Chapter 3: Employers Get to Work on Health Care

34  article: “How Employers Are Fixing Health Care,” Harvard Business Review, March, 2019,

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,

35  Rosen Hotels & Resorts:

35  RosenCare:

35  employer insurance premiums: “Average Annual Single Premium per Enrolled Employee for Employer-Based Health Insurance,” Kaiser Family Foundation, 2018,

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),

37  Haven:

37  Lisa Woods: “The Future of Healthcare with Lisa Woods, US Strategy and Design for Walmart,” Thrive Global, February 18, 2020,

37  her and company CEO Doug McMillon: “World’s 50 Greatest Leaders,” Fortune, 2019,

38  Covera Health:

38  Grand Rounds:

40  wrote in early 2020: “Self-Insured Companies Do No Better on Cost Control,” Axios, January 27, 2020,

42  Crossover Health:

44  annual outlook: “National Business Group on Health Identifies Six Open Enrollment Trends for 2020,” Business Group on Health, September 25, 2019,

44  sixteen Walmart COE providers: “The 16 Health Systems to Which Walmart Sends Employees for Care,” Becker’s Hospital Review, May 21, 2019,

44  Optum:

45  Rally:

46  are booming: “2019: The Year We Learned to Love Instability,” Mercer, January 7, 2020,

46  Anthem’s: “Say Hi to Sydney, Anthem’s Mobile App,” Anthem, November 25, 2019,

46  Aetna’s: “Health is the Real Win,” Aetna,

46  digital health care: “Health on Demand,” U.S. Report, Mercer, February 2020,

49  Motion:

49  Healthcare Bluebook:

49  Health Care Cost Institute:

Chapter 11: Unneeded and Misdiagnosed Care

170  research found: “Surgery for Blocked Arteries Is Often Unwarranted, Researchers Find,” New York Times, November 16, 2019,

170  American Board of Internal Medicine:

170  Choosing Wisely:

171  MedInsight Waste Calculator: “MedInsight Health Waste Calculator,” Milliman,

171  A study found: “Is Great Information Good Enough? Evidence from Physicians as Patients,” National Bureau of Economic Research,

171  The authors of the study: “Do as the Doctor Says, Not as He or She Does,” STAT, July 22, 2019,

172  2017 study: “Treating, Fast and Slow: Americans’ Understanding of and Responses to Low-Value Care.” The Milbank Quarterly, March 2017,

172  Virginia Center on Health Innovation:

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,

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,

175  study: 2017 Statewide Low Value Services Report, Virginia Center on Health Information, April 2917,

175  2018 analysis: Medicare and the Health Care Delivery System, Medicare Payment Advisory Commission, June 2018,

176  Connecticut collaboration: “Leveraging Choosing Wisely as a Tool for Achieving Health Equity,” Connecticut Choosing Wisely Collaborative, July 2017,

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,

177  National Patient Safety Foundation:

177  Society to Improve Diagnosis in Medicine:

177  document never got presented: “The Missing Pathology Report.” Society to Improve Diagnosis in Medicine,

178  Consumers Advancing Patient Safety:

178  Patient-Centered Outcomes Research Center:

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,

179  estimates made twenty years ago: “Patient Safety 15 Years After To Err Is Human – NAM Symposium,” National Academy of Medicine, December 10, 2015,

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,

180  acid reflux or GERD: “Gastroesophageal Reflux Disease (GERD),” Mayo Clinic,

180  Resource Directory:

181  patient toolkit: “Patient’s Toolkit for Diagnosis,” Society to Improve Diagnosis in Medicine,

182  a 2019 study: “Diagnosis Errors Account for One-Third of Severe Harm Malpractice Claims,” Modern Healthcare, July 11, 2019,

Chapter 10: What Quality Looks Like

148  a 2019 survey: 2019 Healthcare Consumer Insight & Digital Engagement Survey, Binary Fountain, September 2019,

148  Consumer Assessment of Healthcare Providers and Systems:

149  Healthgrades:

149  RateMDs:

149  U.S. News & World Report:

149  ShareCare:

149  WebMD:

149  Zocdoc:

149  Vital Signs: Vital Signs, ProPublica,

149  state-by-state details: “Your Doctor Might Have a Disciplinary Record. Here’s How to Find Out.” ProPublica, updated December 11, 2019,

150  recommends: “Using Physician Rating Websites,” Center for Advancing Health, GW Cancer Institute, 2016,!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,

150  Agency for Healthcare Research and Quality: “Get to know the AHRQ Quality Indicators,” Agency for Healthcare Research and Quality       ,

151  Recommended telehealth care: “Virtual Visits”, United HealthCare,

151  the telehealth transition: “Positioning Virtual Care to Transform Health Benefits,” Mercer, June 4, 2020,

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,’t-have-a-primary-care-doctor/.

