Blog Archives

Five Important Questions About Pfizer’s COVID-19 Vaccine As Reported By Kaiser Health News

November 11, 2020 No comment

Pfizer’s announcement on Monday that its COVID-19 shot appears to keep nine in 10 people from getting the disease sent its stock price rocketing. Many news reports described the vaccine as if it were our deliverance from the pandemic, even though few details were released.

There was certainly something to crow about: Pfizer’s vaccine consists of genetic material called mRNA encased in tiny particles that shuttle it into our cells. From there, it stimulates the immune system to make antibodies that protect against the virus. A similar strategy is employed in other leading COVID-19 vaccine candidates. If mRNA vaccines can protect against COVID-19 and, presumably, other infectious diseases, it will be a momentous piece of news.

“This is a truly historic first,” said Dr. Michael Watson, the former president of Valera, a subsidiary of Moderna, which is currently running advanced trials of its own mRNA vaccine against COVID-19. “We now have a whole new class of vaccines in our hands.”

But historically, important scientific announcements about vaccines are made through peer-reviewed medical research papers that have undergone extensive scrutiny about study design, results and assumptions, not through company press releases.

So did Pfizer’s stock deserve its double-digit percentage bump? The answers to the following five questions will help us know.

1. How long will the vaccine protect patients?

Pfizer says that, as of last week, 94 people out of about 40,000 in the trial had gotten ill with COVID-19. While it didn’t say exactly how many of the sick had been vaccinated, the 90% efficacy figure suggests it was a very small number. The Pfizer announcement covers people who got two shots between July and October. But it doesn’t indicate how long protection will last or how often people might need boosters.

“It’s a reasonable bet, but still a gamble that protection for two or three months is similar to six months or a year,” said Dr. Paul Offit, a member of the Food and Drug Administration panel that is likely to review the vaccine for approval in December. Normally, vaccines aren’t licensed until they show they can protect for a year or two.

The company did not release any safety information. To date, no serious side effects have been revealed, and most tend to occur within six weeks of vaccination. But scientists will have to keep an eye out for rare effects such as immune enhancement, a severe illness brought on by a virus’s interaction with immune particles in some vaccinated persons, said Dr. Walt Orenstein, a professor of medicine at Emory University and former director of the immunization program at the Centers for Disease Control and Prevention.

2. Will it protect the most vulnerable?

Pfizer did not disclose what percentage of its trial volunteers are in the groups most likely to be hospitalized or to die of COVID-19 — including people 65 and older and those with diabetes or obesity. This is a key point because many vaccines, particularly for influenza, may fail to protect the elderly though they protect younger people. “How representative are those 94 people of the overall population, especially those most at risk?” asked Orenstein.

Both the National Academy of Medicine and the CDC have urged that older people be among the first groups to receive vaccines. It’s possible that vaccines under development by Novavax and Sanofi, which are likely to begin late-phase clinical trials later this year, may be better for the elderly, Offit noted. Those vaccines contain immune-stimulating particles like the ones contained in the Shingrix vaccine, which is highly effective in protecting older people against shingles disease.

3. Can it be rolled out effectively?

The Pfizer vaccine, unlike others in late-stage testing, must be kept supercooled, on dry ice around 100 degrees below zero, from the time it is produced until a few days before it is injected. The mRNA quickly self-destructs at higher temperatures. Pfizer has devised an elaborate system to transport the vaccine by truck and specially designed cases to vaccination sites. Public health workers are being trained to handle the vaccine as we speak, but we don’t know for sure how well it will do if containers are left out in the Arizona sun too long. Mishandling the vaccine along the way from factory to patient would render it ineffective, so people who received it could think they were protected when they were not, Offit said.

4. Could a premature announcement hurt future vaccines?

There’s presently no way to know whether the Pfizer vaccine will be the best overall or for specific age groups. But if the FDA approves it quickly, that could make it harder for manufacturers of other vaccines to carry out their studies. If people are aware that an effective vaccine exists, they may decline to enter clinical trials, partly out of concern they could get a placebo and remain unprotected. Indeed, it may be unethical to use a placebo in such trials. Many vaccines will be needed in order to meet global demand for protection against COVID-19, so it’s crucial to continue additional studies

5. Could the Pfizer study expedite future vaccines?

Scientists are vitally interested in whether the small number who received the real vaccine but still got sick produced lower levels of antibodies than the vaccinated individuals who remained well. Blood studies of those people would help scientists learn whether there is a “correlate of protection” for COVID-19 — a level of antibodies that can predict whether someone is protected from the disease. If they had that knowledge, public health officials could determine whether other vaccines under production were effective without necessarily having to test them on tens of thousands of people.

But it’s difficult to build such road maps. Scientists have never established correlates of immunity for pertussis, for example, although vaccines have been used against those bacteria for nearly a century.

Still, this is good news, said Dr. Joshua Sharfstein, a vice dean at the Johns Hopkins Bloomberg School of Public Health and a former FDA deputy commissioner. He said: “I hope this makes people realize that we’re not stuck in this situation forever. There’s hope coming, whether it’s this vaccine or another.”

HOW I ESCAPED HOSPITAL BILLING ERROR PRISON

November 10, 2020 No comment

The team at Escaping the Healthcare Prison is dedicated to showing how healthcare consumers can escape their PRISON. Each of us has been a healthcare prisoner one time or another. The spectrum of issues is endless. Our monthly ESCAPE PLANS will help you navigate the healthcare maze.

BACK ROUND:

A 19-Year-old college student (we will call her Sally) became ill while away from home. She went to the emergency room and they determined she needed an Appendectomy. Sally was admitted to the hospital and the surgery was performed. The surgery was successful, and Sally was discharged. Sally had insurance with a large deductible.

SIX TO EIGHT MONTHS LATER:

The bills started to roll in; from the hospital, numerous doctors, etc. Sally’s mom was overwhelmed and asked the team at Escaping the Healthcare Prison to review the bills. The team received a copy of all the bills along with the Explanation of Benefits (EBO’s) from their insurance copy.

THE BILLING AND EOB REVIEW:

The team started to match the bills to the EOB’s. This step is critical because all the claim processing transactions on the EOB should be the same as they are on the bills. In Sally’s case, all EOB’s matched up with bills with the exception of one, the Hospital bill. There was one missing transaction on the EOB that did not appear on the bill, an $850 adjustment. The adjustment was the difference between what the insurance agreed to pay versus the hospital retail charges. The hospital should have adjusted the bill by that amount. The team secured a release from Sally and called the hospital. The hospital was surprised, and customer service representative said they needed to talk with their supervisor and would call us back. Several days later we received a called from the hospital apologizing for the error and adjusted the bill for the $850. Sally was incredibly grateful.

