Notes

 

Reading preferences vary, of course, but I have been conditioned by years of online reading to open links to reference materials as I come across them in the texts of articles and studies. This is impossible when reading print copies of Get What’s Yours for Health Care. If you, like me, have an itchy finger when it comes to clicking on web links, my publisher has approved reproducing all the book’s links here.

Page numbers refer to the page in the printed book where the link appears. The phrases followed by a colon refer to where the linked material is cited, either by name or in the context of what’s being presented in the book.

Lastly, we all know that links can and do change. Gwy.org employs link-checking software to identify broken links and permit them to be corrected. If you see broken or incorrect links, please let us know via email at gwyforhealthcare@gmail.com.

Thank you.

Get What’s Yours for Health Care:

How to Get the Best Care at the Right Price

 

Chapter 1: Game On

3  a story: “To Save Money, American Patients and Surgeons Meet in Cancun,” Kaiser Health News, August 12, 2019, https://khn.org/news/to-save-money-american-patients-and-surgeons-meet-in-cancun/.

3  Ashley Furniture Industries: https://www.ashleyfurnitureindustriesinc.com/.

5  A study: “Telehealth: A quarter-trillion-dollar post-COVID-19 reality?,” McKinsey & Company, https://www.mckinsey.com/~/media/McKinsey/Industries/Healthcare%20Systems%20and%20Services/Our%20Insights/Telehealth%20A%20quarter%20trillion%20dollar%20post%20COVID%2019%20reality/Telehealth-A-quarter-trilliondollar-post-COVID-19-reality.ashx.

6  Healthcare Bluebook: https://www.healthcarebluebook.com/.

8  Organisation for Economic Co-operation and Development: Organisation for Economic Co-operation and Development (OECD), Frequently Requested Health Data, November, 2019, http://www.oecd.org/health/OECD-Health-Statistics-2019-Frequently-Requested-Data.xls.

13  recent: Health, United States, 2018, National Center for Health Statistics, Hyattsville, Maryland, 2019, https://www.cdc.gov/nchs/data/hus/hus18.pdf.

Chapter 2: Health Insurance: Friend and Foe

15  subject of a book I wrote: Philip Moeller, Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs (New York: Simon & Schuster, 2016), https://www.amazon.com/Get-Whats-Yours-Medicare-Maximize/dp/1501124005/.

15  primary reason for its invention: Peter L. Bernstein, Against the Gods: The Remarkable Story of Risk (New York: Wiley, 1998), https://www.amazon.com/Against-Gods-Remarkable-Story-Risk/dp/0471295639/.

17  Patient Protection and Affordable Care Act: Patient Protection and Affordable Care Act, HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/where-can-i-read-the-affordable-care-act/.

20  employers need to follow: Federal rules on high-deductible health plans, HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/glossary/high-deductible-health-plan/.

21  IRS Publication 969: “Health Savings Accounts and Other Tax-Favored Health Plans,” IRS Publication 969, https://www.irs.gov/pub/irs-pdf/p969.pdf.

22  23andme: https://www.23andme.com/.

22  IRS Publication 502: “Medical and Dental Expenses,” IRS Publication 502, https://www.irs.gov/pub/irs-pdf/p502.pdf.

24  More than one-third: “Health Care Administrative Costs in the United States and Canada, 2017,” Annals of Internal Medicine, January 21, 2020, https://annals.org/aim/article-abstract/2758511/health-care-administrative-costs-united-states-canada-2017.

24  Dignity Health: https://www.dignityhealth.org/.

25  posted a story: “How One Employer Stuck a New Mom with an $898,984 Bill for Her Premature Baby,” ProPublica, November 4, 2019, https://www.propublica.org/article/how-one-employer-stuck-a-new-mom-with-a-bill-for-her-premature-baby.

26  how Medicare covers something: “What Medicare Covers,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/what-medicare-covers.

Chapter 3: Employers Get to Work on Health Care

34  article: “How Employers Are Fixing Health Care,” Harvard Business Review, March, 2019, https://hbr.org/cover-story/2019/03/how-employers-are-fixing-health-care.

34  Health Affairs: “Self-Insured Employers Are Using Price Transparency To Improve Contracting With Health Care Providers: The Indiana Experience,” Health Affairs, October 7, 2019, https://www.healthaffairs.org/do/10.1377/hblog20191003.778513/full/.

35  Rosen Hotels & Resorts: https://www.rosenhotels.com/.

35  RosenCare: https://www.rosencare.com/.

35  employer insurance premiums: “Average Annual Single Premium per Enrolled Employee for Employer-Based Health Insurance,” Kaiser Family Foundation, 2018, https://www.kff.org/other/state-indicator/single-coverage/.

36  was updated: Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry, 2nd ed. (New York: Basic Books, 2017), https://www.amazon.com/Social-Transformation-American-Medicine-Profession/dp/0465093027/.

37  Haven: https://havenhealthcare.com/.

37  Lisa Woods: “The Future of Healthcare with Lisa Woods, US Strategy and Design for Walmart,” Thrive Global, February 18, 2020, https://thriveglobal.com/stories/the-future-of-healthcare-with-lisa-woods-senior-director-of-strategy-and-design-for-u-s-benefits-at-walmart/.

37  her and company CEO Doug McMillon: “World’s 50 Greatest Leaders,” Fortune, 2019, https://fortune.com/worlds-greatest-leaders/2019/doug-mcmillon-lisa-woods/.

38  Covera Health: https://www.coverahealth.com/.

38  Grand Rounds: https://grandrounds.com/.

40  wrote in early 2020: “Self-Insured Companies Do No Better on Cost Control,” Axios, January 27, 2020, https://www.axios.com/employers-health-care-insurance-costs-57f06e79-dbb8-4233-898d-f5fd7664d201.html.

42  Crossover Health: https://crossoverhealth.com/.

44  annual outlook: “National Business Group on Health Identifies Six Open Enrollment Trends for 2020,” Business Group on Health, September 25, 2019, https://www.businessgrouphealth.org/who-we-are/newsroom/press-releases/identifies-six-open-enrollment-trends-for-2020.

44  sixteen Walmart COE providers: “The 16 Health Systems to Which Walmart Sends Employees for Care,” Becker’s Hospital Review, May 21, 2019, https://www.beckershospitalreview.com/strategy/the-16-health-systems-where-walmart-sends-employees-for-care.html.

44  Optum: https://www.optum.com/.

45  Rally: https://health.werally.com/partner/optum/optum_360/register/.

46  are booming: “2019: The Year We Learned to Love Instability,” Mercer, January 7, 2020, https://www.mercer.us/our-thinking/healthcare/2019-the-year-we-learned-to-love-instability.html.

46  Anthem’s: “Say Hi to Sydney, Anthem’s Mobile App,” Anthem, November 25, 2019, https://www.anthem.com/ca/blog/member-news/sydney-app-anthem-ca/.

46  Aetna’s: “Health is the Real Win,” Aetna, https://www.attainbyaetna.com/.

46  digital health care: “Health on Demand,” U.S. Report, Mercer, February 2020, https://www.mercer.us/our-thinking/health/mercer-marsh-benefits-health-on-demand.html.