152  American Telehealth Association:

153  American Board of Medical Specialties:

153  Certification Matters:

153  Centers for Medicare & Medicaid Services:


154  Physician Compare: “Physician Compare,”, U.S. Centers for Medicare & Medicaid Services,

154  Hospital Compare: “Hospital Compare,”, U.S. Centers for Medicare & Medicaid Services,

154  Nursing Home Compare: “Nursing Home Compare,”, U.S. Centers for Medicare & Medicaid Services,

154  Hospice Compare: “Hospice Compare,”, U.S. Centers for Medicare & Medicaid Services,

154  Inpatient Rehabilitation Facility Compare: “Inpatient Rehabilitation Facility Compare,”, U.S. Centers for Medicare & Medicaid Services,

154  Dialysis Facility Compare: “Dialysis Facility Compare,”, U.S. Centers for Medicare & Medicaid Services,

154  Home Health Compare: “Home Health Compare,”, U.S. Centers for Medicare & Medicaid Services,

154  Long-Term Care Hospital Compare: “Long-Term Care Hospital Compare,”, U.S. Centers for Medicare & Medicaid Services,

156  Agency for Healthcare Research and Quality: “Major Hospital Quality Measurement Sets,” Agency for Healthcare Research and Quality,

156  National Quality Forum:

157  AHRQ Quality Indicators:

157  National Hospital Quality Measures: “Measures,” Joint Commission,

157  CAHPS Hospital Survey: “CAHPS Adult Hospital Survey,” Agency for Healthcare Research and Quality,

157  ORYX: “ORYX Performance Measurement Reporting,” Joint Commission,

157  The Leapfrog Group:

157  The Advisory Board:

157  series of briefs: “How Hospital Quality Ratings Work,” Advisory Board, February 2020,

157  evaluated: “Rating the Raters: An Evaluation of Publicly Reported Hospital Quality Rating Systems,” New England Journal of Medicine, August 14, 2019,

157  conflicting ratings: “National Hospital Ratings Systems Share Few Common Scores And May Generate Confusion Instead Of Clarity,” Health Affairs, March 2015,

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,

158  IBM/Watson Health: “IBM Watson Health Recognizes Top-Performing U.S. Hospitals and Health Systems,” IBM, June 20, 2020,

159  assessed Nursing Home Compare: “Does Nursing Home Compare Reflect Patient Safety in Nursing Homes?” Health Affairs, November 2018,

159  provides details: “Nursing Home Staffing 2019 Q3,” Long Term Care Community Coalition,

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,

160  of her program: “How to Find a Long-Term Care Ombudsman Program,” National Consumer Voice for Quality Long-Term Care,

160  National Association of Area Agencies on Aging: find one near you: “PACEFinder: Find a PACE Program in Your Neighborhood,” National PACE Association,

160  find one near you: “PACEFinder: Find a PACE Program in Your Neighborhood,” National PACE Association,

160  rules adopted in 2019: “Medicare and Medicaid Programs; Revision of Requirements for Long-Term Care Facilities: Arbitration Agreements,” Federal Register, July 18. 2019,

161  lack the fact-based comparative rankings: “Quality measurement lags in the outpatient surgery arena,” Modern Healthcare, April 6, 2019,

161  performance information: “Quality measures developed and tested by the ASC Quality Collaboration,” ASC Quality Collaboration,

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,

185  American College of Emergency Physicians: “EMTALA Fact Sheet,” American College of Emergency Physicians,–legal/emtala/emtala-fact-sheet/.

186  are charged more: “Per Visit Emergency Department Expenditures By Insurance Type, 1996–2015,” Health Affairs, July 2018,

186  2019 research: “The High Cost of Avoidable Hospital Emergency Department Visits,” UnitedHealth Group, July 22, 2019,

187  ER Inspector: “Be Prepared: Find the ER You Want to Go to Before an Emergency Happens,” ProPublica, September 19, 2019,

189  American Ambulance Association:

190  Urgent Care Association (UCA):

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,

195  enhanced recovery after surgery: “Enhanced Recovery after Surgery,” American Association of Nurse Anesthetists,

195  an online checklist: “Which Facility Is Best for My Outpatient Procedure?”, U.S. Centers for Medicare & Medicaid Services,

196  Top 10 ASC Outpatient Procedures: “Top Outpatient Procedures at Hospitals vs Surgery Centers,” Definitive Healthcare, July 2019,

