www.nydailynews.com/new-york/queens/laguardia-airport-bombing-kills-10-1975-article-1.2454144

3. http://news.bbc.co.uk/onthisday/hi/dates/stories/february/26/newsid_2516000/2516469.stm

4. http://www.nytimes.com/2001/09/22/nyregion/schundler-assails-new-jersey-s-response-to-terrorist-attack.html

5. http://www.nj.com/hobokennow/index.ssf/2009/08/hoboken_creates_swine_flu_task.html

6. http://www.vaccinestoday.eu/vaccines/what-is-herd-immunity/

7. http://hudsonreporter.com/view/full_story/25983889/article-Ebola–Local-medical-professional-releases-paper-on-what-to-do

8. http://www.lexician.com/lexblog/2010/11/no-battle-plan-survives-contact-with-the-enemy/

 

Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.

 

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YIKES! The out-of-pocket costs of my health insurance are clobbering me.

Back in the day we got health care indemnity insurance at work with no contribution toward the premium, and a modest deductible and co-pay.

Employer based health insurance and health insurance obtained from a public or private exchange now includes cost-sharing, disincentives and penalties. Most policy holders don’t know how much risk-sharing is involved until they get a big, unexpected bill after submitting s claim.

It’s important to learn the new health care insurance vocabulary and to be an educated consumer.

“Patients who don’t grasp fundamental health and insurance concepts are less likely to make smart decisions about when and where to seek care, experts said. In fact, people with low “health literacy,” as experts put it, are more likely to be hospitalized and use costly emergency rooms, according to the Institute of Medicine.” (1)

With this array of policy limitations, it is important that physicians consider affordability (out-of-pocket costs) as a factor in ordering diagnostic tests, suggesting referrals to specialists, and writing prescriptions.

So let’s get started:

REFERENCE PRICING.  “Reference pricing serves as a reverse deductible. Rather than the patient paying up to a defined limit and then the insurer covering the remainder, the insurer pays up to a defined limit and the patient pays the remainder. This has the remarkable feature of exposing the patient to the variation in prices for treatments that are above deductible thresholds. And the patient’s contribution isn’t limited by an annual out-of-pocket maximum. “(2))

FIXED INDEMNITY PLANS. “Fixed indemnity plans typically pay a limited cash benefit, with no deductible, to people who are hospitalized or encounter other medical costs. But the federal government said it was concerned that people might confuse those plans with standard health-insurance plans, and that the fixed indemnity plans alone couldn’t be considered to be coverage under the law’s requirement for most people to have insurance or pay a penalty.” (3)

VALUE BASED INSURANCE. “The additional cost when patients choose procedures that research shows are unlikely to help their condition is a key element of ….value-based insurance, the premise of which is that a mix of financial carrots and sticks can steer patients toward medical services that will help them and away from ineffective or unnecessary ones.” (4)

CONSUMER DIRECTED HEALTH PLANS.  “Consumer-directed health plans (CDHPs), which feature a high deductible and a personal health savings account, can reduce medical spending by employers and consumers.” (5)

EMPLOYER DEFINED CONTRIBUTION. “The idea that employers might decide to drop their health plans and replace them with a “defined contribution” for employees has been around for years. It’s one way for employers to control their expenses in the face of relentlessly rising health care costs. Now that the health law has created new online marketplaces where people can shop for coverage and made the individual market more accessible and affordable, the idea is gaining traction.” (6)

SHORT-TERM POLICIES.  “Consumers who missed open enrollment on the state health insurance marketplaces this spring or who are waiting for employer coverage to start don’t have to “go bare.” Short-term policies that last from 30 days up to a year can help bridge the gap and offer some protection from unexpected medical expenses. But these plans provide far from comprehensive coverage, and buyers need to understand their limitations. ” (7)