49  Motion: https://www.unitedhealthcaremotion.com/.

49  Healthcare Bluebook: https://www.healthcarebluebook.com/.

49  Health Care Cost Institute: https://www.healthcostinstitute.org/.

Chapter 4: The Affordable Care Act and Other Health Plans

51  Kaiser Family Foundation’s: “Featured Affordable Care Act Resources,” Kaiser Family Foundation, https://www.kff.org/tag/affordable-care-act/.

51  2020 ACA primer: “Explaining Health Care Reform: Questions About Health Insurance Subsidies,” Kaiser Family Foundation, January 16, 2020 https://www.kff.org/health-reform/issue-brief/explaining-health-care-reform-questions-about-health/.

51  certain circumstances: “Dates and deadlines for 2020 health insurance,” HealthCare.gov., U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/quick-guide/dates-and-deadlines/.

51  Preventive health services: “Preventive health services,” HealthCare.gov., U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/coverage/preventive-care-benefits/.

51  Coverage for pre-existing conditions: “Coverage for pre-existing conditions,” HealthCare.gov., U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/coverage/pre-existing-conditions/.

52  Dental coverage in the marketplace: “Dental Coverage in the Marketplace,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/coverage/dental-coverage/.

52  Birth control benefits: “Birth Control Benefits,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/coverage/birth-control-benefits/.

52  Breastfeeding benefits: “Breastfeeding Benefits,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/coverage/breast-feeding-benefits/.

52  Mental health and substance abuse coverage: “Mental Health & Substance Abuse Coverage,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/.

52  Emergency services: “Emergency Services,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/using-marketplace-coverage/getting-emergency-care/.

52  Pregnancy, maternity, and newborn care: “Pregnancy, Maternity, and Newborn Care,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-get-pregnant/.

52  Mental health and substance use disorder services: “Mental Health and Substance Use Disorder Services,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/.

52  Preventive and wellness services: “Preventive and Wellness Services,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/coverage/preventive-care-benefits/.

53  Federal Poverty Level guidelines: “HHS Poverty Guidelines for 2020,” U.S. Department of Health and Human Services, https://aspe.hhs.gov/poverty-guidelines.

53  a flowchart: “Premium Tax Credit Flow Chart: Are You Eligible?” IRS, https://www.irs.gov/affordable-care-act/individuals-and-families/premium-tax-credit-flowchart-are-you-eligible.

53  Publication 5187: “Affordable Care Act: What You and Your Family Need to Know,” Publication 5187, IRS, https://www.irs.gov/pub/irs-pdf/p5187.pdf.

53  Instructions for Form 8962: “Instructions for Form 8962,” IRS, https://www.irs.gov/pub/irs-pdf/i8962.pdf.

53  Form 8962: “Premium Tax Credit (PTC),” Form 8962, IRS, https://www.irs.gov/pub/irs-pdf/f8962.pdf.

53  summary page: “About Form 8962, Premium Tax Credit,” IRS, https://www.irs.gov/forms-pubs/about-form-8962.

54  ACA navigator: Find Local Help,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://localhelp.healthcare.gov/#/.

54  ACA calculator: Health Insurance Marketplace Calculator, Kaiser Family Foundation, https://www.kff.org/interactive/subsidy-calculator/.

54  an online tool: Income levels and ACA savings, HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/lower-costs/.

54  an online map: “Insurer Participation on ACA Marketplaces, 2014–2020,” Kaiser Family Foundation, https://www.kff.org/private-insurance/issue-brief/insurer-participation-on-aca-marketplaces-2014-2020/.

55  homeless: “How to Claim an Exemption if You Were Homeless,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/homeless.

55  eviction or foreclosure: “How to Claim an Exemption Because You Experienced Eviction or Foreclosure,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/eviction.

55  utility shut-off notice: “How to Claim an Exemption Due to a Utility Shut-off,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/utilities-shut-off.

55  domestic violence: “How to Claim an Exemption if You Experienced Domestic Violence,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/domestic-violence.

55  a death in the family: “How to Claim an Exemption Due to the Death of a Close Family Member,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/death-in-family.

55  a natural disaster: “How to Claim an Exemption Due to Fire, Flood, or Other Disaster,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/disaster.

55  bankruptcy: “How to Claim an Exemption if You Filed for Bankruptcy,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/bankruptcy.

55  medical expenses: “How to claim an exemption for unpaid medical expenses,” HealthCare.gov., U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/owe-medical-expenses.

55  caregiver expenses: “How to claim an exemption due to increased expenses caring for a family member,” HealthCare.gov., U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/care-for-family.

55  child medical support: “How to claim an exemption for a child who’s medically supported by another party and not eligible for Medicaid or CHIP,” HealthCare.gov., U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/medicaid-chip-denied.

55  eligibility appeals: “How to claim an exemption if you were uncovered while waiting for a successful appeal.” HealthCare.gov., U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/eligible-based-on-appeal.

55  ineligible for Medicaid: “How to claim an exemption if you would have qualified for Medicaid if your state had expanded coverage,” HealthCare.gov., U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/secretary-hardship.

56  Healthcare,gov: “Out-of-pocket maximum/limit,” on ACA-covered health expenses,  HealthCare.gov., U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/.

56  struck down: “Obamacare Insurance Mandate Is Struck Down by Federal Appeals Court.” New York Times, December 18, 2019, https://www.nytimes.com/2019/12/18/health/obamacare-mandate.html.

56  3 million people: “Short-term Plans Enrolled 3 Million People, House Committee Finds,” Modern Healthcare, June 26, 2020, https://www.modernhealthcare.com/insurance/short-term-plans-enrolled-3-million-people-house-committee-finds.

57  a guide: “The expansion of short-term limited-duration policies and implications for patients,” Milliman, https://milliman-cdn.azureedge.net/-/media/milliman/pdfs/articles/patient-implications-brief-20200224.ashx?

58  a million people: “New York State Investigates Christian Health Cost-Sharing Affiliate,” New York Times, January 8, 2020, https://www.nytimes.com/2020/01/08/health/christian-health-insurance-subpoena.html.

59  studies regularly find: “VA Health System Generally Delivers Higher-Quality Care Than Other Health Providers,” RAND Corporation, April 26, 2018, https://www.rand.org/news/press/2018/04/26.html.

59  Wounds of War: Suzanne Gordon, Wounds of War: How the VA Delivers Health, Healing, and Hope to the Nation’s Veterans (Ithaca, NY: Cornell University Press, 2018), https://www.amazon.com/Wounds-War-Delivers-Veterans-Politics-ebook/dp/B07BTCBP64/ref.

60  extensive survey: “2018 Survey of Veteran Enrollees’ Health and Use of Health Care,” Advanced Survey Design, January 9, 2019, https://www.va.gov/HEALTHPOLICYPLANNING/SOE2018/2018EnrolleeDataFindingsReport_9January2019Final508Compliant.pdf.

61  preferred generic drugs: “2020 Tier 1 Copay Medication List,” Veterans Health Administration, https://www.pbm.va.gov/PBM/Tiered_Copay/Tier_1_CO-PAY_MEDICATION_LIST.pdf.

Heroes II: The Insurance Claims Expert Marsha Meytlis

63  developmental delay: “Developmental Delay,” Michigan Medicine, University of Michigan, http://www.med.umich.edu/yourchild/topics/devdel.htm.

64  Applied Behavior Analysis: “Applied Behavior Analysis,” Psychology Today, https://www.psychologytoday.com/us/therapy-types/applied-behavior-analysis.