TAKE AWAY REGARDING MEDICAL BILLING:

Always match you EOB’s with the bills received from your hospital, doctor, etc… Never assume the bills are correct. Studies have shown that 8% of the bill’s consumers receive are wrong.
If you detect a difference between your EOB and bill, call the healthcare provider and ask them why. Be professional but demanding…they owe you an explanation.

Your team at Escaping the Healthcare Prison is always there to help the consumer. Use our website to let us know how we can help.

www.escapingthehealthcareprison.org

Job-Based Health Insurance Costs Are Up 4% This Year, 55% in Past Decade, Says Kaiser Health News

October 9, 2020 No comment

Health insurance costs for Americans who get their coverage through work continued a relentless march upward with average family premiums rising 4% to $21,342 this year, according to a study published Thursday.

The annual survey by KFF found workers on average are paying nearly $5,600 this year toward family coverage, up from about $4,000 in 2010 and $1,600 in 2000. (KHN is an editorially independent program of KFF.)

While health insurance costs rose a modest amount in 2020, as has been the trend in recent years, they soared 55% in the past decade — more than twice the pace of inflation and wages.

About 157 million Americans rely on employer-sponsored coverage — far more than any other type of coverage, including Medicare, Medicaid and individually purchased insurance on the Affordable Care Act exchanges. More than half of employers provide insurance to at least some workers.

“Conducted partly before the pandemic, our survey shows the burden of health costs on workers remains high, though not getting dramatically worse,” Drew Altman, KFF’s CEO, said in a statement. “Things may look different moving forward as employers grapple with the economic and health upheaval sparked by the pandemic.”

The survey was conducted from January to July as the coronavirus pandemic took hold and upended the nation’s economy. Many of the details of the employers’ plans that the researchers examined were set before the virus hit.

Since 2012, the cost of family coverage has increased 3% to 5% annually. It’s been more than 15 years since these costs were rising at double-digit rates.

Employers help shield workers from much of the cost of their health insurance premiums, though employees often feel the impact via higher deductibles, copayments and lower wages.

On average, workers pay 17% of the premium for single coverage and 27% for family coverage, the survey found. Workers at smaller companies pay 35% of the premium for family coverage, compared with 24% for larger companies, the survey found.

The average annual deductible for single coverage is now $1,644, up 25% in the past five years and 79% in the past decade.

Workers with coverage are exposed to higher costs when using the hospital since 65% have coinsurance, which means they are responsible for a fixed share of the charge, and 13% contribute a copayment, or fixed fee per visit or service. The average coinsurance for hospital admission is 20% and average copayment is $311 per hospital admission.

Workers are protected for catastrophic costs through limits set on their out-of-pocket spending in provider networks, although those amounts vary by employer: 11% face a maximum of less than $2,000, while 18% are in a plan with a maximum of $6,000 or more.

The study also noted that large employers have made it easier for workers to access care by adopting coverage for telemedicine in recent years. Nearly 9 in 10 companies that have 200 or more workers and offer insurance covered these medical appointments done via telephone or computer this year, up from fewer than 3 in 10 in 2015, according to the research. During the pandemic, telemedicine usage has increased markedly as people sought care from the safety of their home.

The KFF study is based on a telephone survey of 1,765 randomly selected nonfederal public and private employers with three or more workers from January to July.

Heartbreaking Bills, Lawsuit and Bankruptcy — Even With Insurance; Kaiser Health News

September 25, 2020 No comment

Matthew Fentress was just 25 when he passed out while stuffing cannolis as a cook for a senior living community six years ago. Doctors diagnosed him with viral cardiomyopathy, heart disease that developed after a bout of the flu.

Three years later, the Kentucky man’s condition had worsened, and doctors placed him in a medically induced coma and inserted a pacemaker and defibrillator. Despite having insurance, he couldn’t pay what he owed the hospital. So Baptist Health Louisville sued him and he wound up declaring bankruptcy in his 20s.

“The curse of being sick in America is a lifetime of debt, which means you live a less-than-opportune life,” said Fentress, who still works for the senior facility, providing an essential service throughout the coronavirus pandemic. “The biggest crime you can commit in America is being sick.”

Financial fears reignited this year when his cardiologist suggested he undergo an ablation procedure to restore a normal heart rhythm. He said hospital officials assured him he wouldn’t be on the hook for more than $7,000, a huge stretch on his $30,000 annual salary. But if the procedure could curb the frequent extra heartbeats that filled him with anxiety, he figured the price was worth it.

He had the outpatient procedure in late January and it went well.

Afterward, “I didn’t have the fear I’m gonna drop dead every minute,” he said. “I felt a lot better.”

Then the bill came.

Patient: Matthew Fentress is a 31-year-old cook at Atria Senior Living who lives in Taylor Mill, Kentucky. Through his job, he has UnitedHealthcare insurance with an out-of-pocket maximum of $7,900 — close to the maximum allowed by law.

Total Bill: Fentress owed a balance of $10,092.13 for cardiology, echocardiography and family medicine visits on various dates in 2019 and 2020. UnitedHealthcare had paid $28,920.52 total, including $27,561.37 for the care he received on the day of his procedure.

Service Provider: Baptist Health Louisville, part of the nonprofit system Baptist Health.

Medical Service: Fentress underwent cardiac ablation this year on Jan. 23. The outpatient procedure involved inserting catheters into an artery in his groin that were threaded into his heart. He also had related cardiology services, testing and visits to a primary care doctor and a cardiologist before and after the procedure.

What Gives: Fentress said he always made sure to take jobs with health insurance, “so I thought I’d be all right.”

But like nearly half of privately insured Americans under age 65, he has a high-deductible health plan, a type of insurance that experts say often leaves patients in the lurch. When he uses health providers within his insurer’s network, his annual deductible is $1,500 plus coinsurance. His out-of-pocket maximum is $7,900, more than a quarter of his annual salary.

Fentress owed around $5,000 after his 2017 hospitalization and set up a monthly payment plan but said he was sent to collections after missing a $150 payment. He declared bankruptcy after the same hospital sued him.

He faced another bill about a year later, when a panic attack sent him to the emergency room, he said. That time, he received financial aid from the hospital.