INSURANCE WITHOUT HOSPITAL BENEFITS.  “Lance Shnider is confident Obamacare regulators knew exactly what they were doing when they created an online calculator that gives a green light to new employer coverage without hospital benefits. “There’s got to be a problem with the calculator,” said Jost, a law professor at Washington and Lee University and health-benefits authority. Letting employers avoid health-law penalties by offering plans without hospital benefits “is certainly not what Congress intended,” he said. (8)

SKIN-IN-THE-GAME INSURANCE. (High Deductible Health Plans). “A report out today puts numbers behind what hit many workers when they signed up for health insurance during open enrollment last year: deductible shock. Premiums for employer-paid insurance are up 3% this year, but deductibles are up nearly 50% since 2009, the report by the Kaiser Family Foundation shows. The average deductible this year is $1,217, up from $826 five years ago. Nearly 20% of workers overall have to pay at least $2,000 before their insurance kicks in….”  (9)

OUT-OF-NETWORK EMERGENCY CARE. “When you need emergency care, chances are you aren’t going to pause to figure out whether the nearest hospital is in your health insurer’s network. Nor should you. That’s why the health law prohibits insurers from charging higher copayments or coinsurance for out-of-network emergency care. The law also prohibits plans from requiring pre-approval to visit an emergency department that is out of your provider network.  (Plans that are grandfathered under the law don’t have to abide by these provisions.)

Although the law protects patients from higher out-of-network cost sharing in the emergency room, if they’re admitted to the hospital, patients may owe out-of-network rates for the hospital stay….” (10)

GEOGRAPHLICALLY LIMITED HEALTH PLANS.  “UnitedHealthcare’s Oxford division is launching a New Jersey-only network of doctors and hospitals that will provide lower-cost health plans to employers who use the 18,000 doctors and 65 hospitals in the new Oxford Garden State Network.”

“It limits access to New Jersey-only providers and it is a solution for New Jersey employers where a smaller network offers a reduction in cost…,” (11)

DRIVE-BY DOCTORING.” In operating rooms and on hospital wards across the country, physicians and other health providers typically help one another in patient care. But in an increasingly common practice that some medical experts call drive-by doctoring, assistants, consultants and other hospital employees are charging patients or their insurers hefty fees. They may be called in when the need for them is questionable. And patients usually do not realize they have been involved or are charging until the bill arrives.” (12)

HEALTH-CARE SHARING MINISTERIES. “…… religious alternatives to enrolling in the federal insurance program in which members pool monthly payments to help cover one another’s medical expenses. So, unlike most uninsured Americans, (members of H-C SH) did not have to buy health insurance or risk a fine under the Affordable Care Act.” (13)

FEE-FOR-VALUE MODEL. “Horizon Blue Cross Blue Shield of New Jersey, the state’s largest health insurer, announced Thursday that it plans to offer new lower-priced insurance policies that offer discounts for care provided at 34 selected hospitals.” (14)

(1)    http://khn.org/news/many-patients-struggling-to-learn-the-foreign-language-of-health-insurance/

(2)    http://www.wsj.com/news/articles/SB10001424052702303448104579152111004814066

(3)    http://www.wsj.com/news/articles/SB10001424052702304547704579566401099222522

(4)    http://www.reuters.com/article/us-usa-healthcare-insurance-idUSBRE9BI04X20131219

(5)    http://content.healthaffairs.org/content/31/5/1009.abstract

(6)    https://www.washingtonpost.com/national/health-science/defining-what-defined-contributions-means-for-work-based-health-insurance/2014/05/13/a963ae06-da7e-11e3-a837-8835df6c12c4_story.html

(7)    http://www.webmd.com/health-insurance/20140807/shortterm-health-plans-might-offer-some-relief-but-they-have-significant-gaps

(8)    http://khn.org/news/employee-insurance-hospitalization-coverage/

(9)    http://doctordidyouwashyourhands.com/2015/02/employer-health-plan-deductibles-see-big-5-year-jump/

