There
are tremendous advances taking place in medicine today, but in order
to benefit from them, the healthcare consumer must take an active
role. The best healthcare will not find you; you have to seek it
out.
While
the United States offers the highest standard of healthcare in the
world, there is still huge treatment variation based on the doctor
you see. Bottom line, the doctor you choose will determine the quality
of care you will receive. Here is an overview of how to navigate
through the healthcare system to find the best doctor for you.
The
era of the super-specialist
First,
the healthcare consumer needs to understand that today’s medical
field is divided into very narrow specialty categories. Twenty years
ago, the specialty of orthopedic surgery addressed a variety of problems
including knee, foot, hip, shoulder, hand and spine. While an orthopedic
surgeon in a small rural town may still address all these problems,
most orthopedic surgeons today in larger cities specialize in only
one of those areas. Therefore, the educated healthcare consumer with
a knee problem should seek out an orthopedic surgeon who only works
on knees. This increases the likelihood that the surgeon will be more
proficient in surgery and will use the most advanced surgical techniques
available for knees.
Spine
specialists can include neurosurgeons specialized in spine surgery,
orthopedic surgeons specialized in spine surgery, physical medicine
doctors, anesthesiologists and physical therapists who specialize
in the nonsurgical relief of back and neck pain symptoms.
As
with anything in life, practice makes perfect. All clinical outcome
studies confirm that the more times a surgeon performs a procedure,
the better they become at it. Consequently, spine surgeons who perform
more than 150 surgeries per year will be more proficient than those
who perform 50 each year.
A
second indicator of quality is training and experience of the physician.
One might believe that a younger physician a few years out of training
might be at a disadvantage compared to a surgeon who has practiced
for 25 years or more. However, this is not an accurate generalization.
In reality, an older physician may be more comfortable using traditional
techniques, while a younger, fellowship-trained physician may be
trained in the most modern, minimally invasive techniques and instrumentation.
Age is not necessarily a good indicator of quality.
About
using your health insurance plan as a guide
Most
people are surprised to learn that their health insurance provides
little help in finding the best specialist within a specific niche.
Offering a preferred provider directory of specialists gives no real
indicator of quality. Inclusion in a PPO directory typically only means
that the physician has agreed to accept a discounted rate for payment
from the insurance company. In this sense, “preferred provider” simply
means that the insurance company would “prefer” you to
see doctors who have agreed to accept a discount. These discounts can
be steep, depending upon the health insurance plan.
Unlike other industries, in which market demand and the highest quality
product commands the highest price, healthcare is an industry that
is woefully behind the times. But that is changing.
A
growing trend nationwide is that super-specialists, who are in the
highest demand by virtue of reputation and outcomes, can be less
motivated to accept discounted reimbursement from some health plans.
These super-specialists typically have full schedules and don’t
need to discount their services to attract patients. Consequently,
they are opting not to be included in a PPO panel, while other physicians
may have to rely on discounting to attract patients.
Most
PPO plans have out-of-network benefits that enable patients to see
a physician who is not listed in the PPO directory. Typically, the
person may have to pay a larger percent of the bill and a larger
deductible. But for complex problems, this still may be the more
prudent approach in the long run to access the most current technology
and the specialist with the least invasive treatment alternatives.
More
and more employers are recognizing that traditional healthcare plans
have historically done a poor job of establishing panels of physicians
based on quality care. Consequently, several employers are seeking
out centers of excellence for the treatment of complex problems like
cancer, heart disease, neuroscience, organ transplants, joint implants
and spine problems.
The
business of being a super-specialist
Part
of the problem related to PPO panel discounting is that it penalizes
top super-specialists who invest in the most advanced and expensive
technology for their offices, highly trained physician assistants and
a modern clinic facility with multiple capabilities under one roof
for patient convenience. By being on a PPO panel, a super-specialist
who has invested additional years in training, fellowships and advanced,
continuing education courses in the latest procedures must accept the
same level of payment as a generalist who has not similarly invested
in training, support staff and clinic facilities.
In
this sense, health insurance plans are not able to steer consumers
to the highest quality physicians. They are, however, in a difficult
position because they find themselves somewhat handcuffed and unable
to direct consumers to the highest quality physicians. On one hand,
every healthcare plan medical director knows that the best physicians
and super-specialists will save money as their outcomes improve and
as they provide minimally invasive surgery options that are less
risky. These directors are trying to determine ways to subtly encourage
patients to seek out centers of excellence for complex problems.
However, they are also concerned with possible litigation from other
physicians that may develop if they overtly favor one center over
other physicians.