66  FaxZero.com: https://faxzero.com/.

Chapter 5: Medicare Coverage, Costs, and Concerns

68  Medicare book: Philip Moeller, Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs (New York: Simon & Schuster, 2016), https://www.amazon.com/Get-Whats-Yours-Medicare-Maximize/dp/1501124005/.

68  Get What’s Yours: http://getwhatsyours.org/medicare/.

69  current enrollee costs: “Medicare Costs at a Glance,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance.

69  provides broad coverage: “What Medicare Covers,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/what-medicare-covers.

69  guide to Medigap: Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare, Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/pubs/pdf/02110-medicare-medigap-guide.pdf.

71  link to current rates: “Medicare costs at a glance,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance.

75  MA plans can include: “Medicare Advantage Plans cover all Medicare services,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/what-medicare-covers/what-medicare-health-plans-cover/medicare-advantage-plans-cover-all-medicare-services.

75  four savings programs: “Medicare Savings Programs,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/your-medicare-costs/help-paying-costs/medicare-savings-program/medicare-savings-programs.html.

76  projects: The Budget and Economic Outlook: 2020 to 2030, Congressional Budget Office, January 2020, https://www.cbo.gov/publication/56073.

77  MedPACs reports: “Medicare and the Health Care Delivery System,” Medicare Payment Advisory Commission Report to the Congress, June 2020, http://www.medpac.gov/docs/deafault-source/reports/jun20_reporttocongress_sec.pdf?sfvrsn-0.

77  MACPAC: Medicaid and CHIP Payment and Access Commission, https://www.macpac.gov/.

78  annual maximum deductibles: “Yearly deductible for drug plans,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/yearly-deductible-for-drug-plans.

78  current rules: “Costs for Medicare drug coverage,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage.

80  complete this Extra Help application: “Extra Help With Medicare Prescription Drug Plan Costs,” U.S. Social Security Administration, https://secure.ssa.gov/i1020/start.

81  Plan Finder: “Find a Medicare plan,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/find-a-plan/questions/home.aspx.

82  useful rundown: “Medigap Enrollment and Consumer Protections Vary Across States,” Kaiser Family Foundation, July 2018, http://files.kff.org/attachment/Issue-Brief-Medigap-Enrollment-and -Consumer-Protections-Vary-Across-States.

82  Medigap Finder: “Find a Medigap policy that works for you,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/medigap-supplemental-insurance-plans/.

83  set by rules: “IRMAA Sliding Scale Tables,” Program Operations Manual System (POMS), U.S. Social Security Administration, https://secure.ssa.gov/poms.nsf/lnx/0601101020.

84  Turbo Tax: “What Is the Difference Between AGI and MAGI on Your Taxes?” Intuit Turbo Tax, https://turbotax.intuit.com/tax-tips/irs-tax-return/what-is-the-difference-between-agi-and-magi-on-your-taxes/L7kHckNS3.

85  COBRA: “Continuation of Health Coverage (COBRA),” U.S. Department of Labor, https://www.dol.gov/general/topic/health-plans/cobra.

Chapter 6: Medicaid: A Program Everyone May Need

87  split about 60–40: “Medicaid Financing: The Basics,” Kaiser Family Foundation, https://www.kff.org/medicaid/issue-brief/medicaid-financing-the-basics/.

87  Nearly 70 percent: Acceptance of New Patients with Public and Private Insurance by Office-Based Physicians: United States, 2013, National Center on Disease Statistics, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, https://www.cdc.gov/nchs/products/databriefs/db195.htm.

88  research finds: “Data Note: Three Findings about Access to Care and Health Outcomes in Medicaid,” Kaiser Family Foundation, March 23, 2017, https://www.kff.org/medicaid/issue-brief/data-note-three-findings-about-access-to-care-and-health-outcomes-in-medicaid/.

88  2020 report: Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies as of January 2020: Findings from a 50-State Survey, Kaiser Family Foundation, March 2020, http://files.kff.org/attachment/Report-Medicaid-and-CHIP-Eligibility,-Enrollment-and-Cost-Sharing-Policies-as-of-January-2020.pdf.

89  averaged thirty months: Medicaid Home and Community-Based Services Enrollment and Spending, Kaiser Family Foundation, https://www.kff.org/medicaid/issue-brief/medicaid-home-and-community-based-services-enrollment-and-spending/.

90  online national locator: “Find Aging Resources in Your Area,” National Association of Area Agencies on Aging, https://www.n4a.org/.

90  same functional eligibility: Key State Policy Choices About Medicaid Home and Community-Based Services, Kaiser Family Foundation, http://files.kff.org/attachment/Issue-Brief-Key-State-Policy-Choices-About-Medicaid-Home-and-Community-Based-Services.

90  ADvancing States: http://www.advancingstates.org/.

94  according to: “Medicaid’s Treatment of the Home,” Martindale, December 19. 2019, https://www.martindale.com/legal-news/article_levene-gouldin-thompson-llp_2522603.htm.

94  Medicare Savings Programs: Medicare Savings Programs, Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/medicare-savings-programs.

94  Extra Help: “Find your level of Extra Help (Part D),” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/find-your-level-of-extra-help-part-d.

94  State Health Insurance Assistance Program: State Health Insurance Assistance Programs, https://www.shiptacenter.org//.

95  directory of state programs: “Directory of State ABLE Account Programs,” Academy of Special Needs Planners, https://specialneedsanswers.com/able-accounts.

Chapter 7: Your Personal Health Plan

105  Research done a few years ago: “The Association Between Income and Life Expectancy in the United States, 2001–2014,” Journal of the American Medical Association (JAMA), April 26, 2016, https://jamanetwork.com/journals/jama/fullarticle/2513561.

106  a deep dive: “Knowing Is Not Enough—Act on Your Family Health History,” Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, https://www.cdc.gov/genomics/famhistory/knowing_not_enough.htm.

106  online family history form: “My Family Health Portrait,” Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, https://phgkb.cdc.gov/FHH/html/index.html.

107  genomics information: “Genomics and Health Resources (A–Z),” Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, https://phgkb.cdc.gov/PHGKB/phgHome.action?action=a2z.

107  23andMe: https://www.23andme.com/

108  expanding array of reports: “Reports Included in All Services,” 23andMe, https://www.23andme.com/dna-reports-list/.

108  a directory: “Find a Genetic Counselor,” National Society of Genetic Counselors, https://www.nsgc.org/page/find-a-genetic-counselor.

109  Nebula Genetics: https://nebula.org/anonymous-sequencing.

109  preventive health tool: “What Is Preventive Health on Facebook?” Facebook, https://www.facebook.com/help/279392126259317?ref=preventive_health_microsite.

109  Federally Qualified Health Centers: “Federally Qualified Health Centers,” Health Resources & Services Administration, U.S. Department of Health and Human Services, https://www.hrsa.gov/opa/eligibility-and-registration/health-centers/fqhc/index.html.

111  U.S. Preventive Services Task Force: https://www.uspreventiveservicestaskforce.org/.

111  Advisory Committee on Immunization Practices: Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, https://www.cdc.gov/vaccines/acip/index.html.