(10) http://khn.org/news/beware-of-higher-charges-if-you-go-to-an-out-of-network-emergency-room/

(11)http://www.njbiz.com/article/20140820/NJBIZ01/140829979/UnitedHealthcare’s-Oxford-starts-NJ-only-health-care-network

(12)http://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html?_r=0

(13)http://www.nytimes.com/2014/12/26/us/for-members-of-health-ministries-in-texas-caring-means-sharing-the-bills.html?_r=0

(14)http://www.nj.com/healthfit/index.ssf/2015/09/horizon_blue_cross_forms_network_with_22_hospitals.html

 

Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.

To get posts by email subscribe (free) at http://doctordidyouwashyourhands.com/

 

Jonathan M. Metsch, Dr.P.H. http://icahn.mssm.edu/profiles/jonathan-m-metsch

Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai

Adjunct Professor, Zicklin School of Business, Baruch College, C.U.N.Y.

Adjunct Professor, Rutgers Schools of Public Health & Public Affairs and Administration

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EMERGENCY ROOMS are not all created equal!

Let’s start with the “GOLDEN HOUR.”

“The golden hour is a window of opportunity in which rapid medical intervention can save a patient’s life or make a significant difference in the level of impairment a patient experiences after recovering from a medical emergency. People often use this term in the context of trauma medicine, where many members of the lay public are aware that rapid transport to a trauma center can make the difference between life and death, but it is also important for treatment of strokes, heart attacks, and other medical issues.” (1)

For stroke patients “… treatment within the golden hour is more successful because patients are candidates for the powerful clot-busting drug known as tPA (short for tissue plasminogen activator), which must be given within the first few hours after a stroke.” (2)

For heart attack patients the “…Golden Hour is a critical time because the heart muscle starts to die within 80-90 minutes after it stops getting blood, and within six hours, almost all the affected parts of the heart could be irreversibly damaged. So, the faster normal blood flow is re-established, the lesser would be the damage to the heart.” (3)

So it is important to get immediately to the right ER rather than always be taken to, or going to the nearest ER. A stop at the wrong ER for  trauma, stroke or a heart attack, then a transfer to the right ER, can pierce the golden hour.

Some states have multiple levels of Stroke Center with different capabilities. New Jersey has two: Primary and Comprehensive. (4)

Some hospitals have been awarded Chest Pain Center accreditation by the Joint Commission. (5) Cardiac Centers should have interventional cardiac catheterization laboratories; an excellent standard is in-house interventional cardiologists 24/7.

It is worth knowing that some hospitals have separate psych and pediatric ERs. And there are now some separate geriatric ERs and obstetrical ERs.

Next you should know the training of the physicians who staff an ER. The Gold Standard is board certified Emergency Medicine trained physicians 24/7.

“Emergency medicine focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization, and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. A high-pressure, fast-paced, and diverse specialty, emergency medicine requires a broad base of medical knowledge and a variety of well-honed clinical and technical skills.” (6)

Beware of ERs staffed by “moonlighter” from other specialties and/or “on-call” specialty consultants who bill fee-for-service. And while an ER might be in-network for the hospital charges, it is possible (though unconscionable) that the ER physicians and specialty consultants are out-of-network and will not accept what your insurance pays them, leading to “balance billing.”

Just because you think you have been admitted doesn’t mean you have actually been admitted. You may be “Under Observation.” “You’re an inpatient starting when you’re formally admitted to a hospital with a doctor’s order. The day before you’re discharged is your last inpatient day. You’re an outpatient if you’re getting emergency department services, observation services, outpatient surgery, lab tests, X-rays, or any other hospital services, and the doctor hasn’t written an order to admit you to a hospital as an inpatient. In these cases, you’re an outpatient even if you spend the night at the hospital. (7)

Like me you may have seen highway billboards “clicking” nearby ER waiting time. While Waiting times are important all ERs triage patients so seriously ill get to the head of the line

For a serious, undiagnosed problem UrgiCare Centers are not alternatives to ERs. UrgiCenters are appropriate alternatives to the ER for situations where you normally go to a doctor’s office or health center. (8)

The Emergency Room is a new hospital “front door” as protocol driven medicine channels only the sickest patients to hospitals. Hospitals take this “high risk” role very seriously and monitor ER quality diligently. But all ERs are not the same and an educated consumer approach is necessary as you consider emergency health care decisions.

