With soaring prices, supply shortages and growing wait lists for most goods and services — not to mention a virus that continues to disrupt the workforce — it’s tough to be a consumer right now, including a health care consumer.
Back in September, the AARP Bulletin published a package of stories called “Beat the System” that detailed how to get the best possible customer service. Readers told us they found the advice collection hugely helpful. So in that spirit, we’re back with a new edition of “Beat the System,” this time focusing on how to find the health experts and health services you need in these challenging times.
Our team of reporters interviewed dozens of insiders about how to separate the best from the rest, and their advice follows. But the experts also noted that certain approaches are timeless and universal — meaning they still apply right now. So to start, here are the universal rules for finding the best in health care (and anything, really), 2022 style.
Rule 1: Take appropriate time
Yes, when competition is hot, you want to be flexible and move quickly when quality products or services come available. Even so, “big decisions shouldn’t be fast decisions,” says Terrance Odean, a professor at the University of California, Berkeley’s Haas School of Business and an expert in behavioral finance. Do the due diligence required and take the time to verify you are getting a real deal. And absolutely “no decisions at 3 a.m.,” he says.
Rule 2: Research is free
Take advantage of the vast amount of free information available on the internet, social media and beyond to investigate the experts or services you are interested in. Start with price and reputation, of course, then get into the weeds, like efficiency ratings, certifications and areas of expertise. But put little stock in user ratings. Online reviews are increasingly bought, and there’s no way to verify their authenticity. If you wish to scan, look for specific anecdotes and a personal writing style that a paid reviewer (or computer program) couldn’t generate.
Rule 3: Set priorities
Great decision-making lies in the art of filtering. That requires knowing what features or skills are most important to you; use that to pare down your choices, says Katy Milkman, author of How to Change: The Science of Getting From Where You Are to Where You Want to Be.
Rule 4: Pretend you’re making a mistake
Many of us are overconfident about how a choice will turn out, Milkman says. For a reality check, she suggests envisioning what could go wrong with your choice. Better to think about this now rather than later in order to help you prepare for — and possibly prevent — things that could go awry.
Rule 5: Involve other humans
A productive half hour on the internet can make you feel smart. Perhaps too smart. The golden rule: Always find a responsible friend, family member or adviser — “preferably someone who is as good or even better at decisions as you,” says Odean — and get into the habit of asking for his or her feedback before making a big decision.
Finding the best hospital
There’s no way to sugarcoat it: Our hospitals are in crisis. Yes, many have responded to COVID by upgrading their ventilation systems and adding new protocols that may reduce the risk of airborne illnesses, but that can’t overcome the human cost: Eighty-seven percent of nurses surveyed recently reported they were burned out, and last September the American Nurses Association sent a letter to the U.S. Department of Health and Human Services urging the government to declare the current nursing shortage a national crisis. We don’t always get to choose which hospital we’re treated in, but when we do, it’s more important than ever to match up our particular needs with a facility that’s set up to manage them.
Read the right rankings. Numerous organizations rank hospitals, but a 2019 report in the New England Journal of Medicine rated the raters — and deemed U.S. News & World Report its top choice. Next in line was the Centers for Medicare and Medicaid Services’ star ratings program.
Apply the insurance filter. Once you know the best hospitals in your area, check with your insurance provider to make sure it covers services within that facility (if you’re a Medicare Advantage patient, confirm that the facility falls within your plan’s umbrella).
Know your options in advance. Just like doctors, hospitals offer different specialties. Some have psychiatric services, others have specialties in bone health, oncology, drug abuse treatment, etc. An overwhelmed hospital might struggle to manage a problem that’s outside its expertise, so become familiar with the options in your area. If that broken arm is a result of osteoporosis, it may make sense to travel a bit farther to a hospital with a bone center. If it’s a grandchild who took a spill, make sure you know which hospital has a pediatric ER. “Going online and seeing what services they have available is really helpful in terms of some of the subspecialty services,” says Marianne Gausche-Hill, M.D., president of the American Board of Emergency Medicine.