When he got the bill for his ablation this spring, he figured he wouldn’t qualify for financial aid a second time. So instead of applying, he tried to set up a payment plan. But hospital representatives said he’d have to pay $500 a month, he said, which was far beyond his means and made him fear another spiral into bankruptcy.

This precarious situation makes him “functionally uninsured,” said author Dave Chase, who defines this as having an insurance deductible greater than your savings. “It’s a lot more frequent than a lot of people realize,” said Chase, founder of Health Rosetta, a firm that advises large employers on health costs. “We’re the undisputed leaders in medical bankruptcy. It’s a sad state of affairs.”

Jennifer Schultz, an economics professor and co-director of the Health Care Management program at the University of Minnesota-Duluth, said Fentress faces a difficult financial road ahead. “Once you declare bankruptcy, your credit rating is destroyed,” she said. “It will be hard for a young person to come back from that.”

A recent survey by the Commonwealth Fund found that just over a quarter of adults 19 to 64 who reported medical bill problems or debt were unable to pay for basic necessities like rent or food sometime in the past two years. Three percent had declared bankruptcy. In the first half of 2020, the survey found, 43% of U.S. adults ages 19 to 64 were inadequately insured. About half of them were underinsured, with deductibles accounting for 5% or more of their household income, or out-of-pocket health costs, excluding premiums, claiming 10% or more of household income over the past year.

In Fentress’ case, the $10,092 he owed the hospital was more than a third of what his insurer paid for his care. The majority of his debt — $8,271.56 — was coinsurance, about 20% of the bill, which he must pay after meeting his deductible. Because the bill covered services spanning two years, he owed more than his annual out-of-pocket maximum. If all his care had been provided during 2019, he would have owed much less and the insurer would have been responsible for more of the bill.

Dr. Kunal Gurav, an Atlanta cardiologist who wrote about medical costs for the American College of Cardiology, said ablation usually costs about $25,000-$30,000, a range also confirmed by other experts.

The insurer’s payment for Fentress’ care that January day — around $27,600 — falls into the typical cost range, Gurav said. Fentress is being asked to pay $9,296, meaning the hospital would get more than $36,000 for the care.

Schultz, a state representative from Minnesota’s Democratic-Farmer-Labor Party, said nonprofit hospitals could potentially waive or reduce costs for needy patients.

“They definitely have a moral responsibility to provide a community benefit,” she said.

Resolution: Charles Colvin, Baptist Health’s vice president for revenue strategy, said hospital officials quoted Fentress an estimated price for the ablation that was within a few dollars of the final amount, although his bill included other services such as tests and office visits on various dates. Colvin said there appeared to be some charges that UnitedHealthcare didn’t process correctly, which could lower his bill slightly.

Maria Gordon Shydlo, communications director for UnitedHealthcare, said Fentress is responsible for 100% of health costs up to his annual, in-network deductible, then pays a percentage of health costs in “coinsurance” until he reaches his out-of-pocket maximum. So he will owe around $7,900 on his bill, she said, and any new in-network care will be fully covered for the rest of the year.

A hospital representative suggested Fentress apply for financial assistance. She followed up by sending him a form, but it went to the wrong address because Fentress was in the process of moving.

In September, he said he was finally going to fill out the form and was optimistic he’d qualify.

The Takeaway: Insurance performs two functions for those lucky enough to have it. First, you get to take advantage of insurers’ negotiated rates. Second, the insurer pays the majority of your medical bills once you’ve met your deductible. It pays nothing before then. High-deductible plans have the lowest premiums, so they are attractive or are the only plans many patients can afford. But understand you will be asked to pay for everything except preventive care until you’ve hit that number. And your deductible may be only part of the picture: “Coinsurance” is the bulk of what Fentress owes.

Out-of-pocket maximums are regulated by federal law. In 2021, the maximum will be $8,550 for single coverage. Try to plan treatment and procedures with an eye on the calendar — people with chronic conditions and this kind of insurance could save a lot of money if they have an expensive surgery in December rather than January.

As always, if you face a big medical bill, ask about payment plans, financial aid and charity care. According to the Baptist Health system’s website, the uninsured and underinsured can get discounts. Those with incomes equivalent to 200%-400% of the federal poverty level — or $25,520-$51,040 for an individual — may be eligible for assistance.

If you don’t qualify for help, negotiate with the hospital anyway. Arm yourself with information about the going rate insurers pay for the care you received by consulting websites like Healthcare Bluebook or Fair Health.

As Fentress tries to move past his latest bill, he’s now worried about something else: racking up new bills if he contracts COVID-19 down the road as an essential worker with existing health problems and the same high-deductible insurance.

“I don’t have hope for a financially stable future,” he said. “It shouldn’t be such a struggle.”

Dan Weissmann, host of “An Arm and a Leg” podcast, reported the radio interview of this story. Joe Neel of NPR produced Sacha Pfeiffer’s interview with KHN Editor-in-Chief Elisabeth Rosenthal on “All Things Considered.”

Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

ALERT!!!! Is Your Hospital Rated 1 Star by Medicare Their Lowest Rating?

September 25, 2020 No comment

CMS updated its Overall Hospital Quality Star Ratings Jan. 28, recognizing 228 hospitals with one star.

CMS’ Hospital Compare website reports on quality measures for more than 4,500 hospitals nationwide. Here is a breakdown of the updated star ratings:

One star: 228 hospitals
Two stars: 710 hospitals
Three stars: 1,191 hospitals
Four stars: 1,136 hospitals
Five stars: 407 hospitals

Below is a listing of CMS’ one-star hospitals, broken down by state, as listed on the Hospital Compare website. To view a list of CMS’ five-star hospitals, click here.

