A patient’s guide to finding quality health care
There are tremendous advances taking place in medicine
today, but in order to benefit from them, the health care consumer must
take an active role. The best health care will not find you; you have
to seek it out.
While the United States offers the highest standard of
health care 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 health care system to find the best doctor for you.
The era of the super-specialist
First, the health care consumer needs to understand that
today’s medical field is divided into very narrow specialty categories.
Twenty years ago, the specialty of neurosurgery addressed a variety of
problems. While a neurosurgeon in a small, rural town may still address
all these problems, most neurosurgeons today specialize in a few of those
areas. Therefore, the educated health care consumer should seek out a
neurosurgeon who primarily treats patients with a particular condition.
This increases the likelihood that the surgeon will be more proficient
in surgery and will use the most advanced surgical techniques available.
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. A second key indicator of quality, aside
from specializing 100 percent in a specific niche, is the volume of surgeries
a physician performs annually. Within the field of spine, for example,
a surgeon who specializes 100 percent in spine surgery may perform more
than 200 spine surgeries annually.
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, health care 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
may choose 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
health care plans have historically done a poor job of establishing panels
of physicians based on quality care. Consequently, larger 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 health care plan medical director knows that the best physicians
and super-specialists will save money as outcomes are typically better,
and many times these specialty centers 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, health care consumers are
left on their own to search for a top health care 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 health care 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 health care 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.
Get a second opinion
Most health insurance plans advise or require that the
health care consumer receive a second opinion when treatment involves
a complex surgical procedure. This is excellent advice. Furthermore,
the health care 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.
Click here for a second opinion
Be willing to travel
A 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. 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.
[Top]
Quick navigation links:
About us | Our Physicians: Dr. Kevin Ammar, Dr. Roy Baker, Dr. Randolph Bishop, Dr. Cliff Cannon, Dr. Louis G. Horn, IV, Dr. Jay U. Howington, Dr. James Lindley, Jr., Dr. Daniel Y. Suh, Dr. Willard D. Thompson, Dr. Fremont P. Wirth | Expertise | Resources | Contact Us | Driving directions: Savannah, Statesboro, Bluffton, SC (near Hilton Head Island)
Disclaimer:
The pictures displayed in www.NeurologicalInstitute.com are images of actual patients and employees who have consented to have their picture in this website.
Need more information
on health and wellness?
Click here for information on diet, nutrition and health resource books. Learn when to see the doctor and what causes symptoms.
Educational illustrations and content Copyright © 2010 Prizm Development, Inc.
Web design & Copyright 2010 © Prizm Development, Inc.
www.prizmdevelopment.com |
|
|