Check for a GEDA. That stands for Geriatric Emergency Department Accreditation, and it means the hospital has an ER that meets a higher standard of care for older Americans, according to a set of criteria established by the American College of Emergency Physicians.
And check the H-caps. Each year, more than 3 million patients from more than 4,000 hospitals complete an HCAHPS (pronounced “H-caps”) hospital survey on everything from cleanliness to the responsiveness of the staff. Go to the Medicare website and conduct a search to see how hospitals scored.
Check accreditation status. Make sure your hospital is accredited by an accrediting agency approved by the Centers for Medicare and Medicaid Services. The largest is the Joint Commission, a nonprofit that accredits more than 22,000 U.S. health care organizations and programs that meet its quality and care standards. Not all hospitals are accredited — and some may be on probation — so it’s an important indicator of quality, Gausche-Hill says. Visit qualitycheck.org to see if your hospital has met the Joint Commission standards, or call the hospital to verify its status with other accreditation agencies.
Finding the best surgeon
Someone is going to reach an instrument, or maybe even their hands, into your body. In a recent poll, 69 percent of surgeons say they feel overwhelmed, so having someone who’s experienced and cool under pressure is paramount. Before signing up for any surgery, take these steps:
Get the hard numbers. Go to the American College of Surgeons NSQIP Surgical Risk Calculator. You’ll be able to plug in your age, sex, weight, chronic and acute health issues, and other prevailing factors, and get a no-nonsense statistical assessment of the surgery’s possible downsides and chances of success for someone who fits your physical profile. This is great information to have as you start your research journey.
Research your condition. You can’t easily assess a surgeon if you don’t have some grasp of the ailment or injury they are trying to remedy. So start by conducting research on reputable sites (think cancer.org, run by the American Cancer Society, or orthoinfo.org, the American Academy of Orthopaedic Surgeons’ site). Remember, disinformation is rampant on the web, so look at a few different sites, focusing on those representing accredited medical institutions or government agencies, not just individual doctors or media companies. Armed with a reasonable knowledge of the ailment and the surgery, you can ask more specific questions and understand the answers, says Mark Glover, M.D., a general surgeon with Austin Surgeons in Austin, Texas.
Assemble the candidates. Your primary care physician is the best source for a referral, but don’t just stop with her or his recommendations. Search your insurance provider’s website for a list of surgeons it covers and consider them, too.
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Find the right letters. Doctors often have multiple abbreviations after their names, but look for “FACS” (Fellow of the American College of Surgeons). That means surgeons are not only board certified, but they have also passed a thorough professional and ethical evaluation, says Patricia Turner, M.D., executive director of ACS. Also check your state’s medical board for any previous judgments, complaints or restrictions to a surgeon’s license (you can find info on your medical board at fsmb.org).
Go all Mike Wallace on ’em. Glover recommends asking these hard questions: How often do you perform this procedure? What complications have you experienced? What are the risks? What are the alternatives? What would the results be if I didn’t have this operation? Look not only for useful answers, but also that they are given eagerly and openly.
And then get a second opinion, just in case. “Many medical systems refer to the surgeon within their organization, which may or may not be the best surgeon for your condition,” Glover says. “A different surgeon may offer a different procedure or different opinion.”
Finding the best primary care physician
The great disruption of the past two years means that a lot of us have changed jobs, insurance companies, living situations. And that means it’s a hot market for primary care physicians. Picking the right one is critical: Studies show that staying with the same physician for many years can extend your life, reduce your risk of needing to visit the ER and improve the management of your medications. But finding the right one can be a challenge; last year the Association of American Medical Colleges warned that more than 4 in 10 general physicians will approach retirement age within the next decade, and that with fewer med students choosing primary care, combined with a growing population, by 2034 we could be short as many as 48,000 primary care doctors. Even today, the “not accepting new patients” line is all too common on online doctor listings. Here’s what to do:
Start with your insurance card. Use the “find a doctor" feature on your insurance provider’s website — for obvious reasons. Look for “generalist” or “internist” to find a primary care physician. In many parts of the country, you’ll find dozens. To avoid wasting research time, check the website or call the office to verify the doctor is accepting new patients. (Ignore the “patient reviews.” They’re mostly unreliable, according to consumer watchdog site FakeReviewWatch.)