Arkansas

Baptist Health-Fort Smith

Chi-St. Vincent Infirmary (Little Rock)

Conway Regional Health System

Jefferson Regional Medical Center (Pine Bluff)

National Park Medical Center (Hot Springs)

St. Bernards Medical Center (Jonesboro)

Uams Medical Center (Little Rock)

California

Adventist Health and Rideout (Marysville)

Antelope Valley Hospital (Lancaster)

Beverly Hospital (Montebello)

Community Regional Medical Center (Fresno)

Doctors Hospital Of Riverside

Emanuel Medical Center (Turlock)

Hemet Valley Medical Center

Hollywood Presbyterian Medical Center (Los Angeles)

Kern Medical Center (Bakersfield)

LAC+USC Medical Center (Los Angeles)

Madera Community Hospital

Memorial Hospital Of Gardena

Menifee Global Medical Center (Sun City)

Mercy Hospital (Bakersfield)

Mercy Medical Center (Merced)

Mercy Medical Center Redding

O’Connor Hospital (San Jose)

Pioneers Memorial Healthcare District (Brawley)

Riverside University Health System-Medical Center (Moreno Valley)

San Joaquin General Hospital (French Camp)

San Leandro Hospital

Sierra View Medical Center (Porterville)

St. Bernardine Medical Center (San Bernardino)

St. Joseph’s Medical Center (Stockton)

St. Mary Medical Center (Apple Valley)

Twin Cities Community Hospital (Templeton)

USC Verdugo Hills Hospital (Glendale)

Victor Valley Global Medical Center (Victorville)

Zuckerberg San Francisco General Hospital and Trauma Center

Connecticut

Charlotte Hungerford Hospital (Torrington)

Waterbury Hospital

Florida

AdventHealth Lake Wales

AdventHealth New Smyrna Beach

Bayfront Health-Brooksville

Bayfront Health-Port Charlotte

Bayfront Health-Punta Gorda

Bayfront Health-Seven Rivers (Crystal River)

Blake Medical Center (Bradenton)

Boca Raton Regional Hospital

Broward Health Coral Springs

Broward Health North (Pompano Beach)

Cleveland Clinic Martin North Hospital (Stuart)

Halifax Health Medical Center (Daytona Beach)

Jackson Memorial Hospital (Miami)

JFK Medical Center (Atlantis)

Lakeland Regional Medical Center

Lawnwood Regional Medical Center and Heart Institute (Fort Pierce)

Manatee Memorial Hospital (Bradenton)

North Shore Medical Center (Miami)

Parrish Medical Center (Titusville)

Steward Melbourne Hospital

The Villages Regional Hospital

Wellington Regional Medical Center

Westside Regional Medical Center (Plantation)

Winter Haven Hospital

Georgia

Augusta University Medical Center (Augusta)

Coffee Regional Medical Center (Douglas)

Emory Decatur Hospital

Grady Memorial Hospital (Atlanta)

The Medical Center, Navicent Health (Macon)

Memorial Health University Medical Center (Savannah)

Phoebe Putney Memorial Hospital (Albany)

Piedmont Columbus Regional-Midtown

Piedmont Rockdale Hospital (Conyers)

Piedmont Walton Hospital (Monroe)

WellStar Atlanta Medical Center

Iowa

St. Luke’s Regional Medical Center (Sioux City)

Illinois

Franciscan Health Olympia Fields

Gateway Regional Medical Center (Granite City)

Jackson Park Hospital (Chicago)

John H. Stroger Jr. Hospital (Chicago)

Louis A. Weiss Memorial Hospital (Chicago)

Mercy Hospital and Medical Center (Chicago)

Mount Sinai Hospital (Chicago)

OSF Saint Francis Medical Center (Peoria)

University of Illinois Hospital (Chicago)

Kansas

St. Catherine Hospital (Garden City)

Kentucky

Hazard ARH Regional Medical Center

Highlands Regional Medical Center (Prestonsburg)

Jennie Stuart Medical Center (Hopkinsville)

Paul B. Hall Regional Medical Center (Paintsville)

Pikeville Medical Center

The Medical Center at Bowling Green

University of Kentucky Hospital (Lexington)

University of Louisville Hospital

Louisiana

Jennings American Legion Hospital

Ochsner LSU Health Shreveport

Tulane Medical Center (New Orleans)

University Medical Center New Orleans

Massachusetts

Good Samaritan Medical Center (Brockton)

MelroseWakefield Healthcare (Melrose)

Morton Hospital (Taunton)

Sturdy Memorial Hospital (Attleboro)

UMass Memorial Medical Center (Worcester)

Maryland

University of Maryland Prince George’s Hospital Center (Cheverly)

University Of Maryland Medical Center (Baltimore)

University Of Maryland Laurel Regional Hospital

Michigan

Detroit Receiving Hospital and University Health Center

Hurley Medical Center (Flint)

Sinai-Grace Hospital (Detroit)

Mississippi

Baptist Memorial Hospital-Desoto (Southaven)

Delta Regional Medical Center (Greenville)

Forrest General Hospital (Hattiesburg)

Memorial Hospital at Gulfport

Merit Health River Region (Vicksburg)

Southwest Mississippi Regional Medical Center (McComb)

St. Dominic-Jackson Memorial Hospital

University Of Mississippi Med Center (Jackson)

Missouri

Christian Hospital Northeast-Northwest (St. Louis)

Poplar Bluff Regional Medical Center

SoutheastHealth (Cape Girardeau)

SSM Health St. Louis University Hospital

Nebraska

Regional West Medical Center (Scottsbluff)

Nevada

Desert Springs Hospital (Las Vegas)

Spring Valley Hospital Medical Center (Las Vegas)

Summerlin Hospital Medical Center (Las Vegas)

Sunrise Hospital And Medical Center (Las Vegas)

University Medical Center (Las Vegas)

Valley Hospital Medical Center (Las Vegas)

New Jersey

Carepoint Health-Christ Hospital (Jersey City)

Carepoint Health-Hoboken University Medical Center

East Orange General Hospital

Hackettstown Medical Center

Inspira Medical Center Vineland

JFK Medical Center-Anthony M. Yelencsics Community (Edison)

Salem Medical Center

St. Joseph’s University Medical Center (Paterson)

Trinitas Regional Medical Center (Elizabeth)

University Hospital (Newark)

New Mexico

MountainView Regional Medical Center (Las Cruces)

UNM Hospital (Albuquerque)

New York

Albany Medical Center Hospital

Alice Hyde Medical Center (Malone)

Auburn Community Hospital

Bellevue Hospital Center (New York City)

Bronx-Lebanon Hospital Center (New York City)

Brookdale Hospital Medical Center (New York City)

Brooklyn Hospital Center at Downtown Campus (New York City)

Columbia Memorial Hospital (Hudson)

Coney Island Hospital Center (New York City)

Crouse Hospital (Syracuse)

Eastern Niagara Hospital (Lockport)

Ellis Hospital (Schenectady)

Elmhurst Hospital Center

Faxton-St. Luke’s Healthcare (Utica)

Flushing Hospital Medical Center (New York City)

Geneva General Hospital

Good Samaritan Hospital Medical Center (West Islip)

Good Samaritan Hospital of Suffern

Harlem Hospital Center (New York City)

Interfaith Medical Center (New York City)

Jacobi Medical Center (New York City)

Jamaica Hospital Medical Center (New York City)