111  American Academy of Pediatrics: https://www.aap.org/en-us/Pages/Default.aspx.

111  Health Resources and Services Administration: https://www.hrsa.gov/.

112  top-graded preventive care measures: “USPSTF A and B Recommendations,” U.S. Preventive Services Task Force,” https://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/.

112  a 2018 study: “Few Americans Receive All High-Priority, Appropriate Clinical Preventive Services,” Health Affairs, June 2018, https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.1248.

Chapter 8: Your Personal Care Team

115  Health care: Trudy Lieberman, Consumer Reports Complete Guide to Health Services for Seniors (Three Rivers Press, 2000), https://www.amazon.com/Consumer-Reports-Complete-Services-Seniors/dp/0812931475/.

115  read it online: “Health Care Journalist Struggles to Navigate Her Own Health Crisis,” Tarbell, February 25, 2019, https://tarbell.org/2019/02/health-care-journalist-struggles-to-navigates-her-own-health-crisis/.

119  free patient access: “UpToDate Subscriptions for Patients and Caregivers,” Wolters Kluwer, https://www.uptodate.com/home/uptodate-subscription-options-patients.

120  PatientsLikeMe: https://www.patientslikeme.com/.

120  The Patient Will See You Now: Eric Topol, MD, The Patient Will See You Now: The Future of Medicine Is in Your Hands (Basic Books, 2016), https://www.amazon.com/Patient-Will-See-You-Now/dp/0465040020/.

120  WEGO Health: https://www.wegohealth.com/.

121  community standards: “Community Standards,” Facebook, https://www.facebook.com/communitystandards/introduction.

122  National Finance Resource Directory: “National Finance Resource Directory,” Patient Advocate Foundation, https://www.patientadvocate.org/explore-our-resources/national-financial-resource-directory/.

123  Center for Improving Value in Health Care: https://www.civhc.org/.

124   2018 study: “Assessment of US Hospital Compliance with Regulations for Patients’ Requests for Medical Records,” Journal of the American Medical Association (JAMA), October 5, 2018, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2705850.

125  Prepare for Your Care: https://prepareforyourcare.org/welcome.

125  downloaded for your state: “Downloading Your State’s Advance Directive,” National Hospice and Palliative Care Organization, https://www.nhpco.org/patients-and-caregivers/advance-care-planning/advance-directives/downloading-your-states-advance-directive/.

126  Social Security: “Form SSA-1696—Appointment of Representative,” U.S. Social Security Administration, https://www.ssa.gov/forms/ssa-1696.html.

126  Medicare: “Appointment of Representative,” U.S. Centers for Medicare & Medicaid Services, https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms1696.pdf.

127  state directory: “Click a state for more information,” National POLST Paradigm, https://polst.org/programs-in-your-state/.

Heroes IV: The Social Media Maven Julie Croner

129  avascular necrosis: “What Is Avascular Necrosis?” Johns Hopkins Medicine, https://www.hopkinsmedicine.org/health/conditions-and-diseases/avascular-necrosis.

131  Regenexx: https://regenexx.com/.

131  Centeno-Schultz Clinic: https://centenoschultz.com/.

Chapter 9: Your Professional Care Team

133  live longer and healthier: “Interpersonal Continuity of Care and Care Outcomes: A Critical Review,” Annals of Family Medicine, March 2005, https://www.annfammed.org/content/3/2/159.

133  Dr. Jennifer DeVoe: https://www.ohsu.edu/providers/jennifer-e-devoe-md.

133  Oregon Health & Science University: https://www.ohsu.edu/.

134  Knoema: “US Population by Age and Generation in 2020,” Knoema, April 16, 2020, https://knoema.com/infographics/egyydzc/us-population-by-age-and-generation.

134  Accenture: Accenture 2019 Digital Health Consumer Survey, Accenture, March 2020, https://www.accenture.com.

135  sobering report: The Economic Consequences of Millennial Health, Moody’s Analytics and Blue Cross Blue Shield Association, November 6, 2019, https://www.bcbs.com/the-health-of-america/reports/how-millennials-current-and-future-health-could-affect-our-economy.

135  emotional retelling: “Dad’s Last Week,” Annals of Family Medicine, May 2016, http://www.annfammed.org/content/14/3/273.full.pdf+html?.

135  ranked 27th out of 36: “Doctors.” OECD Data, https://data.oecd.org/healthres/doctors.htm.

136  predicts: “New Findings Confirm Predictions on Physician Shortage,” Association of American Medical Colleges, April 23, 2019, https://www.aamc.org/news-insights/press-releases/new-findings-confirm-predictions-physician-shortage.

136  reported: “Geisinger’s med school to provide free tuition for primary-care students,” Modern Healthcare, November 6, 2019, https://www.modernhealthcare.com/physicians/geisingers-med-school-provide-free-tuition-primary-care-students.

137  UpToDate: https://www.uptodate.com/home.

138  Beth Bortz: “Meet our team,” Virginia Center for Health Innovation, https://www.vahealthinnovation.org/our-team/.

138  direct primary care: “Direct Primary Care Gaoms Ground as Employer Strategy,” Mercer, July 9. 2020, https://www.mercer.us/our-thinking/healthcare/.

139  concierge medicine: “What to Know About Concierge Medicine,” AARP, April 25, 2019, https://www.aarp.org/health/conditions-treatments/info-2019/what-to-know-about-concierge-medicine.html.

139  Accountable care organizations: “Accountable Care Organizations (ACOs): General Information,” U.S. Centers for Medicare & Medicaid Services, https://innovation.cms.gov/initiatives/ACO/.

140  Ambulatory Surgical Center: “ASC Quality Reporting,” U.S. Centers for Medicare & Medicaid Services, https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ASC-Quality-Reporting/index.html.

141  Affordability concerns: “Health Insurance Affordability Concerns and Health Care Avoidance Among US Adults Approaching Retirement,” Journal of the American Medical Association (JAMA), February 7, 2020, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2760437.

142  formally asked: “Implementation of Financial Education Curriculum for Medical Students and Physicians in Training,” American Medical Association, October 2019, https://www.ama-assn.org/system/files/2019-10/i19-refcomm-c-addendum.pdf.

142  Dr. Caroline Sloan: https://medicine.duke.edu/faculty/caroline-sloan-md.

142  The 7 Habits of Highly Effective Cost-of-Care Conversations: “The 7 Habits of Highly Effective Cost-of-Care Conversations,” Annals of Internal Medicine, May 7, 2019, https://annals.org/aim/fullarticle/2732826/7-habits-highly-effective-cost-care-conversations.

144  surging growth: “Implications of the Rapid Growth of the Nurse Practitioner Workforce in the US,” Health Affairs, February 2020, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2019.00686.

145  National Association of Free & Charitable Clinics: http://www.nafcclinics.org/.

145  searchable directory: “Find Free/Low-Cost/Sliding Scale Clinics,” NeedyMeds, https://www.needymeds.org/free-clinics-branch.

Chapter 10: What Quality Looks Like

148  a 2019 survey: 2019 Healthcare Consumer Insight & Digital Engagement Survey, Binary Fountain, September 2019, https://go.binaryfountain.com/2019-healthcare-consumer-insights-survey.html.

