Insider’s Guide to Quality, Affordable Healthcare

Welcome to my Insider’s Guide to Quality, Affordable Healthcare book summary!

“Four hundred thousand Americans die each year from doctor and hospital preventable errors.” (p. 10)

One-Sentence-Summary: Extraordinarily comprehensive information geared towards the elderly, but relevant to everyone receiving medical care in the USA health care system, written by two MDs.

I’ve finished reading Insider’s Guide to Quality, Affordable Healthcare by Lawrence Lazarus, MD and Jeffrey Foster, MD.

booboo real-time book rating: ★★★★★ (percentage of books with this rating: 8%)

Key Concepts

When visiting different medical facilities as their patient (hospitals, specialists, etc.), it’s of paramount importance to understand who the point person is at each facility and how the communication flows in both directions, as this is where many errors can occur.

Always have a patient advocate who serves as a second set of eyes and ears.

If there are multiple parties involved, you need to assign a lead or captain doctor who will be responsible.

This blog will contain both my summary and review of the book Insider’s Guide to Quality, Affordable Healthcare.

Useful Resources

Organize your medical information with www.webmd.com/phr or www.healthvault.com

Buying medication online? Make certain they are certified by the Verified Internet Pharmacy Practice Site (VIPPS)

Three sources to locate prospective doctors: The American Medical Association’s “DoctorFinder”, MedlinePlus’s “Directories”, and Medicare’s “Physician Compare”

“The increasing use of CAM treatments led to the establishment of the National Center for Complementary and Alternative Medicine (NCCAM, or updated to NCCIH) to evaluate the effectiveness and safety of these non-traditional healing practices.” (p. 247)

“..one precaution you can take when buying a nutritional supplement is to look for the label on the container that indicates the product is ‘USP-verified.’ This signifies that the U.S. Pharmacopeia, a nonprofit organization, has confirmed that the product contains what the manufacturer claims it has.” (p. 254)

• “symptom checker” from Mayo Clinic
• “search by symptoms” from familydoctor.org, operated by the American Academy of Family Physicians
• WebMDsymptonchecker from WebMD Health Corp

Find out what your insurance actually pays the doctors or hospitals for particular procedures with Healthcare Blue Book and Fair Health, Inc.

“There are two excellent Internet sites to obtain reliable hospital ratings, which can serve as one of a number of guidelines for selecting one of the best available hospitals for you and a loved one. One website is managed by The Joint Commission (JCAHO), the other by Medicare. Regarding Medicare’s website, the information comes from hospitals that have agreed to submit their success and error information for review by the public.” (p. 123)

“You can check a hospital’s accreditation status via www.qualitycheck.org.” (p. 123)

“New Choice Health lets you compare fair prices with the list prices for particular procedures.” (p. 27)

Access Project is a non-profit, professional billing advocate that can help you negotiate to reduce your bill. Other options are Medical Billing Advocates of America, Morgans, and Lambs. Also, the free Patient Advocate Foundation/PAF (they can help get you a second opinion if your insurance company denies the request).

“To become licensed to perform acupuncture, about eighteen states and the District of Columbia require a degree from a school for acupuncture and Oriental medicine accredited by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM).” (p. 250) See also, National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).

“..naturopathic colleges in the United States..are accredited by the Council on Naturopathic Medical Education (CNME)..” (p. 250)

American Academy of Urgent Care Medicine (for Urgent Care Centers or UCCs)

“The American Board of Medical Specialties (ABMS) is the parent organization of [the 24 PCP specialties].” (p. 100) You can use them to find out if your doctor is board-certified. Maybe this is where you can also find if there are any disciplinary actions or malpractice claims against the doctor.

Second Opinion Expert

Commission on Massage Therapy Accreditation (COMTA)

National Certification Board for Therapeutic Massage and Bodywork (NCBTMB)

“The Federation of State Medical Boards itself makes available additional doctor information pertaining to disciplinary sanctions, education, medical specialty, and practice locations. Regarding malpractice claims, the National Practitioner Data Bank is an electronic information repository created by Congress that contains information on medical malpractice payments and certain adverse actions related to healthcare practitioners, entities, providers, and suppliers.” (p. 115) Some of this information is not available to the public. You can also do an online search “Dr. Joseph Smith” + malpractice or lawsuit or action or problem.

Caring Bridge (www.caringbridge.org) is a free way to keep everyone informed about a hospital operation.

As I read the book, you will find my in-progress Insider’s Guide to Quality, Affordable Healthcare review and book summary notes below.