Jones Memorial Hospital (Wellsville)

Kings County Hospital Center (New York City)

Kingsbrook Jewish Medical Center (New York City)

Lincoln Medical & Mental Health Center (New York City)

Long Island Community Hospital (Patchogue)

Maimonides Medical Center (New York City)

Mary Imogene Bassett Hospital (Cooperstown)

Mercy Medical Center (Rockville Centre)

Montefiore Medical Center (New York City)

Nassau University Medical Center (East Meadow)

Queens Hospital Center (New York City)

Richmond University Medical Center (New York City)

Rochester General Hospital

St. Barnabas Hospital (New York City)

St. Catherine of Siena Medical Center (Smithtown)

St. Elizabeth Medical Center (Utica)

St. John’s Episcopal Hospital (New York City)

St. Joseph’s Medical Center (Yonkers)

Staten Island University Hospital (New York City)

United Health Services Hospitals (Binghamton)

University Hospital of Brooklyn-SUNY Downstate (New York City)

Vassar Brothers Medical Center (Poughkeepsie)

Westchester Medical Center (Valhalla)

Wyckoff Heights Medical Center (New York City)

North Carolina

Halifax Regional Medical Center (Roanoke Rapids)

Nash General Hospital (Rocky Mount)

Ohio

Clinton Memorial Hospital (Wilmington)

East Ohio Regional Hospital (Martins Ferry)

Trumbull Regional Medical Center (Warren)

University of Toledo Medical Center

Oklahoma

Comanche County Memorial Hospital (Lawton)

Hillcrest Medical Center (Tulsa)

OU Medicine (Oklahoma City)

Saint Francis Hospital Muskogee

Pennsylvania

Albert Einstein Medical Center (Philadelphia)

Conemaugh Memorial Medical Center (Johnstown)

Hahnemann University Hospital (Philadelphia)

Pottstown Hospital

Regional Hospital of Scranton

Thomas Jefferson University Hospital (Philadelphia)

Wilkes-Barre General Hospital

Puerto Rico

Auxilio Mutuo Hospital (San Juan)

Doctors’ Center Hospital-San Juan

Doctors’ Center Hospital (Manati)

Hima San Pablo-Bayamon

Hima San Pablo-Caguas

Rhode Island

Rhode Island Hospital (Providence)

South Carolina

Trident Medical Center (Charleston)

The Regional Medical Center of Orangeburg and Calhoun (Orangeburg)

Tennessee

Holston Valley Medical Center (Kingsport)

Jackson-Madison County General Hospital

Johnson City Medical Center

Methodist Medical Center of Oak Ridge

Texas

City Hospital at White Rock (Dallas)

Coleman County Medical Center

HCA Houston Healthcare Tomball

Huntsville Memorial Hospital

Medical Center Hospital (Odessa)

Southwest General Hospital (San Antonio)

Virginia

Bon Secours Maryview Medical Center (Portsmouth)

Wisconsin

Ascension All Saints Hospital (Racine)

West Virginia

Charleston Area Medical Center

Wheeling Hospital

Washington, D.C.

George Washington University Hospital

Howard University Hospital

Medstar Georgetown University Hospital

Medstar Washington Hospital Center

HOW I ESCAPED THE BIG PHARMA PRISON

September 25, 2020 No comment

The team at Escaping the Healthcare Prison is dedicated to showing how healthcare consumers can escape their PRISON. Each of us has been a healthcare prisoner one time or another. The spectrum of issues is endless. Our monthly ESCAPE PLANS will help you navigate the healthcare maze.

HOW I ESCAPED THE BIG PHARMA PRISON

BACK ROUND:

Jim, a 59-year-old male recently had his yearly check up with his specialty doctor. Jim and his doctor were reviewing his prescriptions of which one was specialty drug not covered by his insurance. Jim asked his doctor to renew all his prescriptions with his local Pharmacy. The specialty drug was included. Jim knew the drug was not covered under is insurance plan. Jim had never bought the prescription because it was of the high cost.

SEVERAL DAYS LATER:

Jim received a call from the Pharmacy that his prescriptions were ready, but the specialty drug was not covered. They advised him to find a coupon and bring it in. Jim heard about companies that helped consumers reduce their drug costs. Jim looked up the drug on Good RX and found a coupon for 30 pills for $19.85. Jim printed the coupon and went to Pharmacy.

THE PHARMACY:

Jim arrived at the pharmacy to pick up his prescription. The pharmacist told Jim prescription for his speciality drug was priced at $2,164.49 for 30 pills. This is the cash and carry price. They asked Jim if he brought in a coupon. Jim presented the Good RX coupon, the Pharmacy accepted it and Jim paid $19.85. Jim saved $2,144.64. Remember, in previous years Jim never bought the prescription because it was too expensive, and he did not realize how Good RX works. Also, congratulations to Pharmacy for suggesting to Jim to check on coupons.

TAKE AWAY REGARDING PRESCITIONS:

1. Always check on Good RX or similar companies the cost of your prescription and compare the Good RX cost with your insurance co pays. You may be surprised to find out that they are cheaper.

2. If you do not have insurance or your insurance will not cover the prescription, always check Good RX or other similar companies.

3. Shopping healthcare is the future. Start small and work up to the bigger purchases.

Your team at Escaping the Healthcare Prison is always there to help the consumer. Use our website to let us know how we can help.

www.escapingthehealthcareprison.org

FINDING PRICE ESTIMATES ON A HOSPITAL WEBSITE,,,GOOD LUCK Only 20% of the Hospitals Received an A Grade. Find Out Who They Are!

August 6, 2020 No comment

CMS has mandated healthcare providers to publish 300 services and the associated payments they receive from insurance companies on January 1, 2021. This information will give healthcare consumers an insight as to how much insurance companies pay providers. Most likely, this information will be published on their websites.

The Team at Healthcare Consumer Navigator Center (HCNC) wanted to know how easy or hard it is to navigate and find this information on providers current websites. The primary goal was to locate pricing information and secondarily to validate the following:

Ease of Use and Number of Steps required to find price information as well as availability

Price Information Available Real Time or Call Provider for the Price

Consumer Financial Policies

Provider Contact Information

Quality Data and,

Charge Description Master

The HCNC Team identified 15 hospital providers throughout the country that rated as one of the top 5 facilities within their metropolitan area. Most facilities had multiple locations, surgical centers, outpatient centers and multiple physician practices. Conventional wisdom would lead you to believe that these high-profile facilities would have easy to use websites and real time information available. You be the judge.