148  Consumer Assessment of Healthcare Providers and Systems: https://www.ahrq.gov/cahps/index.html.

149  Healthgrades: https://www.healthgrades.com/.

149  RateMDs: https://www.ratemds.com/.

149  U.S. News & World Report: https://health.usnews.com/doctors.

149  ShareCare: https://www.sharecare.com/.

149  WebMD: https://doctor.webmd.com/.

149  Zocdoc: https://www.zocdoc.com/.

149  Vital Signs: Vital Signs, ProPublica, https://projects.propublica.org/vital-signs/.

149  state-by-state details: “Your Doctor Might Have a Disciplinary Record. Here’s How to Find Out.” ProPublica, updated December 11, 2019, https://projects.propublica.org/graphics/investigating-doctors.

150  recommends: “Using Physician Rating Websites,” Center for Advancing Health, GW Cancer Institute, 2016, https://www.guroo.com/#!insights/Quality/quality-using-physician-rating-websites.

150  a thorough review: Empowering New Yorkers with Quality Measures That Matter to Them, United Hospital Fund, December 2017, https://nyshealthfoundation.org/wp-content/uploads/2017/12/empowering-new-yorkers-with-quality-measures-dec-2017.pdf.

150  Agency for Healthcare Research and Quality: “Get to know the AHRQ Quality Indicators,” Agency for Healthcare Research and Quality       , https://www.qualityindicators.ahrq.gov/.

151  Recommended telehealth care: “Virtual Visits”, United HealthCare, https://www.uhc.com/individual-and-family/member-resources/health-care-tools/virtual-visits.

151  the telehealth transition: “Positioning Virtual Care to Transform Health Benefits,” Mercer, June 4, 2020, https://www.mercer.us/our-thinking/healthcare/positioning-virtual-care-to-transform-health-benefits.html.

151  do not have a primary care physician: “One-Fourth of Adults and Nearly Half of Adults Under 30 Don’t Have a Primary Care Doctor,” Kaiser Family Foundation, February 8, 2019, https://www.kff.org/other/slide/one-fourth-of-adults-and-nearly-half-of-adults-under-30-don’t-have-a-primary-care-doctor/.

152  American Telehealth Association: https://www.americantelemed.org/.

153  American Board of Medical Specialties: https://www.abms.org/.

153  Certification Matters: https://www.certificationmatters.org/.

153  Centers for Medicare & Medicaid Services: https://www.cms.gov/.

154  HHS.gov: https://www.hhs.gov/.

154  Physician Compare: “Physician Compare,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/physiciancompare/.

154  Hospital Compare: “Hospital Compare,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/hospitalcompare/search.html?

154  Nursing Home Compare: “Nursing Home Compare,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/nursinghomecompare/search.html?

154  Hospice Compare: “Hospice Compare,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/hospicecompare/.

154  Inpatient Rehabilitation Facility Compare: “Inpatient Rehabilitation Facility Compare,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/inpatientrehabilitationfacilitycompare/.

154  Dialysis Facility Compare: “Dialysis Facility Compare,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/dialysisfacilitycompare/.

154  Home Health Compare: “Home Health Compare,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/homehealthcompare/search.html.

154  Long-Term Care Hospital Compare: “Long-Term Care Hospital Compare,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/longtermcarehospitalcompare/.

156  Agency for Healthcare Research and Quality: “Major Hospital Quality Measurement Sets,” Agency for Healthcare Research and Quality, https://www.ahrq.gov/talkingquality/measures/setting/hospitals/measurement-sets.html.

156  National Quality Forum: http://www.qualityforum.org/About_NQF/.

157  AHRQ Quality Indicators: https://www.qualityindicators.ahrq.gov/.

157  National Hospital Quality Measures: “Measures,” Joint Commission, https://www.jointcommission.org/measurement/measures/.

157  CAHPS Hospital Survey: “CAHPS Adult Hospital Survey,” Agency for Healthcare Research and Quality, https://www.ahrq.gov/cahps/surveys-guidance/hospital/about/adult_hp_survey.html.

157  ORYX: “ORYX Performance Measurement Reporting,” Joint Commission, https://www.jointcommission.org/measurement/reporting/accreditation-oryx/.

157  The Leapfrog Group: http://www.leapfroggroup.org/.

157  The Advisory Board: https://www.advisory.com/.

157  series of briefs: “How Hospital Quality Ratings Work,” Advisory Board, February 2020, https://www.advisory.com/research/physician-executive-council/resources/2017/metrics-used-in-hospital-quality-rating-programs#CMSstar.

157  evaluated: “Rating the Raters: An Evaluation of Publicly Reported Hospital Quality Rating Systems,” New England Journal of Medicine, August 14, 2019, https://catalyst.nejm.org/doi/full/10.1056/CAT.19.0629.

157  conflicting ratings: “National Hospital Ratings Systems Share Few Common Scores And May Generate Confusion Instead Of Clarity,” Health Affairs, March 2015, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2014.0201.

158  conflicting information for patients: “Consumers’ Interest in Provider Ratings Grows, and Improved Report Cards and Other Steps Could Accelerate Their Use,” Health Affairs, April 2016, https://www.healthaffairs.org/doi/10.1377/hlthaff.2015.1654.

158  IBM/Watson Health: “IBM Watson Health Recognizes Top-Performing U.S. Hospitals and Health Systems,” IBM, June 20, 2020, https://www.prnewswire.com/news-releases/ibm-watson-health-recognizes-top-performing-us-hospitals-and-health-systems-301085296.html.

159  assessed Nursing Home Compare: “Does Nursing Home Compare Reflect Patient Safety in Nursing Homes?” Health Affairs, November 2018, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.0721.

159  provides details: “Nursing Home Staffing 2019 Q3,” Long Term Care Community Coalition, https://nursinghome411.org/category/nursing-home-information/staffing/.

159  who has reviewed: “How Are Nursing Homes Doing When It Comes to Staffing? This Tool Helps You Find Out,” Association of Health Care Journalists, January 3, 2020, https://healthjournalism.org/blog/2020/01/how-are-nursing-homes-doing-when-it-comes-to-staffing-this-tool-helps-you-find-out/.

160  of her program: “How to Find a Long-Term Care Ombudsman Program,” National Consumer Voice for Quality Long-Term Care, https://theconsumervoice.org/get_help.

160  National Association of Area Agencies on Aging: https://www.n4a.org/. find one near you: “PACEFinder: Find a PACE Program in Your Neighborhood,” National PACE Association, https://www.npaonline.org/pace-you/pacefinder-find-pace-program-your-neighborhood.

160  find one near you: “PACEFinder: Find a PACE Program in Your Neighborhood,” National PACE Association, https://www.npaonline.org/pace-you/pacefinder-find-pace-program-your-neighborhood.

160  rules adopted in 2019: “Medicare and Medicaid Programs; Revision of Requirements for Long-Term Care Facilities: Arbitration Agreements,” Federal Register, July 18. 2019, https://www.federalregister.gov/documents/2019/07/18/2019-14945/medicare-and-medicaid-programs-revision-of-requirements-for-long-term-care-facilities-arbitration.

161  lack the fact-based comparative rankings: “Quality measurement lags in the outpatient surgery arena,” Modern Healthcare, April 6, 2019, https://www.modernhealthcare.com/safety-quality/quality-measurement-lags-outpatient-surgery-arena.

