How to find the best medical treatment

[Guest guest]

How to find the best medical treatment

By Brink, Los Angeles Times Staff Writer

http://www.latimes.com/features/printedition/health/la-he-besttips23-

2008jun23,0,125529.story

Even if you're not rich or well-connected, you can find leading-edge

treatment when it matters. And it could well matter if your condition

is rare or if few doctors have developed expertise in treating it.

For starters, be Internet savvy -- and pushy. Here are some tips for

getting what you need:

Be open to the hospital your insurance plan recommends.

Seeking out the best medical care possible

Insurers want to keep costs down, and one way to do that is to

minimize costly complications. So they try to contract with

institutions that have the most experience and the best outcomes.

Even HMOs contract with outside centers of excellence for some rare

disorders when their own physicians lack unique expertise.

" This whole notion of centers of excellence used to be based on

gestalt and individual recommendations, " says Dr. Roper, dean

of the medical school and chief executive of the healthcare system at

the University of North Carolina.

" It's becoming much more data-driven and evidence-based. "

To determine the " best, " arm yourself with numbers.

If the doctor, or hospital, you want has more experience than the one

your insurer has chosen, show your insurer the numbers. A surgeon who

has done a procedure a few hundred times will have better results

than one who has done it two or three times. " There's a growing body

of evidence that says that volume matters, " Roper says.

The only way to find out is to ask, so don't be shy about asking

physicians how many times they've done the procedure, or treated the

condition.

And be specific. A cardiac surgeon who has done hundreds of heart

bypasses is not necessarily an expert in valve replacements.

Get recommendations.

The less common the disorder, the fewer the institutions that will

have deep experience with it. But it's just those institutions you

want to find. Each time you talk to a provider, don't end the

conversation without asking who else has experience with your

condition or which institutions are known for treating the disease.

Keep following the chain of recommendations to see if one or two

names are consistently repeated.

Do your homework.

Track down statistics and studies as tailor-made to your condition as

possible.

Search for articles at the National Institutes of Health's free

archive of medical journals (pubmedcentral.nih.gov). You can often

see the entire study for free, sometimes only the abstract, but

poring over the list will give you an idea of which institutions are

actively publishing articles. Be as specific as possible in your

search. For example, don't type in " brain cancer. " Use " malignant

glioma, " " brain tumor " and " left parietal lobe. "

Find out who is doing research into your condition.

If a physician publishes a lot about your condition, there's a good

chance he or she is already onto potentially better techniques, even

if results haven't yet been published. " What is published is always

years behind what is happening at major academic centers, " says Dr.

Henry Friedman, deputy director of the Preston Tisch Brain

Tumor Center at Duke University Medical Center in North Carolina.

Even if you don't want, or qualify for, a clinical trial, find out

which institutions are researching your condition. Go to

clinicaltrials.gov for a list of more than 50,000 federally and

privately sponsored trials.

Make appointments.

When you find a doctor or hospital doing research into your disease,

call the physician or the institution. Large academic centers all

have physician referral departments set up to connect patients with

the appropriate physician. Your insurance company will cover a second

opinion, and going to a large center for that second opinion can be

the entryway to excellence.

Whatever your disease, go online.

Look for Internet-based support and advocacy groups. For example, the

National Multiple Sclerosis Society's website has a page on recent

research into the disease, who is doing it and where.

Check out the disease advocacy group's chat rooms. Patients who have

gone through what you're facing have a lot of first-hand advice about

what they've done, where they've gone and how it turned out. In the

absence of good national quality and outcomes measures of doctors and

hospitals, the personal experience of your peers is invaluable.

Seeking out the best medical care possibleBut beware of websites

trying to sell something or promoting a treatment not available in

any academic center. Leading-edge research is usually backed by the

NIH and carried out by academic centers. Private organizations may be

pushing their own product or technique. " Any Internet site that

sounds too good to be true usually is, " says Dr. Adler, vice

chairman of pediatric medicine at Childrens Hospital Los Angeles.

Try to change Medicare plans if necessary.

The original Medicare plan has more geographic flexibility than the

private plan alternatives. (First of all, consider carefully when

choosing a plan.) If you need help changing plans after a diagnosis,

try calling the Medicare Rights Center (medicarerights.org or [800]

333-4114), a national consumer organization that provides counseling

about Medicare. " Sometimes our advocates have been able to help

people get off the private plan and back on original Medicare, " says

Precht, director for policy and communications at the

center. " But it's getting harder. "

Be realistic.

Don't think you can find a cutting-edge technique developed by one

surgeon, then ask your own doctor to do it. " That's like going to a

restaurant with a recipe from another restaurant and asking the

kitchen to make it, " Adler says. You could ask the doctor who

developed the procedure if he or she has trained any others. If so,

find out where they are practicing, and how experienced they have

become. That process of training others, and having them fan out, is

how once-unique techniques spread across the country, but it takes a

lot of time.

Be prepared to fight.

Use the ammunition you've accumulated through research. Fights with

insurance companies can be frustrating and drawn out, so if you're

also fighting disease, you might need to enlist a spouse or friends

to make phone calls and write letters, to the insurer, to legal aid

societies or to a private lawyer.

If you're wrangling with Medicare, the Medicare Rights Center might

be able to help fight a denial.

Get your doctor's support.

Whether you're facing Medicare or an insurance company, your chosen

doctor is your best ally. He or she is the one best armed with

numbers to make your case to the insurer.

For example, surgeons at s Hopkins Medical Center published a

study in 1995 of a surgical technique, called a Whipple procedure,

that can help some pancreatic cancer patients. The study examined all

501 cases of pancreatic cancer in which the procedure was used

between 1988 to 1993 throughout land.

It found that 54% of Whipple procedures were performed at s

Hopkins Medical Center. The remainder were performed at 38 other

hospitals throughout the state. The in-hospital death rate at Hopkins

was 2.2%, compared with an average of 13.5% at the other hospitals.

But what probably got the attention of insurance companies was that

the cost at s Hopkins was $26,204, compared with an average of

$31,659 at other hospitals.

Even if there isn't such incontrovertible, published proof supporting

your decision, your chosen physician will likely have other numbers.

If you lose the fight and continue to be convinced that where you go

matters to you, be prepared to shell out.

Whether it's a higher co-payment for going out of network, or taking

on the entire cost yourself if you can afford it, your preference may

be important enough to you to pull out your checkbook or credit card.

Make a choice.

Finally, try not to second-guess your own decision. " No one really

knows what the outcome will be, " Adler says. " Make the best decision

you can in the time you've got, and then don't look back. "