The following is a recap of the study:

Ease of Use; Number of Steps/Clicks required to find price information.

Average Number of steps/clicks to locate Pricing: 6.6 steps/clicks on the average with a low of 4 and high of 15.

This assumes you were lucky enough to find it on the first try. Add many more; 7-10 steps/clicks if you were not lucky. Adding more is the usual process. Most consumer do not have a clue were to start on the providers home page.

HINT: ON THE HOME PAGE, LOOK FOR “PATIENT AND VISTORS” OR SOMETHING SIMILAR; CLICK ON IT AND IT SHOULD TAKE YOU TO PATIENT INFORMATION.

Price Information Available Real Time or Call Provider

Only five (5) providers. 33%, had real time pricing using the consumers’ insurance plan and 67% required the consumer to call the facility.

HINT: MAKE SURE WHEN YOU CALL THE FACILITY YOU HAVE ASK YOUR PHYSICIAN IF THE TEST/PROCEDURE REQUIRES PRE-CERTIFICATION AND HAVE THE FOLLOWING IN FRONT OF YOU:

YOUR INSURANCE CARD

A COPY OF THE PHYSICIAN ORDER WITH THE NAME OF TEST/PROCEDURE AND HCPCS (HEALTHCARE COMMON PROCEDURE CODING SYSTEM) CODES.

Consumer Financial Policies

All providers had copies of various polices and procedure available and information to call the provider with additional questions.

HINT: MOST OF THE POLICES AND PROCEDURES THAT WERE AVAILABLE WERE INFORMATIVE AND HELPFUL TO THE CONSUMER.

Provider Contact Information

All providers had telephone numbers of the various departments the consumer would need.

HINT: IF YOU ARE LOOKING FOR A PRICE AND WHAT YOU WOULD BE REQUIRED TO PAY, MOST PROVIDERS HAD A SPECIFIC TELEPHONE NUMBER TO CALL.

Quality Data Available

Only four (4) providers 26% had quality information available and 74% did not.

HINT: THE QUALITY DATA THAT WAS AVAILABLE WAS LIMITED OR REFERRED THE CONSUMER TO AN EXTERNAL WEBSITE.

Charge Description Master Available

Twelve (12) providers 80% had Charge Description Masters available, 20% did not.

HINT: CMS REGULATIONS REQUIRE HOSPITAL PROVIDERS TO HAVE AVAILABLE THEIR CHARGE DESCRIPTION MASTER AS OF 1/1/2020. THE CHARGE DESCRIPTION MASTERS WERE VERY DIFFICULT TO FIND ON TH WEBSITES. IT IS POSSIBLE THAT THE 20% THAT WERE NOT FOUND COULD BE ON THE SITE BUT WERE NOT FOUND.

Provider Scores

The HCNC Team develop a scoring system for each provider website. Categories 1-6 above have a potential point score of 0-5, with a total score of 30 possible points. The team rated each provider as objectively as possible. The following is a summary of the scores:

30-25 3 20% A

24-20 7 47% B

19-15 5 33% C

14 and Below 0

Conclusion

As we asked earlier: “You Be The Judge”. If these facilities are designated as the premier facilities in their respective metropolitan areas, healthcare consumers may have a long wait to see improvements. With only 20% of the facilities receiving a A, one would like to think the scores would be higher. It is clear, consumers will continue to struggle navigating the healthcare maze.

After Thought

The HCNC Team is letting you know which hospitals were included in the review. We mentioned these are highly rated organizations in their metropolitan area. We believe they are.

Also included are the plaintiffs in the lawsuit filed against Health and Human Services that are trying to block the publishing of the 300 services. NOTE: The last three (3) plaintiffs in the lawsuit were hospitals. I would suggest you review their websites; “You Be The Judge; Good or Bad”

Hospital Providers Included In the Review

Baylor Scott and White Medical Center; Grapevine, Texas

Wellstar Atlanta Medical Center; Atlanta, Georgia

Emory University Hospital; Atlanta, Georgia

Northwestern Memorial Hospital; Chicago, Illinois

Baptist Hospital of Miami; Miami, Florida

Tampa General Hospital; Tampa, Florida

Cedar Sinai Medical Center, Los Angeles, California

UC San Francisco Medical Center; San Francisco, California

Hoag Memorial Hospital Presbyterian; New Port Beach, California

New York Presbyterian Hospital; New York, New York

Cleveland, Clinic, Cleveland, Ohio

Mayo Clinic, Rochester, Minnesota TOP 3…A SCORE

Virginia Mason Medical Ctr, Seattle, Washington TOP 3 A SCORE

Vanderbilt University Medical Center, Nashville, Tennessee

Porter Adventist Hospital; Denver, Colorado TOP 3 A SCORE

Plaintiffs in the Lawsuit filed against HHS

American Hospital Association

Association of Medical Colleges

Children’s Hospital Association

Federation of American Hospitals

Memorial Community Hospital and Health Systems; Blair, Nebraska

Providence Health System; Southern California

Bothwell Regional Health System; Sedelia, Missouri

DISCLAIMER

The views expressed in this article are the authors’ alone and do not necessarily reflect our views.
The information contained in the article have been obtained from sources believed to be reliable. We do not guarantee the accuracy, sufficiency or completeness of the information contained in the article.

From Prisoner to Customer to Sophisticated Consumer

July 28, 2020 No comment

As previously predicted an appeal has been filed to the pricing transparency legislation. So now it’s time for everyone to ask “what is the healthcare industry hiding?” Recently, we’ve become very interested in the company, GoodRx. For those unfamiliar with this organization. It is a consumer deluxe organization. The business is to help consumers find discounted prices on pharmaceuticals. Ironically, my first experience with the organization was when a friend needed to buy cancer drugs for her dog. With the GoodRx card 75% discount. That’s right 7…..5…..Percent!!!

Upon exploring the GoodRx website, over the course of the business they’ve helped consumer save $15 billion on drug purchases. This is over and above insurance savings. That’s a significant number.Which again begs the question, “Aren’t insurance companies suppose to have their policyholders’ best financial interests in mind?”Surprisingly, no. Because insurance companies along with third party administrative companies, are mostly publicly traded, their number one priority is shareholders and number two priority is executive compensation. Policyholders’ financial interest rank third at best. On average this has become about a $24,000 annual financial issue for the family of 4. Since stimulus checks are top-of-mind for many people these days. Think about this. It would take a monthly stimulus check of $2,000 to cover the annual healthcare premium for a family of 4. In many cases it will take $1,000 up to $5,000 to cover the deductible for just 1 hospitalization event.