197  Healthcare Bluebook:

198  Patients Beyond Borders:

198  Joint Commission:

198  glossary: “Glossary of Terms,” Joint Commission,



198  specific procedures: “Benefits of JCI Accreditation and Certification,”, Joint Commission International,

199  price comparisons: “International Medical Treatment Prices,” Medical Tourism Association,

200  Narayana Health:

200  The story: “The World’s Cheapest Hospital Has to Get Even Cheaper,” Bloomberg Businessweek, March 26, 2019,

200  coronary thromboendarterectomy: “Pulmonary Thromboendarterectomy,” Cleveland Clinic,


200  cost calculator:

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),

15  primary reason for its invention: Peter L. Bernstein, Against the Gods: The Remarkable Story of Risk (New York: Wiley, 1998),

17  Patient Protection and Affordable Care Act: Patient Protection and Affordable Care Act,, U.S. Centers for Medicare & Medicaid Services,

20  employers need to follow: Federal rules on high-deductible health plans,, U.S. Centers for Medicare & Medicaid Services,

21  IRS Publication 969: “Health Savings Accounts and Other Tax-Favored Health Plans,” IRS Publication 969,

22  23andme:

22  IRS Publication 502: “Medical and Dental Expenses,” IRS Publication 502,

24  More than one-third: “Health Care Administrative Costs in the United States and Canada, 2017,” Annals of Internal Medicine, January 21, 2020,

24  Dignity Health:

25  posted a story: “How One Employer Stuck a New Mom with an $898,984 Bill for Her Premature Baby,” ProPublica, November 4, 2019,

26  how Medicare covers something: “What Medicare Covers,”, U.S. Centers for Medicare & Medicaid Services,

Chapter 16: When Consumers Make the Call

258  spring 2020 article: “Direct-to-consumer digital health,” The Lancet, April 2020,

258  author Eric Topol: Eric Topol, MD, The Patient Will See You Now: The Future of Medicine Is in Your Hands (Basic Books, 2016),

258  late 2019 report: The Economic Consequences of Millennial Health, Moody’s Analytics for the Blue Cross Blue Shield Association, September 2019,

259  Modernizing Medicine:

259  Its findings: “How Millennials Are Reshaping Healthcare’s Future,” KaufmanHall, 2019,

260  MDLIVE:

260  mid-2019 list of telehealth providers: “275+ Telehealth Companies to Know | 2019,” Becker’s Hospital Review, June 28, 2019,

260  Amwell:

260  Doctor on Demand:

260  HeyDoctor:

260  Teladoc:

261  One Medical:

262  Bind:

266  investing a billion dollars: “Walgreens to Open Doctors’ Offices at Its U.S. Stores,” Wall Street Journal, July 8, 2020,

266  extensive list: “Services,” minute clinic, CVS Pharmacy, CVS,

268  summary of prices: “Summarized Pricing List for Dallas, GA Store #3403,”

270  Patient Rights Advocate:

Chapter 15: How to Fight Back

243  2019 study: “Claims Denials and Appeals in ACA Marketplace Plans,” Kaiser Family Foundation, February 25, 2019,

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),

244  Paying Till It Hurts: “Paying Till It Hurts,” New York Times,

244  a 2017 piece: “Those Indecipherable Medical Bills? They’re One Reason Health Care Costs So Much,” New York Times Magazine, March 29, 2017,

245  Alliance of Claims Assistance Professionals:

247  Medicare’s prices for outpatient surgeries: “Procedure Price Lookup,”, U.S. Centers for Medicare & Medicaid Services,

249, U.S. National Library of Medicine, U.S. National Institutes of Health, U.S. Department of Health and Human Services,

250  related educational materials: “Learn About Clinical Studies,” Clinical, U.S. National Library of Medicine, U.S. National Institutes of Health, U.S. Department of Health and Human Services,

250  Project Patient Voice: U.S. Food and Drug Administration,

250  reported: “FDA and NIH let clinical trial sponsors keep results secret and break the law,” Science, January 13, 2020,

250  National Financial Resource Directory:


250  a website: “Who’s sharing their clinical trial results?,” FDAAA Trials Tracker,

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,

251  sweeping study: “Death or Debt? National Estimates of Financial Toxicity in Persons with Newly-Diagnosed Cancer,” American Journal of Medicine, June 12, 2018,