(1) http://www.wisegeek.com/in-medicine-what-is-the-golden-hour.htm#didyouknowout

(2) https://www.caring.com/questions/golden-hour-stroke

(3) http://apollolife.com/HealthTopics/Heart/GoldenHourforHeartAttackPatients.aspx

(4) http://www.thenecc.org/images/Mammo.Gizzy.pdf

(5) http://www.jointcommission.org/chest_pain_certification_process/

(6) https://www.aamc.org/cim/specialty/list/us/336838/emergency_medicine.html

(7) https://www.medicare.gov/Pubs/pdf/11435.pdf

(8) http://www.usatoday.com/story/money/personalfinance/2015/12/30/primary-care-urgent-care-er-all-depends-what-ails-you/76979284/

 

Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.

To get a once weekly post by email subscribe (free) at http://doctordidyouwashyourhands.com/

Jonathan M. Metsch, Dr.P.H.

http://icahn.mssm.edu/profiles/jonathan-m-metsch

Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai

Adjunct Professor, Zicklin School of Business, Baruch College, C.U.N.Y.

Adjunct Professor, Rutgers Schools of Public Health & Public Affairs and Administration

 

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How to find the best doctor?

A great way to find out who the best doctors are is to learn who respected doctors themselves see and send their families to see. But this is not so easy unless you are an ”insider” like me having worked as a hospital executive with physician colleagues to ask.

So here is a suggested strategy:

1. Find a well qualified primary care physician (PCP). Usually a physician in family practice, internal medicine, obstetrics/gynecology, or pediatrics who is a patient’s first contact for routine, outpatient health care. (Start with personal recommendations than use Google to get more information.)

2. “Best Doctor” lists are useful but learn to differentiate between lists which are independent publications from ones where physicians can “pay to play.” (can usually be found in an appendix.)

3. Your PCP should be Board Certified. Many specialties now require periodic Maintenance of Certification, beyond initial certification.

4. Look for a PCP who has admitting privileges at a nearby community hospital and a regional teaching hospital. Better yet a physician with a medical school faculty appointment who teaches medical students and residents.

5. Ask if your PCP will participate in managing your care if you are admitted to the hospital, or transfer your care off to a “hospitalist.”

6. Takes your insurance and is not “out-of-network.” And has a an in-network panel for specialist referrals.

7. Uses your preferred medical decision making style – e.g., physician led, shared patient/ doctor discussion.

8. Has convenient office hours and off-hours phone/ email availability or back-up.

9. Listens to you and does not appear to be preoccupied or rushed. And does not continually get interrupted or take phone calls during your visit.

10. Answers your questions clearly in an evidenced-based way.

11. Uses an Electronic Medical Record to share information with your other clinicians, and with a patient portal so you can easily access your medical record.

12. Orders diagnostic test thoughtfully (not defensively) and prescribes antibiotics carefully (and not simply because you ask).

13. Washes his or her hands in front of you every time and is not insulted if you ask “Doctor, Did You Wash Your Hands? ™”

 

To get one weekly post by email subscribe (free) at http://doctordidyouwashyourhands.com/

Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.

 

Jonathan M. Metsch, Dr.P.H.

http://icahn.mssm.edu/profiles/jonathan-m-metsch

Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; Adjunct Professor, Zicklin School of Business, Baruch College, C.U.N.Y.; Adjunct Professor, Rutgers Schools of Public Health & Public Affairs and Administration

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