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 email@example.com.
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/.
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: https://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/.