161  performance information: “Quality measures developed and tested by the ASC Quality Collaboration,” ASC Quality Collaboration, https://higherlogicdownload.s3.amazonaws.com/ASCACONNECT/1b34f1a1-0180-4005-9507-902fdf8f242e/UploadedImages/ASC_Quality_Collaboration/Documents/2019-Summary-ASC-QC-Measures.pdf.

Chapter 11: Unneeded and Misdiagnosed Care

170  research found: “Surgery for Blocked Arteries Is Often Unwarranted, Researchers Find,” New York Times, November 16, 2019, https://www.nytimes.com/2019/11/16/health/heart-disease-stents-bypass.html.

170  American Board of Internal Medicine: https://www.abim.org/.

170  Choosing Wisely: https://www.choosingwisely.org/.

171  MedInsight Waste Calculator: “MedInsight Health Waste Calculator,” Milliman, https://milliman-cdn.azureedge.net/-/media/medinsight/pdfs/medinsight-health-waste-calculator.ashx.

171  A study found: “Is Great Information Good Enough? Evidence from Physicians as Patients,” National Bureau of Economic Research, https://www.nber.org/papers/w26038.

171  The authors of the study: “Do as the Doctor Says, Not as He or She Does,” STAT, July 22, 2019, https://www.statnews.com/2019/07/22/doctors-information-personal-health-decisions/.

172  2017 study: “Treating, Fast and Slow: Americans’ Understanding of and Responses to Low-Value Care.” The Milbank Quarterly, March 2017, https://www.milbank.org/quarterly/articles/treating-fast-slow-americans-understanding-responses-low-value-care/.

172  Virginia Center on Health Innovation: https://www.vahealthinnovation.org/.

173  A research study: “Cascades of Care After Incidental Findings in a US National Survey of Physicians,” Journal of the American Medical Association (JAMA), October 16, 2019, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2752991.

173  comprehensive study: “Waste in the US Health Care System: Estimated Costs and Potential for Savings,” Journal of the American Medical Association (JAMA), October 7, 2019, https://jamanetwork.com/journals/jama/fullarticle/2752664.

175  study: 2017 Statewide Low Value Services Report, Virginia Center on Health Information, April 2917, http://www.vahealthinnovation.org/wp-content/uploads/2019/04/2017-Statewide-and-Regional-Low-Value-Service-Reports-Final.pdf.

175  2018 analysis: Medicare and the Health Care Delivery System, Medicare Payment Advisory Commission, June 2018, http://www.medpac.gov/docs/default-source/reports/jun18_medpacreporttocongress_rev_nov2019_note_sec.pdf?sfvrsn=0.

176  Connecticut collaboration: “Leveraging Choosing Wisely as a Tool for Achieving Health Equity,” Connecticut Choosing Wisely Collaborative, July 2017, http://nebula.wsimg.com/dab11e19782c29368719396db04d1d01?AccessKeyId=EE1E8CCBEA1024792D71&disposition=0&alloworigin=1.

177  four-page checklist: “Improving Diagnosis in Health Care: Improving Resources for Patients, Families, and Health Care Professionals,” Institute of Medicine, National Academy of Sciences, https://www.nap.edu/resource/21794/DiagnosticError_Toolkit.pdf.

177  National Patient Safety Foundation: https://npsf.digitellinc.com/npsf/.

177  Society to Improve Diagnosis in Medicine: https://www.improvediagnosis.org/.

177  document never got presented: “The Missing Pathology Report.” Society to Improve Diagnosis in Medicine, https://www.improvediagnosis.org/stories_posts/the-missing-pathology-report/.

178  Consumers Advancing Patient Safety: https://www.patientsafety.org/.

178  Patient-Centered Outcomes Research Center: https://www.pcori.org/.

178  Idaho Supreme Court: “SHERIDAN v. John J. Jambura, M.D., David B. Bettis, M.D. and John Does I-V, Defendants.” Supreme Court of Idaho, May 22, 2001, https://caselaw.findlaw.com/id-supreme-court/1364599.html.

179  estimates made twenty years ago: “Patient Safety 15 Years After To Err Is Human – NAM Symposium,” National Academy of Medicine, December 10, 2015, https://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12072015a.

179  2014 study: “The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations,” The BMJ (British Medical Journal), 2014, https://qualitysafety.bmj.com/content/23/9/727.

180  acid reflux or GERD: “Gastroesophageal Reflux Disease (GERD),” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940.

180  Resource Directory: https://www.patientadvocate.org/explore-our-resources/national-financial-resource-directory/.

181  patient toolkit: “Patient’s Toolkit for Diagnosis,” Society to Improve Diagnosis in Medicine, https://www.improvediagnosis.org/patients-toolkit/.

182  a 2019 study: “Diagnosis Errors Account for One-Third of Severe Harm Malpractice Claims,” Modern Healthcare, July 11, 2019, https://www.modernhealthcare.com/safety-quality/diagnosis-errors-account-one-third-severe-harm-malpractice-claims.

Chapter 12: When You’re in Control, and When You’re Not

185  2017 research: “One in Five Inpatient Emergency Department Cases May Lead to Surprise Bills,” Health Affairs, January 2017, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2016.0970?

185  American College of Emergency Physicians: “EMTALA Fact Sheet,” American College of Emergency Physicians, https://www.acep.org/life-as-a-physician/ethics–legal/emtala/emtala-fact-sheet/.

186  are charged more: “Per Visit Emergency Department Expenditures By Insurance Type, 1996–2015,” Health Affairs, July 2018, https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2018.0083.

186  2019 research: “The High Cost of Avoidable Hospital Emergency Department Visits,” UnitedHealth Group, July 22, 2019, https://www.unitedhealthgroup.com/newsroom/posts/2019-07-22-high-cost-emergency-department-visits.html.

187  ER Inspector: “Be Prepared: Find the ER You Want to Go to Before an Emergency Happens,” ProPublica, September 19, 2019, https://www.propublica.org/article/prepared-find-the-er-you-want-to-go-to-before-an-emergency-happens.

189  American Ambulance Association: https://ambulance.org/.

190  Urgent Care Association (UCA): https://www.ucaoa.org/.

191  A 2017 study: “Comparing Utilization and Costs of Care in Freestanding Emergency Departments, Hospital Emergency Departments, and Urgent Care Centers,” Annals of Emergency Medicine, February 15, 2017, https://www.annemergmed.com/article/S0196-0644(16)31522-0/abstract.

195  enhanced recovery after surgery: “Enhanced Recovery after Surgery,” American Association of Nurse Anesthetists, https://www.aana.com/practice/clinical-practice-resources/enhanced-recovery-after-surgery.

195  an online checklist: “Which Facility Is Best for My Outpatient Procedure?” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/what-medicare-covers/outpatient-facility-checklist.

196  Top 10 ASC Outpatient Procedures: “Top Outpatient Procedures at Hospitals vs Surgery Centers,” Definitive Healthcare, July 2019, https://blog.definitivehc.com/top-outpatient-procedures-at-hospitals-versus-ascs.

197  Healthcare Bluebook: https://www.healthcarebluebook.com/.

198  Patients Beyond Borders: https://www.patientsbeyondborders.com/.

198  Joint Commission: https://www.jointcommission.org/.

198  glossary: “Glossary of Terms,” Joint Commission, https://www.qualitycheck.org/glossary/.