In looking at the many issues surrounding the healthcare pricing transparency issue and being baffled by the amount of resistance it is encountering, we have come to the conclusion there’s more than meets the eye. One can read all the healthcare industry’s defense of the current system. Most of which applied to any other consumer area sounds ridiculous if not out right stupid. One of the few airline companies that seems like it will survive the Covid virus, Southwest, was built on consumer pricing transparency.Their original business model focused on making air transportation affordable for the non-flying customer.

Here’s some unusual facts about healthcare. Most healthcare providers don’t know what their services or procedures actually cost to perform. Why? Because implementing cost accounting systems in healthcare organizations is very difficult. Second, Peter Drucker, a world-class business consultant, promoted the concept, “price led costing” vs “cost led pricing.” As it turns out healthcare doesn’t use either of these concepts. Healthcare providers use a complex concept of “reimbursement focused pricing.” This methodology ignores both what procedures actually cost and what is a marketplace accepted price. This methodology uses sophisticated technology to arrive at prices that produce optimum reimbursement levels under government contracts and insurance contracts taken in aggregate. To explain it more simply, this is the methodology that recently created the discovery of the $10,000 toilet seat cover by the Air Force. Pulling back the curtain on years and years of this type of pricing strategy is sure to produce many of these similar type of pricing discoveries. For the insurance companies, they’ve built in discounting tools in their own technology packages that discount these prices by as much as 90%.

So GoodRx has pulled back the curtain on a segment of the healthcare industry, pharmaceuticals. But at best this probably represents only about one quarter to one third of the US healthcare spend. There are several trillion dollars that haven’t gone under any type of third party consumer microscope. And remember the vast majority of hospitals are still tax-exempt, community supporting organizations. Or at least that’s what they were once upon a time. Stay tuned as this is bound to get very interesting.

From Prisoner to Customer to Sophisticated Consumer (We interrupt our previous segment to bring you important news)

July 16, 2020 No comment

Dear Healthcare Consumer-

Pay attention! This is very important. On June 23, 2020, a federal judge ruled against the American Hospital Association in their lawsuit attempting to block an HHS rule for pricing transparency. (In all likelihood the AHA will appeal the ruling).

This is shockingly important for several reasons! First and most obvious is it’s a “baby step” forward for healthcare consumers. During a time when transparency is ubiquitous in all areas of our lives, the bastion of healthcare remains steadfast in its unwillingness to share information of any sort without a battle. What this legislation provides for, as we’ll explain in more detail later, is really a small, small, step toward “real” pricing transparency. But it is a step forward.

Secondly, in the words of some wise person, “don’t listen to what I say but watch what I do.” Pricing transparency rhetoric has been coming out of the American Hospital Association and the American Medical Association for at least 10 years. Believe it or not pricing transparency was included in the Obamacare legislation(The Affordable Care Act) in 2010. There’s been much bravado and chest thumping as to the importance this is to the American consumer. But rather that initiate any initiatives it took an act of Congress (Hospital Price Transparency and Disclosure Act of 2018) to get the ball rolling. Then after passage of the legislation the industry leaders fought in court to prevent the legislation from being implemented.

A prudent consumer would ask the question “what the hell are they hiding?” and “why are they so concerned about hiding it?” Think about this for a minute. The majority of hospital providers in this country are community resources operating under tax exemption statutes because of the alleged “community benefit” being provided to the communities being served. So why do these hospitals act like Apple and Microsoft in some kind of corporate battle to the death?

If you read any of the media stories regarding the pricing transparency legislation and pay particular attention as to the “reasons” being provided by hospitals to not cooperate, they boarder on the absurd and at times seem just plain stupid.

We have declared this initiative as a “baby step” in the world of healthcare transparency because initially there is so little context and education to help the consumer understand the information and more importantly to be able to connect quality to the prices.

A leading healthcare periodical has presented a “Myth of Health Care Consumerism” position. The basis for this argument is the vast preponderance of healthcare is emergent and unplanned and people don’t “shop” for healthcare in the conventional way they shop for other consumer goods such as cars, appliances, homes, college, etc. We believe healthcare shopping is going to follow a similar trajectory as the home personal computer. While at the beginning, many people didn’t understand the need or utility of a home computer, today the story is much different. In addition, as people became educated on using this technology then along came the smartphone so people could take the technology with them wherever they went.

We strongly believe as consumers become more health educated about different healthcare options and services price and quality shopping are sure to follow. Here’s an example available in Plano, TX today.

See Advancedbodyscan.com, this company is providing preventative scans for heart, heart and lung and whole body. On their website it says, “to detect illnesses such as heart disease and cancer months or even years before symptoms may appear to help put You in control of Your health.” Oops so much for unscheduled healthcare visits. And we are only at the early stages of these type of services.

We will continue to provide updates and sources of information to enable you to be better able to utilize this upcoming source of information.

From Prisoner to Customer to Sophisticated Consumer Part 2

July 15, 2020 No comment

Welcome back. Now that you have your families medical history documented. Let’s proceed to the next step of locating Drs. Let me start with a short antidotal story:

Healthcare customer: Could you recommend a high quality Doctor?

Hospital Executive: Do you know what they call the person at the bottom of

their medical class?

Healthcare customer: No, what?

Hospital Executive: Doctor.

In a world of ratings, scores, customer feedback and all sorts of mechanisms for customers to determine quality. Hospitals and healthcare providers continue to operate in the byzantine era of the forties and fifties when all Doctors sat atop the cultural intellectual and quality hierarchy. In this realm all Doctors and Hospitals are considered equal. As most of us know, this reality isn’t true. Now I recognize in this current environment of Covid 19 all medical professionals are considered heroes and rightly so. So for the appropriate context, my comments today are for more normal times whenever that might be.

People within the medical infrastructure will tell you the practice of medicine is a science. Thus giving society the impression the practice of medicine the aura of a “scientific” structure based on facts, proven theories, accountable results and evidence.

So let me tell a story which has surprisingly huge ramifications for today’s Covid environment. Once upon a time at the General Hospital of Vienna a Doctor by the name of Ignaz Semmelweis, was confronted with a medical dilemma. The Hospital had twin maternity wards and the death rate within one ward was almost four times that within the other ward. He studied and studied the potential differences between the two wards searching for the cause of the deaths. The only significant difference he arrived at was medical students tended patients in the ward with the higher death rate and midwifery students attended to patients in the ward with the lower death rate. Another factor he discovered was mothers that had delivered prematurely before arriving at the hospital also had a much lower death rate.

