En español | When the person in your care has a medical issue, you want a first-rate specialist with experience and a great track record. But everyone looks professional in a lab coat. How can you tell a top doc from one the state medical board has put on probation?
Without research, you can’t.
There is no national public record that reveals which doctors have been disciplined or are among the 1 percent of U.S. doctors responsible for 32 percent of malpractice payouts. A doctor disciplined in one state may be practicing in another. And doctors on probation are not obliged to tell patients.
Put the odds in your favor. Here’s how to make sure your loved one is in competent hands.
Finding a Doctor
Step 1. Shop around
- Ask the care recipient’s general practitioner and other doctors to recommend a local specialist.
- Talk to friends, neighbors and people in your caregiver’s support group who have faced the same medical issue. Their stories — good or bad — will be useful.
- Most city magazines have an annual issue on the area’s best doctors. It’s always worth a read.
Step 2. Check out recommended doctors
- First stop: the Federation of State Medical Boards (FSMB) website. Type in the name of the doctor and state in order to find out if any disciplinary actions have been taken against him or her. You can also find out where the doctor went to medical school, if he or she is board certified and in which states he or she is licensed.
- Look at online ratings by patients. They are subjective, but repeated complaints are a red flag.
- If surgery is required, go to SurgeonRatings.org, a consumer-funded national database that is free of charge. Click on the needed operation to get a list of surgeons in your area. Doctors are rated based on the risk-adjusted number of surgery-related deaths, prolonged hospital stays and readmissions. The surgeon’s record is compared with the national average. Board certifications and the hospitals at which the surgeon operates are also listed.
Step 3. Arrange a meeting
When you find a surgeon or specialist who looks good on paper, confirm that the doctor accepts your health insurance plan, including Medicare, Medicaid or private health insurance. If you get a go-ahead, make an office appointment.
For additional help: Call 800-MEDICARE (800-633-4227). TTY users can dial 877-486-2048 toll-free.
Step 4. Ask the right questions
No procedure is risk free, but the right questions and clear answers can help make a solid choice. At the office appointment ask:
- Can you explain this surgery or treatment?
- Do you follow a standard procedure?
- Do you specialize in this operation or treatment?
- How many have you done?
- What is your rate of success?
- What are the risks?
- What is the best-case outcome?
- What could happen if the procedure or treatment is postponed or not done?
- What is the usual outcome for someone this age and in this condition?
- Will the patient be hospitalized and, if so, for how long?
- How long is recovery?
Always consider getting a second opinion.
Where you go matters. Hospital error is the third-leading cause of death in the U.S., just after heart disease and cancer. Most errors are caused by systemic problems, including missing or underused safety protocols and inconsistent standard of care. Fortunately, the odds are in everyone’s favor— some 35 million people are hospitalized every year— but you can improve your loved one’s odds by finding out how your local hospitals rate and which is the leader in the needed procedure. Research the routine surgeries with the same zeal as the complicated ones. After all, minor surgery only happens to other people.
Step 1. Check out:
- Hospital Compare, a rating site run by Medicare, compares hospitals in your area, based on the procedure or treatment needed. The overall rating compares the hospital’s performance with other U.S. hospitals.
- SurgeonRatings.org When looking up doctors, you’ll notice that the hospitals at which they operate are also rated. A red check indicates the hospital has top scores for patient safety and outcomes for the chosen surgery.
Step 2. Make sure you’re covered.
- Confirm that the hospital participates in Medicare or the patient’s Medicare Advantage Plan, be it an HMO, PPO or another plan.
- Find out what Medicare covers. Enter the procedure, surgery or treatment to find out.
- If the patient is a Medicaid recipient, see what Medicaid covers.
- If covered by insurance, contact customer service or an agent to confirm coverage and get pre-approval.
- If the doctor who will be performing the procedure is not on the plan, ask if the insurance will cover the doctor’s fees since the hospital is in your network.
- Call the hospital’s business office and complete preadmission forms. Ask for a copy of the preapproval to be sent to you by email.