198  QualityCheck.org: https://www.qualitycheck.org/.

198  WorldHospitalSearch.org: https://www.worldhospitalsearch.org/.

198  specific procedures: “Benefits of JCI Accreditation and Certification,” worldhospitalsearch.org, Joint Commission International, https://www.worldhospitalsearch.org/the-value-of-jci-accreditation/benefits-of-jci-accreditation-and-certification/.

199  price comparisons: “International Medical Treatment Prices,” Medical Tourism Association, https://www.medicaltourism.com/compare-prices.

200  Narayana Health: https://www.narayanahealth.org/.

200  The story: “The World’s Cheapest Hospital Has to Get Even Cheaper,” Bloomberg Businessweek, March 26, 2019, https://www.bloomberg.com/news/features/2019-03-26/the-world-s-cheapest-hospital-has-to-get-even-cheaper.

200  coronary thromboendarterectomy: “Pulmonary Thromboendarterectomy,” Cleveland Clinic, https://my.clevelandclinic.org/health/treatments/21024-pulmonary-thromboendarterectomy-surgery.

200  MediBid.com: https://www.medibid.com/.

200  cost calculator: https://www.medibid.com/cost-calculator/.

Heroes VI: The Warrior Mother Cynthia Buness

201  published a piece: “Oral Vancomycin Therapy in a Child with Primary Sclerosing Cholangitis and Severe Ulcerative Colitis,” pghn [Pediatric Gastroenterology, Hepatology & Nutrition], September 2016, https://pghn.org/search.php?where=aview&id=10.5223/pghn.2016.19.3.210&code=1121PGHN&vmode=FULL.

Chapter 13: Shopping for Health Care

207  controversial health insurance substitutes: “ ‘Sham’ Sharing Ministries Test Faith of Patients and Insurance Regulators,” Kaiser Health News, May 17, 2019, https://khn.org/news/sham-sharing-ministries-test-faith-of-patients-and-insurance-regulators/.

207  cost calculator: https://www.medibid.com/cost-calculator/.

208  Patient Rights Advocates: https://www.patientrightsadvocate.org/.

208  Cynthia Fisher: “A Powerful Lobbying Tool in the Trump Era: the President’s Ear,” Wall Street Journal, April 17, 2019, https://www.wsj.com/articles/a-powerful-lobbying-tool-in-the-trump-era-the-presidents-ear-11555493400.

208  New Choice Health: https://www.newchoicehealth.com/.

208  ClearHealthCosts: https://clearhealthcosts.com/.

208  Surgery Center of Oklahoma: https://surgerycenterok.com/.

208  KISx Card: https://getkisx.com/.

209  downloads of its chargemaster: “Hospital Standard Charges” (Excel spreadsheet), University of Utah Health, https://healthcare.utah.edu/bill/pdfs/standard-charges-to-publish.xlsx.

210  2,900-item chargemaster: “Intermountain Medical Center Chargemaster” (Excel spreadsheet), Intermountain Healthcare, https://intermountainhealthcare.org/-/media/files/chargemasters/2019-cm/intermountain-medical-center—chargemaster.xlsx?la=en.

211  report from Altarun: “Revealing the Truth about Healthcare Price Transparency,” Altarun, June 2018, https://www.healthcarevaluehub.org/advocate-resources/publications/revealing-truth-about-healthcare-price-transparency.

211  later study by Altarum: “Consumer-Centric Evaluation of Healthcare Price and Quality Transparency Tools,” Altarum, April 19, 2019, https://altarum.org/publications/consumer-centric-evaluation-healthcare-price-and-quality-transparency-tools.

213  popularized by Malcolm Gladwell: Malcolm Gladwell, “Complexity and the Ten-Thousand-Hour Rule,” New Yorker, August 21, 2013, https://www.newyorker.com/sports/sporting-scene/complexity-and-the-ten-thousand-hour-rule.

216  “Find a Fair Price”: “Find Your Fair Price,” Healthcare Bluebook, https://www.healthcarebluebook.com/ui/consumerfront.

217  Health Care Cost Institute: https://www.healthcostinstitute.org/.

217  Healthy Marketplace Index: https://www.healthcostinstitute.org/research/hmi.

218  Guroo.com: https://www.guroo.com/#!

219  FAIR Health: https://www.fairhealthconsumer.org/.

219  Healthcare Common Procedural Coding System: “HCPCS – General Information,” CMS.gov, U.S. Centers for Medicare & Medicaid Services, https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/index.

219  Procedure Price Lookup Tool: https://www.medicare.gov/procedure-price-lookup/.

220  keeps track: “Interactive State Report Map,” All-Payer Claims Database (APCD) Council, https://www.apcdcouncil.org/state/map.

221  Maryland Health Care Commission: http://mhcc.maryland.gov/.

221  Center for Improving Value in Health Care: https://www.civhc.org/.

222  Illinois Hospital Report Card: http://www.healthcarereportcard.illinois.gov/.

222  Compare Maine: https://www.comparemaine.org/.

222  MNHealthScores: http://www.mnhealthscores.org/.

222  NH HealthCost: https://nhhealthcost.nh.gov/.

222  Oregon Hospital Guide: https://oregonhospitalguide.org/.

222  Hospital Report Cards: “Review and Compare Hospitals Using Hospital Report Cards (2020),” Vermont Department of Health, https://www.healthvermont.gov/health-statistics-vital-records/health-care-systems-reporting/hospital-report-cards.

222  Healthcare Pricing Transparency Report: “Healthcare Pricing Transparency,” Virginia Health Information, https://www.vhi.org/HealthcarePricing/default.asp.

222  Washington State MONAHRQ: http://www.wamonahrq.net/.

222  My Health Wisconsin: http://wisconsinhealthinfo.org/.

223  ViaCord: https://www.viacord.com/.

Chapter 14: Getting and Paying for Drugs

225  NeedyMeds: https://www.needymeds.org/.

226  insulin availability and pricing crisis: “The Blame Game: Everyone and No One Is Raising Insulin Prices,” Kaiser Health News, April 10, 2019, https://khn.org/news/the-blame-game-everyone-and-no-one-is-raising-insulin-prices/.

229  Ardon Health: http://ardonhealth.com/.

230  Stelara: https://www.stelarainfo.com/.

230  FundFinder: https://fundfinder.panfoundation.org/.

230  pharmaceutical assistance programs: “Find a Pharmaceutical Assistance Program for the drugs you take,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/pharmaceutical-assistance-program/.

230  RxAssist: https://www.rxassist.org/patients.

230  National Financial Resource Directory: https://www.patientadvocate.org/explore-our-resources/national-financial-resource-directory/.

231  Several federal prosecutions: “Fourth Foundation Resolves Allegations That It Conspired with Pharmaceutical Companies to Pay Kickbacks to Medicare Patients,” U.S. Attorney’s Office, District of Massachusetts, https://www.justice.gov/usao-ma/pr/fourth-foundation-resolves-allegations-it-conspired-pharmaceutical-companies-pay.

231  GoodRx: https://www.goodrx.com/.

233  Blink Health: https://www.blinkhealth.com/.

233  FamilyWize: https://familywize.org/.

233  WeRx: https://werx.org/.

233  HealthWarehouse: https://www.healthwarehouse.com/.

234  drug shopping test: “Shop Around for Lower Drug Prices,” Consumer Reports, April 5, 2018, https://www.consumerreports.org/drug-prices/shop-around-for-better-drug-prices/.