Then one day an unusual event occurred where a Doctor friend of Ignaz died after being “nicked with a knife” during an autopsy of a victim of the fever the women were dying from. With this new information Ignaz concluded the medical personnel that were touching cadavers were transmitting the disease back to the maternity ward. Because patients in the other ward were treated by midwifes that were not exposed to the cadavers, this would account for the difference it mortality rates. Ignaz immediately instituted a requirement for all medical personnel to wash their hands in a disinfectant solution. The result of implementing the procedure was the death rate dropped from 11.4% to 1.2%.

Here’s the shocker! The medical profession dismissed Ignaz’s theory. Over a hundred years later in 2002, a CDC report estimated 2 million patients contracted a bacterial infection while being in American hospitals, 90 thousand of those patients died. Just a few years ago CMS introduced financial incentives to motivate healthcare personnel to wash their hands.

Today, we are confronted daily with the mortality counts of a highly contagious disease. Health care workers are suited up with face shields, masks, specialty uniforms etc to protect themselves from contracting the disease. Just a few years ago, however, when the potential victim of bacterial disease was the patient, the industry did not share the same level of precaution nor the current level of reporting. Everyday the number of Covid deaths are reported by the 6 o’clock news sources. Imagine just a few years ago when 100,000 deaths caused by the hospital industry were ignored by the news media and just like during Ignaz’s life the medical industry. The reason I know is my father died as the result of a hospital acquired infection.

By now you’re wondering what does any of this have to do with finding a primary care physician? What this means for you and your physician is the representation created by Hollywood, the media and the industry isn’t completely current reality. Many physicians no longer are in control of how they practice medicine, because they’re employed by hospital providers or insurers causing their financial incentives to be impacted not only by the insurance companies but also their employers. So knowing who’s paying your doctor is important.

In the 1980’s with the advent of Medicare DRG payments, many health insurers adopted tactics to minimize their costs by changing how their customers accessed their doctors. Primary care doctors were somewhat vilified because they became known as “gatekeepers.” While before an insured patient could freely choose to see whatever doctor they wished to see whenever they wished to see them. This now meant in order to see a specialist, a gatekeeper first has to provide an “authorization.” For gatekeeper doctors that over-authorized, they soon found themselves eliminated from the insurers’ doctor networks. As we now in any complex systems, actions will cause reactions. In the case of healthcare, this caused the rise of “concierge doctors” and “concierge medical practices.” These are most often independently physician owned and operated. In most cases, they are not included in insurance networks and don’t accept insurance payments. In some cases, they include doctors that specialize in geriatrics, chronic diseases or specialty care ie orthopedics etc. The underlying driver for these “new” practices is in response to the “discounted” payments being offered by insurers.

So what was once perceived as a “one size fits all healthcare delivery system” healthcare reform has had the unintended consequence of pulling back the curtain, on what has always existed, a multi-level, variable quality healthcare system. That’s right The Mayo Clinic, The Cleveland Clinic, the MD Anderson Cancer Center are just of few healthcare providers that promote their excellence of above all others. No different than Porsche, Tesla, Audi or Mercedes-benz touting their autos as the best luxury autos in the very large United States auto market. Or Louis Vuitton, Chanel, Tiffany & Co., Gucci, or Burberry touting their brands as the best in the world in their relative markets. So while the politicians have been working on making healthcare a right for all, accessible for all and affordable for all. The Healthcare industry is working on going from a “equatable and one size fits all approach” to a luxury branding strategy and searching for the customers they really want. And for those of you that doubt me Google “Cadillac” insurance plans or Concierge medicine.

What’s the next step in becoming a more powerful and sophisticated healthcare consumer? Get the right Primary Care Physician for you and each member of your family.

If you’re healthy right now that’s great. In doing “Your Family’s Health History,” you discovered some “symptoms” lurking in your family’s medical history like; cancer, cardiovascular disease, high blood pressure, obesity-related illnesses, Alzheimer’s/dementia, Parkinson, alcohol-related etc than it’s time to take action. If you don’t have a primary care physician, it’s time to get one. A good place to begin is with your insurer. Call and ask for a recommendation. Be prepared to explain exactly what you are looking for.

Like all parts of our lives, social media has also found healthcare. One survey showed over 75% of patients use online reviews as the first step in choosing a doctor. Another survey showed about half of “providers” were looking at physician review websites to understand their patients’ satisfaction levels. Another survey showed half of respondents would pick an out of network doctor vs. an in network doctor with less favorable reviews. In a very dramatic shift 80% of consumers trust online reviews as much as personal recommendations. These factors are all indicators of a very different environment for choosing a doctor.

Here’s a list of additional sources providing information about selecting doctors.

-Yelp

-Google

-Facebook

-WebMD

-Healthgrades.com

-RateMDs.com

-Vitals.com

-ZocDoc.com

-CareDash.com

-AngiesList.com

-TeleDoc

-CMS Physician Compare website (Medicare.gov)

-Castleconnolly.com

-doctorfinder.ama-assn.org

-verywellhealth.com

All of the above websites provide additional guidance on how to search for and select an appropriate doctor.

A critical point we want you to know about is there are at least two healthcare systems operating in this country (and probably more that we haven’t been exposed to). One is the general system comprised of all the Doctors, Hospitals, Nurses etc that are available to the general public that will be included in the aforementioned websites. In addition, there is an undisclosed healthcare system comprised of the Hospitals, Doctors etc the Doctors and medical community use. This is the “unofficial” highest quality medical System used by Doctors, Doctors’ family members, professional athletes and other influential people. Referrals to these networks occurs through relationships. If you want to access these networks, you must be willing to ask your Doctor where he/she would go for the treatment you’re seeking. In addition you may need to research and see where influential people are seeking care.

To summarize, having your and your family’s medical history in hand, you are prepared for the next step in becoming sophisticated healthcare consumer. Understand the industry is not yet prepared to cater to your needs or advanced knowledge. The healthcare industry will still attempt to treat you as a compliant, tolerant, obedient, submissive individual. Ultimately the care you need and receive will be directly influenced by your selection of a primary care physician to assist you in navigating the healthcare delivery system. This person needs your complete trust and confidence to act as your advocate. The level of your current involvement with the healthcare system is the primary determinant in selecting this person. Good luck in this next phase. The following phase will go more in-depth in selecting specialist doctors.

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