Powerful Knowledge

Question to ask your physician when making a tough decision: “‘If you were my age with the same overall health status and similar insurance and financial limitations, which options would you choose and why?'” (p. 14)

Or, when your doctor is referring you to someone: “..would you use this doctor for yourself or for your own family?” (p. 100)

“ERs are required by federal law to provide care to all patients, regardless of their ability to pay.” (p. 86)

Bring a recorder to your visits, but always ask if you can record. Thsi is for you memory, but also services to keep the doctor thinking about what they are saying a bit more.

“..medical bills are fraught with errors. There is a whole industry of experts trained to spot these errors and negotiate medical bills down to reasonable levels. They are called medical b billing advocates.” (p. 24)

“The four legal documents that are crucially important to complete include:

• The HIPPA form – giving consent to share information with someone
• The POLST or the MOST
• Helathcare Directive (living will)
• Power of attorney

The CPT (current procedural terminology) code is a long numerical code used by commercial and government insurance carriers that identifies the particular medical test or procedure.

“Some types of surgery, such as knee surgery, can be performed in an outpatient surgery center (surgicenter) at a much lower cost than in the hospital.” (p. 34)

If you have a minor illness, skip the ED (expensive): personal physician, workplace clinic, large retail drugstores, urgent care clinics.

“..two new ways of paying your physician other than through your medical insurance. They are called Concierge Services (CS) and Direct Primary Care (DPC) services.” (p. 89)

“Do a search with the keywords ‘clinical practice guidelines for [insert here your diagnosis or condition]’ to find current recommendations that are intended for health professionals but also can be perused by patients. Such practice guidelines can also be accessed from the Update site at a modern cost. An additional useful site is the Treatment Options site of the Agency for Healthcare Research & Quality.” (p. 113) www. uptodate.com

“Get a second opinion from a specialist in your condition. If your specialists cannot agree, then get a third opinion at a reputable comprehensive institution such as the Mayo Clinic in Rochester, Minnesota, or Johns Hopkins Hospital in Baltimore, Maryland, or MD Anderson Cancer Center in Houston, Texas, or Dana-Farber Cancer Institute in Boston, Massachusetts.” (p. 113)

“Consider directing nursing complaints to the senior ‘charge’ nurse on your unit. If your complaints are about your clinical care from medical staff, such as an intern or a resident, speak with your lead doctor. If your complaints concern treatment plans or complications, and your principal doctor has not addressed them satisfactorily, ask the doctor if it would be okay to get a second opinion and even who he might recommend. While you don’t need his ‘permission’ to get a second opinion, this approach conveys respect and emphasizes the seriousness of the issues and/or questions you have. / If your complaint is not tended to at the levels and you are in a JCAHO-accredited hospital, you can call at 630-792-5800 or file a complaint online at joincommission.org.” (p. 153)

You are reading my book review and summary by Lawrence Lazarus, MD and Jeffrey Foster, MD. Be sure to check out my digital bookshelf for 100+ book summaries.

Medical Errors

“If the U.S. Centers for Disease Control and Prevention (CDC) included ‘preventable medical errors’ as a disease-specific category, it would be the sixth leading cause of death in the United States.” (p. 124)

To avoid medication errors: “..periodically ask your nurse or doctor for a copy of your most current medication record so you are familiar with medication names and dosages.” (p. 155)

“You have the right to refuse any tests or procedures. In fact, the law requires that the benefits and potential risks be explained to you and you have a clear understanding of them before signing consent forms.” (p. 155)

“..the majority of medically related errors occur during transition periods, such as shift changes, transfers to other areas of the hospital, or during times when the hospital is understaffed, such as holidays and weekends. During these transitions, try to have a knowledgeable family member or your advocate present. During a shift change, for example, he or she can ask the nurse, ‘You’re changing shift now; what important things do you want me and the new nurse to know?'” (p. 155)

“..ask to speak with the hospital’s customer service representative. If your concerns are still not being addressed, ask to speak to the chief of clinical service or chief of surgery.” (p. 156)

Negotiating Your Bill

“‘My insurance only partially covers this procedure, and I’ll be paying a lot of money for out-of-pocket costs (the co-pay). Could you lower my portion of the approved amount?'” (p. 28)

“..ask if the doctor or hospital would consider accepting from you as full payment what an insurance company’s approved fee would be.” (p. 28)

Did you know I’m an author? I wrote four books on real estate investing, travel, and language learning.

Types of Medical Staff

When deciding on your doctor: check speciality board certification, professional affiliations, confirm no legal issues. You can ask for a referral from a major hospital or school of medicine.