Match your history. Did one or both of your parents have a heart condition? Does autoimmune disease run in your family? Many internists will have a second specialty, like cardiology or rheumatology. Zero in on those whose specialty aligns best with your health history.
Then check their education and affiliation. Insurance sites will often list a doctor’s undergraduate and graduate schools, as well as the hospital where they completed their residency. Keep an eye out for prestigious medical schools or residencies at top hospitals: Great doctors can come from anywhere, but the more rigorous their studies, the more they might know about patient care. An affiliation with a teaching hospital is a good indicator that the doctor is up on the latest research.
Seek nonprofit help. The shortage of doctors is most acute in rural areas. That’s where a community health center can be a lifesaver — literally. “Fifty-five percent of health centers are located in rural communities, and in many cases they’re the only provider for hundreds of miles,” says Amy Simmons Farber, spokesperson for the National Association of Community Health Centers. “Studies show the care is as good or even better than what a patient may find in private practice.” Ninety-eight percent of the nation’s roughly 1,400 health centers also offer telehealth services. Check out findahealthcenter.hrsa.gov.
Go on a date. If you think of your relationship with your doctor as a long-term commitment, the first appointment is like a first date. “If you walked out of a room feeling heard and understood, then I think there’s a good match,” says Arif Kamal, M.D., chief patient officer with the American Cancer Society. And remember to ask about the long term: If you’re most comfortable with a doctor who is part of your generation and understands firsthand how aging is affecting you, make sure he or she isn’t planning to retire anytime soon.
Finding the Best Fitness Center
If you’re trying to figure out a way to burn off that quarantine 15, you’re not alone: The U.S. has more gyms — over 32,270 — than McDonald’s, Dunkin’ Donuts and Taco Bells combined. And their size, personality and offerings range hugely. What’s the best one for you? The one that you’ll actually use.
Observe the under-4-mile rule. “Research shows if you live further from your gym, you’re less likely to go,” says Chris Sciamanna, professor of medicine at Penn State College of Medicine and founder of the Faster Workouts exercise program. In one survey, people who lived 3.7 miles from their gyms went five times or more a month. Those who drove 5.1 miles went only once.
Check their safety protocols. You want a gym that has upgraded its ventilation systems and cleaning services in response to the pandemic (good news: Many have). But your best bet for avoiding future COVID surges is to practice social distancing by making sure you’re going to the gym when it’s not overly crowded. To do that ...
- Pick the right preview time. Ninety-one percent of gym-goers are between the ages of 18 and 54; as a result, gyms are most crowded in the hours right before and right after work. That leaves a lot of room for older people who have different schedules and different lifestyles. (Advantage, you: A small 2020 study of men at risk for or diagnosed with diabetes, average age 58, found that those who exercised between 3 and 6 in the afternoons showed the greatest improvement in fat loss and blood glucose levels.) Test-drive your gym at the time when you’d most likely want to use it, to get a sense of the crowd and equipment availability.
- Recruit a partner. Having a fitness buddy can help you stay more dedicated to exercising and can even help improve your fitness results, numerous studies show. Find out where friends exercise, or challenge someone to go with you regularly.
- Don’t pay for stuff you’ll never access. Why pay for a huge gym with pools, spin classes, saunas, drink bars or top-grade strengthening machines if you have little intention of using them? Sometimes, a small yoga studio, a Y or even an online fitness app may be just the right match. Different gyms also have different vibes and clientele. Women-only gyms are also increasing in popularity. Be honest about your needs.
- Check your trainer’s training. Want a personal trainer? Get one who’s certified through the National Strength and Conditioning Association (NSCA). “That’s the gold standard,” says Festus Amoye, an occupational therapy assistant and owner of MedXFit Houston. Also look for trainers certified through the National Academy of Sports Medicine, especially one who has completed Senior Fitness Specialization training (go to nasm.org and scroll down to click on Find an NASM Trainer).
Nicole Pajer writes about health for The New York Times, Woman’s Day and others.