Under
this current scenario, healthcare consumers are left on their own
to search for a top healthcare provider. It is their responsibility
to research the best center of excellence for treatment of a complex
health problem.
How
to find a super-specialist
There
are many ways to identify the best specialist within a given area.
A good place to start is to consult a family practice doctor who addresses
your general healthcare needs. This “primary care” doctor
will usually know the best super-specialists within a specific region.
Also, since this primary care physician may have referred patients
to that specialist before, they may have seen firsthand their clinical
outcomes after surgery. If these outcomes are poor, the primary doctor
will not refer additional patients.
On
the downside, this referral process abdicates the selection process
to someone else. The educated healthcare consumer would do well to
perform secondary research to identify the best possible specialists
and clinics within a given specialty.
The
Internet can provide a wealth of helpful information. The educated
consumer can locate information on a doctor’s education, training,
clinic and area of specialization.
Cues
on physician competence
Fellowship
training, the highest level of training in the United States, can be
an indicator that the physician has invested an additional year in
a specific area of specialization. Note where the physician has trained.
Training at a large or prestigious institution would expose the physician
to more complex cases, which in turn makes them more proficient in
their chosen specialty.
Board
certification is another criteria that indicates a physician has
met the competency standards within an area of specialization, as
judged by the specialty board. Board certification typically requires
that a physician has been in practice for several years since graduating
from medical school and has passed a rigorous written and oral exam.
Using
the Internet for information
When
looking at a physician’s own Internet site, determine if the
physician takes a multidisciplinary approach to his specialty. Typically,
the best specialists will place a variety of complementary services
under one roof for the convenience of the patient. This center of excellence
approach can involve having therapists who are specialized in a particular
niche as well as an internal diagnostic center with X-ray, MRI and
treatment suites, so that patients don’t need to drive around
town for various diagnostic studies or treatments.
Complement
this search within individual Internet sites with a review of reputable
national sites that provide overall information about a specialty.
These sites will list all the various treatment options for a given
problem, including watchful waiting. Then compare this impartial,
unbiased list with the recommendations provided by a specific clinic’s
Internet site.
Beware
of sites that appear to be informational but are, in fact, steerage
devices for physicians who pay the site to be listed as “preferred
providers.” Typically, the only impartial sites are those related
to the specialty boards of the American Medical Association such
as the American Academy of Orthopedic Surgeons (AAOS) or the American
Academy of Neurological Surgeons (AANS). The societies responsible
for board certification usually provide a nonbiased listing of the
board-certified physicians in your area.
Get
a second opinion
Most
health insurance plans advise or require that the healthcare consumer
receive a second opinion when treatment involves a complex surgical
procedure. This is excellent advice. Furthermore, the healthcare consumer
should not inform the second provider that their visit relates to a
second opinion, since some physicians are reluctant to provide conflicting
opinions. If you have received two identical, unbiased opinions related
to your diagnosis and recommended treatment, you can proceed accordingly
with more confidence that you are pursuing the right approach.
If
the two opinions disagree, you should examine the training and qualifications
behind each opinion to determine which is most likely the correct
recommendation. Another option is to pursue a third opinion, but
this can add to your confusion.
Be
willing to travel
The
trend in medicine is that the best specialists are creating Centers
of Excellence that focus on certain problems like cancer, neuroscience,
spine problems, diabetes, asthma, etc. Because the cost of developing
these centers is high, they typically exist only in larger cities.
Consequently, if you need complex surgery, be prepared to travel.
The
physician visit
The
best specialists within a given niche will typically provide all the
appropriate nonsurgical and surgical treatment options for your problem,
along with the pros and cons of each approach. In some cases, treatment
may include watchful waiting. If your doctor is unwilling to answer
questions about your diagnosis or treatment, you’re in the wrong
place. Go find another doctor.
Be
a good patient
After
all the searching, if you’ve found a good doctor, the rest is
in your hands. To be a good patient, you must comply with the physician’s
recommendations and prescriptions. Too many times, it’s natural
to want a magic pill or miracle surgery to provide an easy route back
to activity. However, you should always view surgery as the last card
to be played, after all nonsurgical options are explored.
For
nonsurgical treatment alternatives to work, the patient must often
follow physician and therapist prescriptions, which may include a
commitment to therapy. For spine and joint problems, this may mean
incorporating special strengthening exercises that rebuild supporting
muscles, so that surgery isn’t necessary. While athletes are
familiar with the required commitment and pain associated with the
exercise gym, others may not. It can be new territory for many people,
but it is essential if you are to give nonsurgical options a chance
to work.
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