New Ways to Find the Best Doctor
Dear Readers,
If you’re lucky, you have an established relationship with a health-care provider who has good medical and communication skills, generous availability and responsive office management. If that doesn’t describe you, then you know how hard it is to find the right doctor.
Now there are new sources of help for making your best patient-doctor match.
New Ways to Track a Doctor’s Treatment Patterns
ProPublica.org, the nonprofit investigative news service we regularly consult, has a new tool, Treatment Tracker. Now you can look over any doctor’s shoulder and see how his or her practice patterns compare to peers.
So, you can see not only how a doctor approaches diagnosis and treatment, but also whether the charges for them are in line with others.
Treatment Tracker crunches newly released Medicare data to help you know if:
- a doctor performs more services and orders more tests per patient than others in his or her specialty and state;
- the most common services and treatments chosen by a doctor are similar to others in the same specialty and state;
- a doctor’s cost per patient is higher than his or her peers.
Treatment Tracker helps you understand when a lot of treatment is appropriate, and when it might be overtreatment. It helps you understand if doctors are relying on unconventional or even questionable therapies that their peers avoid. “You may want to look for large gaps between where a service ranks for your doctor and where it ranks among similar providers,” it advises. “You’ll see an orange symbol in our app if one of a doctor’s services has been performed by five or fewer providers in his/her specialty and state.”
It will help you assess the value of the tests your doctor orders. One example: “Radiation exposure carries risks, and screening tests may turn up false positives or abnormalities that may not actually be health problems, such as a precancerous node that won’t develop into cancer. In addition, tests may add unnecessarily to your costs, via your co-pay, and to those of the government. It’s worth asking whether medical tests are necessary, especially if you have recently had similar tests.”
If you need a procedure, Treatment Tracker can help you determine how much experience a certain doctor has performing it, based, of course, only on Medicare patient data. Still, it’s one indicator of how much practice someone has doing the procedure, and doctors with more experience generally have better outcomes.
Last month, NPR aired an interesting and informative discussion about Treatment Tracker’s ability to ferret out doctors who routinely overcharge for office visits, in comparison with their peers.
As ProPublica reporter Charles Ornstein said, “There’s 200 million [office visits] across the country in a given year and on the whole, about 4% of these visits are classified as the most complex and the most expensive that Medicare pays the most for.
“Hundreds, if not thousands of doctors … were billing exclusively for these most complex visits, even in situations where their colleagues who have similar credentials and in similar fields, were not doing the same thing.”
Isn’t that something you would want to know in choosing a practitioner?
Another ProPublica initiative, Dollars for Docs, tracks the billions of dollars paid to doctors, other medical providers and health-care institutions by 15 pharmaceutical companies since 2009. The disclosures are assembled in a single, comprehensive database that enables you to search for a physician or medical center for a list of all payments matching that name. You can search also by state and by company, filtered by category and by year.
Although the 15 companies in the ProPublica database represent only 43% of market share, as of this autumn, per the Affordable Care Act’s Physician Payment Sunshine provision, all pharmaceutical and medical device companies must publicly report payments they make to physicians. The first disclosures will cover August to December 2013, and will be available on a government website.
Tapping Your Own Network
Most people are familiar with “provider networks,” the collection of practitioners, hospitals and pharmacies that a given insurance plan wants you to use in exchange for underwriting part or all of the cost. Some plans cover part of the cost of out-of-network providers, but under some, if you don’t stay within the network, you’re on your own, financially.
But “network” can be a more casual, personal concept, too, and often it can help you find the care you need from the provider you want. Your network is family, friends, work and professional association colleagues … any discrete group, large or small, with whom you have something in common, including where you live.
People who share the same things connect in similar ways, and often that can include relationships with the people delivering their health care. Ask members of your “network” if they’re happy with their doctors, and if so, why. Make sure their priorities are yours in terms of medical specialty, availability, responsiveness, proximity … whatever is important to you. Find out if their providers welcome engaged patients, or prefer a more paternal, remote kind of treatment delivery. How do they relate to their doctors, and is that how you want to relate to yours?
Of course, many referrals you get might not be within your insurance plan’s provider network, and some might not be accepting new patients. But it’s a starting point.
Check out any promising candidates with Treatment Tracker and with your state’s medical licensing board — link here for a list. Many state boards have websites, but the range of information beyond licensing details varies. Some offer information about disciplinary actions taken against a physician and medical malpractice claims; some don’t. If your state’s info is thin, contact the medical board directly, and request more information.
See our blog, “How to Find Out if Your Doctor Has Been in Trouble” for other databases of information.
Casting a Wider Net
The Federation of State Medical Boards (FSMB) collects data about physicians, osteopaths and physician assistants and makes it available to the public for about $10 per report on its DocInfo site.
Healthgrades.com provides information about doctors and dentists for free, and is subsidized by pharmaceutical and device manufacturers, and providers who pay extra to highlight their entries. There’s a patient satisfaction rating as well, but remember — an unknown person’s priorities for care might not be yours. Still, reading the comments can help you decide how close they are and whom to research further.
Remember that although websites such as Yelp and Angie’s List can be helpful for finding a competent plumber or a hot new taco truck, a medical provider is a different story, and choosing one primarily based on general public ratings is risky. Use these resources only in conjunction with other sources of information.
And remember the law of small numbers. If there are only a handful of ratings for a particular doctor, it’s hard to know if, on the downside, it’s the work of a few lunatics, or on the upside, if it’s just the doctor’s relatives writing in.
Before you leap into the doctor-rating frenzy, read our blog, “The Ups and Downs of Patient Ratings of Doctors.”
Controlling Your Care, for Health and Happiness
Finally, when you do settle on a doctor, to get the most out of your appointments:
- Make sure the doctor has your thorough medical history, and has reviewed it. Knowing a patient’s history is critical to correct diagnosis, and often makes testing unnecessary. A doctor who orders tests instead of studying your history and listening to your complaints invites unnecessary interventions, potential misdiagnoses and complications.
- Write down questions in advance and don’t leave until they are answered to your satisfaction.
- Engage in the relationship. Trust is key, and that includes the freedom to question the doctor — good practitioners appreciate patient curiosity.
- Become informed about your treatment. Before having any tests, ask the doctor what he or she thinks you might have, what he or she expects the tests to show, what are its risks and benefits, what happens if a test is negative or positive and what is expected if you do nothing at all. The answers help you know how critical it is to do something now instead of watchfully waiting.
The more you know, the happier your doctor should be, and the better the care delivered to you.
Here’s to a healthy 2014!
Patrick Malone
Patrick Malone & Associates