235  PharmacyChecker.com: https://www.pharmacychecker.com/.

235  in a story: “Shopping Abroad for Cheaper Medication? Here’s What You Need to Know,” Kaiser Health News, August 22, 2019, https://khn.org/news/shopping-abroad-for-cheaper-medication-heres-what-you-need-to-know/.

235  Valisure: https://www.valisure.com/.

235  cipa.com: http://www.cipa.com/.

Heroes VII: The Warrior Daughter Areta Buness

238  erythema nodosum: “Erythema nodosum,” Web MD, https://www.webmd.com/skin-problems-and-treatments/erythema-nodosum.

240  autobiographical story: “My Story of Perseverance: Indomitable Spirit.” Stanford University Athletics, Stanford University, https://gostanford.com/feature/indomitablespirit.

Chapter 15: How to Fight Back

243  2019 study: “Claims Denials and Appeals in ACA Marketplace Plans,” Kaiser Family Foundation, February 25, 2019, https://www.kff.org/report-section/claims-denials-and-appeals-in-aca-marketplace-plans-issue-brief/.

244  An American Sickness: Elisabeth Rosenthal, An American Sickness: How Healthcare Became Big Business and How You Can Take It Back (New York: Penguin Books, 2017), https://www.amazon.com/dp/B01IOHQ9LO/.

244  Paying Till It Hurts: “Paying Till It Hurts,” New York Times, https://www.nytimes.com/interactive/2014/health/paying-till-it-hurts.html.

244  a 2017 piece: “Those Indecipherable Medical Bills? They’re One Reason Health Care Costs So Much,” New York Times Magazine, March 29, 2017, https://www.nytimes.com/2017/03/29/magazine/those-indecipherable-medical-bills-theyre-one-reason-health-care-costs-so-much.html.

245  Alliance of Claims Assistance Professionals: https://www.claims.org/.

247  Medicare’s prices for outpatient surgeries: “Procedure Price Lookup,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/procedure-price-lookup/.

249  ClinicalTrials.gov: ClinicalTrials.gov, U.S. National Library of Medicine, U.S. National Institutes of Health, U.S. Department of Health and Human Services, https://clinicaltrials.gov/ct2/home.

250  related educational materials: “Learn About Clinical Studies,” Clinical Trials.gov, U.S. National Library of Medicine, U.S. National Institutes of Health, U.S. Department of Health and Human Services, https://clinicaltrials.gov/ct2/about-studies/learn.

250  Project Patient Voice: U.S. Food and Drug Administration, https://www.fda.gov/about-fda/oncology-center-excellence/project-patient-voice.

250  reported: “FDA and NIH let clinical trial sponsors keep results secret and break the law,” Science, January 13, 2020, https://www.sciencemag.org/news/2020/01/fda-and-nih-let-clinical-trial-sponsors-keep-results-secret-and-break-law.

250  National Financial Resource Directory: https://www.patientadvocate.org/explore-our-resources/national-financial-resource-directory/.

250  AllTrials.net: https://www.alltrials.net/.

250  a website: “Who’s sharing their clinical trial results?,” FDAAA Trials Tracker, https://fdaaa.trialstracker.net/.

251  cancer patients who filed for bankruptcy: “Financial Insolvency as a Risk Factor for Early Mortality Among Patients With Cancer,” Journal of Clinial Oncology, 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4933128/.

251  sweeping study: “Death or Debt? National Estimates of Financial Toxicity in Persons with Newly-Diagnosed Cancer,” American Journal of Medicine, June 12, 2018, https://www.amjmed.com/article/S0002-9343(18)30509-6/pdf.

252  National Foundation for Credit Counseling: https://www.nfcc.org/.

252  RIP Medical Debt: https://ripmedicaldebt.org/.

252  a list: “Debt Resources,” RIP Medical Debt, https://ripmedicaldebt.org/debt-resources/.

253  GoFundMe: https://www.gofundme.com/.

253  New Yorker article: “The Hidden Cost of GoFundMe Health Care,” New Yorker, July 1, 2019, https://www.newyorker.com/magazine/2019/07/01/the-perverse-logic-of-gofundme-health-care.

254  ProPublica: “Health Care,” ProPublica, https://www.propublica.org/topics/healthcare.

254  by Vox: “Hospitals Kept ER Fees Secret. We Uncovered Them,” Vox, https://www.vox.com/2018/2/27/16936638/er-bills-emergency-room-hospital-fees-health-care-costs.

254  “Bill of the Month”: “Bill of The Month,” Kaiser Health News, https://khn.org/news/tag/bill-of-the-month/.

254  “Investigations”: “Investigations,” Kaiser Health News, https://khn.org/news/tag/investigation/.

255  that article: “Column: A 20-year-old fights back against her health insurer,” PBS NewsHour, https://www.pbs.org/newshour/health/column-a-20-year-old-fights-back-against-her-health-insurer.

Chapter 16: When Consumers Make the Call

258  spring 2020 article: “Direct-to-consumer digital health,” The Lancet, April 2020, https://www.thelancet.com/journals/landig/article/PIIS2589-7500(20)30057-1/fulltext.

258  author Eric Topol: Eric Topol, MD, The Patient Will See You Now: The Future of Medicine Is in Your Hands (Basic Books, 2016), https://www.amazon.com/Patient-Will-See-You-Now/dp/0465040020/.

258  late 2019 report: The Economic Consequences of Millennial Health, Moody’s Analytics for the Blue Cross Blue Shield Association, September 2019, https://www.bcbs.com/sites/default/files/file-attachments/health-of-america-report/HOA-Moodys-Millennial-10-30.pdf.

259  Modernizing Medicine: https://www.modmed.com/.

259  Its findings: “How Millennials Are Reshaping Healthcare’s Future,” KaufmanHall, 2019, https://www.kaufmanhall.com/ideas-resources/ebook/how-millennials-are-reshaping-healthcares-future.

260  MDLIVE: https://www.mdlive.com/.

260  mid-2019 list of telehealth providers: “275+ Telehealth Companies to Know | 2019,” Becker’s Hospital Review, June 28, 2019, https://www.beckershospitalreview.com/lists/275-telehealth-companies-to-know-2019.html.

260  Amwell: https://business.amwell.com/.

260  Doctor on Demand: https://www.doctorondemand.com/.

260  HeyDoctor: https://www.heydoctor.com/.

260  Teladoc: https://www.teladoc.com/.

261  One Medical: https://www.onemedical.com/.

262  Bind: https://www.yourbind.com/.

266  investing a billion dollars: “Walgreens to Open Doctors’ Offices at Its U.S. Stores,” Wall Street Journal, July 8, 2020, https://www.wsj.com/articles/walgreens-to-open-doctors-offices-at-its-u-s-stores-11594209601.

266  extensive list: “Services,” minute clinic, CVS Pharmacy, CVS, https://www.cvs.com/minuteclinic/services.

268  summary of prices: “Summarized Pricing List for Dallas, GA Store #3403,” https://corporate.walmart.com/media-library/document/walmart-health-center-summarized-pricing-list/_proxyDocument?id=0000016d-26f0-da5a-ab7d-26fb9d760000.

270  Patient Rights Advocate: https://www.patientrightsadvocate.org/.