252  National Foundation for Credit Counseling:

252  RIP Medical Debt:

252  a list: “Debt Resources,” RIP Medical Debt,

253  GoFundMe:

253  New Yorker article: “The Hidden Cost of GoFundMe Health Care,” New Yorker, July 1, 2019,

254  ProPublica: “Health Care,” ProPublica,

254  by Vox: “Hospitals Kept ER Fees Secret. We Uncovered Them,” Vox,

254  “Bill of the Month”: “Bill of The Month,” Kaiser Health News,

254  “Investigations”: “Investigations,” Kaiser Health News,

255  that article: “Column: A 20-year-old fights back against her health insurer,” PBS NewsHour,

Chapter 14: Getting and Paying for Drugs

225  NeedyMeds:

226  insulin availability and pricing crisis: “The Blame Game: Everyone and No One Is Raising Insulin Prices,” Kaiser Health News, April 10, 2019,

229  Ardon Health:

230  Stelara:

230  FundFinder:

230  pharmaceutical assistance programs: “Find a Pharmaceutical Assistance Program for the drugs you take,”, U.S. Centers for Medicare & Medicaid Services,

230  RxAssist:

230  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,

231  GoodRx:

233  Blink Health:

233  FamilyWize:

233  WeRx:

233  HealthWarehouse:

234  drug shopping test: “Shop Around for Lower Drug Prices,” Consumer Reports, April 5, 2018,


235  in a story: “Shopping Abroad for Cheaper Medication? Here’s What You Need to Know,” Kaiser Health News, August 22, 2019,

235  Valisure:


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,

207  cost calculator:

208  Patient Rights Advocates:

208  Cynthia Fisher: “A Powerful Lobbying Tool in the Trump Era: the President’s Ear,” Wall Street Journal, April 17, 2019,

208  New Choice Health:

208  ClearHealthCosts:

208  Surgery Center of Oklahoma:

208  KISx Card:

209  downloads of its chargemaster: “Hospital Standard Charges” (Excel spreadsheet), University of Utah Health,

210  2,900-item chargemaster: “Intermountain Medical Center Chargemaster” (Excel spreadsheet), Intermountain Healthcare,—chargemaster.xlsx?la=en.

211  report from Altarun: “Revealing the Truth about Healthcare Price Transparency,” Altarun, June 2018,

211  later study by Altarum: “Consumer-Centric Evaluation of Healthcare Price and Quality Transparency Tools,” Altarum, April 19, 2019,

213  popularized by Malcolm Gladwell: Malcolm Gladwell, “Complexity and the Ten-Thousand-Hour Rule,” New Yorker, August 21, 2013,

216  “Find a Fair Price”: “Find Your Fair Price,” Healthcare Bluebook,

217  Health Care Cost Institute:

217  Healthy Marketplace Index:


219  FAIR Health:

219  Healthcare Common Procedural Coding System: “HCPCS – General Information,”, U.S. Centers for Medicare & Medicaid Services,

219  Procedure Price Lookup Tool:

220  keeps track: “Interactive State Report Map,” All-Payer Claims Database (APCD) Council,

221  Maryland Health Care Commission:

221  Center for Improving Value in Health Care:

222  Illinois Hospital Report Card:

222  Compare Maine:

222  MNHealthScores:

222  NH HealthCost:

222  Oregon Hospital Guide:

222  Hospital Report Cards: “Review and Compare Hospitals Using Hospital Report Cards (2020),” Vermont Department of Health,

222  Healthcare Pricing Transparency Report: “Healthcare Pricing Transparency,” Virginia Health Information,

222  Washington State MONAHRQ:

222  My Health Wisconsin:

223  ViaCord:

Chapter 8: Your Personal Care Team

115  Health care: Trudy Lieberman, Consumer Reports Complete Guide to Health Services for Seniors (Three Rivers Press, 2000),

115  read it online: “Health Care Journalist Struggles to Navigate Her Own Health Crisis,” Tarbell, February 25, 2019,

119  free patient access: “UpToDate Subscriptions for Patients and Caregivers,” Wolters Kluwer,

120  PatientsLikeMe:

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),

120  WEGO Health:

121  community standards: “Community Standards,” Facebook,

122  National Finance Resource Directory: “National Finance Resource Directory,” Patient Advocate Foundation,

123  Center for Improving Value in Health Care:

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,

125  Prepare for Your Care:

125  downloaded for your state: “Downloading Your State’s Advance Directive,” National Hospice and Palliative Care Organization,

126  Social Security: “Form SSA-1696—Appointment of Representative,” U.S. Social Security Administration,

126  Medicare: “Appointment of Representative,” U.S. Centers for Medicare & Medicaid Services,

127  state directory: “Click a state for more information,” National POLST Paradigm,