A Registered Nurse (RNs) is the most basic designation. A Nurse Practitioner (NPs) is also an RN. A Clinical Nurse Specialists (CNSs) are RNs with graduate level nurse training at a master’s or doctoral level. A Physician Assistant (PA) is the top of all of these and must work under the supervision of a physician. A Medical Assistant is below all the above roles

Primacy Care Physician (PCP) and Physician Assistant (PA). There are two types of PCP: family medicine doctors (family practitioners) and internal medicine (internists). The difference is that internists specialize in adults while family medicine doctors can treat anyone. Family Medicine physicians receive training in six major medical areas: pediatrics, obstetrics and gynecology, internal medicine, psychiatry and neurology, surgery, and community medicine. Internists do not train in pediatrics or obstetrics and gynecology.

It’s a very good sign if your doctor is on the staff of the best hospitals and/or on the faculty of a school of medicine.

“Because each state licenses its doctors to practice, you can go online to the state medical board in your state and look up the potential doctor.” (p. 115)

“There currently are twenty-four recognized board-certified specialties and one hundred recognized subspecialty areas.” (p. 100)

“Hospitalists are physicians who dedicate their clinical work to the medical care of hospitalized patients.” (p. 125)

Choosing A Doctor/Hospital/ED

• Are you Board Certified? by which board? in which speciality?
• Do you participate in the ABMS Maintenance of Certification program? What does this involve?
• Where did you attend medical school? How long have you been in practice?
• Whcih hospitals do you use? Are they accredited?
• Who covers for you when you are unavailable?
• How long does it take to get a routine appointment?
• Do you/nurse/PA give advice over the phone for common medical problems?
• How common is it for you or your team to not be able to recommend a specialist?

From Chapter 6: Choosing the Best Hospital:

• I the hospital and its ED accredited by JCAHO?
• Ask for PCPhy. what hospital he/she would choose for the medical condition you have.
• Does the hospital have board-certified medical specialists who treat your particular medical or surgical condition?
• Will you insurance pay for treatment of your medical condition at the hospital you are considering? Are there some services ar the considered our-of-pocket?
• If you’ll be treated by a hospitalist, how will your PCP convey all your important medical information to the hospitalist and vice versa when you leave the hospital?
• Is the hospital a teaching hospital affiliated with a medical school? Around July they switch so new, inexperienced students.
• Does the hospital offer private rooms?
• For serious conditions, how often is the operation performed the hospital? What percentage of patients have a successful outcome and what is the rate of complications?
• If you don’t have a patient advocate, can the hospital provide or suggest one? There is such a thing as a professional Patient Advocate/Representative at hospitals
• Consider taking a tour to view the meal in their dining room.
• Find out if all services can be received in the same hospital. The more you move, the more likely errors and delays occur.

“It is also important to find out if he health providers (such as the radiologist) at the facility are in network. Just because a facility is covered does not guarantee that those working there are too.” (p. 151)

Emergency Department:

• Ask your PCP what ED he/she would choose for a medical emergency
• What hospital does the ED have a transfer agreement with
• Will your insurance company pay
• Is your PCP on staff at that hospital? If not, you will get a hospitalist.
• What is the closest ED that specialises in trauma
• Are the physicians in board-certified in emergency medicine?
• EMTs are sometimes required by law to take you to the closest hospital or the one they think will be best for your situation. You can request to go to your chosen ED, if time is not essential, even if it’s overcrowded due to its reputation.
• You can choose a UCC that is faster and less expensive for minor problems.

Homeopathy

Although this was a tiny section with a chapter, I am including it due to the following quote: “One of the authors knew a physician in Maine who ‘poopooed’ homeopathy for year.s He himself became so uncomfortable wit ha medical condition that traditional medicine could not improve that he gave in to a friend’s urging and tried homeopathy. It owkred to well that he now practices hoempathy as part of his traditional medical practice.” (p. 251)

“Homeopathy is based on the concept that self-healing is a basic characteristic of human life. Extremely small doses of derivatives from plants (such as ergot fungus) and minerals (such as silver and iodine) are believed by homeopathic practitioners to help the body build a defense against particular diseases.” (p. 250)

6,000 practitioners in the USA. Homeopathic medicine is sold over-the-counter in the USA.

New Words!

Cantankerous (adj) – bad-tempered, argumentative, or uncooperative. (The cantankerous EMT refused to take me to my preferred hospital.)

Thanks for visiting and thanks to Lawrence Lazarus, MD and Jeffrey Foster, MD for writing Insider’s Guide to Quality, Affordable Healthcare!

Date Started: Saturday, August 24, 2024

Date Finished: Friday, May 9, 2025 (259 days)