staticnrg Posted April 23, 2009 Report Share Posted April 23, 2009 (I've underlined and bolded some portions) The Right Hospital for You By Sandra G. Boodman, May & June 2009 When your diagnosis is serious, the most familiar choice isn't always the best one. What to know before you decide When Kate Probst learned she needed surgery to remove a brain tumor, she launched a nationwide search for the best medical care. Probst, an environmental-policy analyst who lives in McLean, Virginia, consulted doctors in nearby Washington, D.C. She telephoned specialists at Duke University Medical Center in North Carolina and sent her records to experts at Massachusetts General Hospital in Boston and the Barrow Neurological Institute in Phoenix. Ultimately, Probst chose the second of two neurosurgeons she interviewed at Johns Hopkins Hospital in Baltimore. Her operation to remove the benign tumor was a success. But a year earlier, in 2006, when Probst received a diagnosis of early breast cancer, she looked no farther away than a community hospital a few miles from her home. That time, her condition was so common, and treatment so uniform, that there was no compelling reason to leave town. "I was told there were ten doctors here who could do it," said Probst, 52, who underwent a lumpectomy followed by radiation and has not had a recurrence. A generation ago most ailing Americans received treatment in their hometown hospitals, no matter how rare the illness or grave the diagnosis. Today it is increasingly common to venture hundreds or thousands of miles for care. Although statistics are elusive, several of the largest U.S. hospitals report significant increases in out-of-state patients during the past decade. M.D. Anderson Cancer Center in Houston, for example, recorded a 69 percent jump between 1999 and 2007. Americans are more mobile these days, but that's not the only factor fueling the trend. Some large insurance companies are steering patients with unusual or complex medical problems to specialized institutions. These facilities, sometimes dubbed "centers of excellence" by health experts, have more experience and better results at such difficult tasks as performing transplants or treating rare cancers. They can significantly change a patient's outlook by offering treatments that local physicians may not have been aware of. Says oncologist John Glaspy of UCLA's Jonsson Comprehensive Cancer Center: "What happens at least once a week is that someone comes here and finds there are new treatment options that work." Another change is that it's easier to study the success rates of different hospitals than it used to be. The federal government has taken a leading role in making such information available to consumers through its Hospital Compare website. The site lets you look up a particular hospital's success at treating heart attacks, pneumonia, heart failure, and other conditions. It also reports the results of patient surveys, telling you everything from whether the hallways are quiet at night to whether nurses respond quickly to calls. Private organizations such as the nonprofit Consumers' Checkbook (CC) in Washington, D.C., use government statistics along with their own research to compare and rank hospitals. For example, CC surveys doctors nationwide about the quality of hospitals in their area, and adds that data to its calculations. On this page, at right, you can see which out-of-town specialty hospitals were recommended most frequently in CC's doctor survey. (See link to this article) But just because a particular hospital appears to be the most successful at treating your disorder doesn't mean you should go there. Deciding whether to travel for care can involve weighing difficult trade-offs. Travel costs money, even if insurance covers the cost of treatment. (For more on costs, see "Can You Afford to Travel?" below.) And it's impossible to put a price tag on the advantages of being in familiar surroundings, cocooned by family and friends who can stay by your side and ask questions. So how do you know when to travel? Clearly, any emergency such as a stroke or heart attack requires a prompt visit to the closest hospital. But many illnesses, including most cancers, do not require immediate treatment, giving patients time to consider their options. Your own doctor can tell you how urgent your need for care really is. Even though it can literally be a life-and-death decision, "there are no hard and fast guidelines" about when or whether to leave home for treatment, says Arthur A. Levin, who directs the Center for Medical Consumers, a New York City-based patient-advocacy group. One key step, Levin says, is simply to ask local hospitals how frequently they see patients with your illness. If one hospital has a specialized program for patients like you, it is likely to have more familiarity with the latest research findings. The rarity and severity of your disease also make a difference: for patients diagnosed with common malignancies, such as early breast or prostate cancer, experienced physicians can be found in many communities, Levin says. But for those with rare or hard-to-treat illnesses, such as pancreatic or esophageal cancer, "it's less likely you're going to get the best advice and treatment" nearby, unless you live near a teaching hospital. Doctors don't see enough cases. There's another reason to leave town: when treatment at home isn't going well. That's what first prompted Baidwatie Rita Lecoin, 59, a medical surgical technician with diabetes and kidney failure, to transfer more than 300 miles from a Chicago hospital to Minnesota's Mayo Clinic in 2005 when her heart, too, mysteriously began to fail. Mayo fixed that problem with a change of meds and, on subsequent visits, saved one of Lecoin's hands and both of her feet from amputations that had been recommended at various Illinois hospitals. "Had we not traveled out of state, she would have had two below-the-knee amputations," says her daughter Joanna Ammons, 37. Treatment at Mayo saved not only her mother's feet and hand, says Ammons, but also her life. Frequently patients are the ones driving the decision to seek care out of town. But sometimes a doctor will recommend it. If yours does, advises Sharonne Hayes, director of the Women's Heart Clinic at Mayo, "you should go." That's how Carlos A. Andrade wound up at M.D. Anderson Cancer Center in Houston, 750 miles east of his El Paso home. Since May 2008, the 70-year-old retired printer and his wife have made eight trips to treat a recurrence of Andrade's esophageal cancer, first diagnosed in 2005. "My doctor told me that there was no other thing they could do for me here in El Paso," Andrade says. Andrade received radiation treatments at Anderson and receives follow-up care at a clinic near his home. Some patients are reluctant to travel for fear of offending their doctors. While that's understandable, it's important to remember that your doctor's ego will recover, while you may not. And though most doctors have their patients' best interest at heart, other agendas?such as reluctance to part with a challenging case?can occasionally taint their advice. The message: If the facts point toward better care elsewhere, don't stay home just to be nice. Stuart Freedman, 58, a health insurance executive in Seattle, ran into resistance from one of the neurosurgeons he met with after he was diagnosed with a large benign brain tumor. [Robin says: Can we say pituitary tumor?] That doctor tried to talk him out of undergoing a novel procedure devised by Amin Kassam, chair of neurosurgery at University of Pittsburgh Medical Center. In certain patients, Freedman had learned, Kassam removes brain tumors via the nose instead of through a hole in the skull. One advantage of this treatment, according to Kassam, is a reduced risk of serious neurological damage. Freedman talked to Kassam and looked at the data from his procedure. He then compared that with the treatment offered by local neurosurgeons, studying the risks of death, paralysis, and brain damage from each of them. Freedman wanted the treatment, but his insurance company initally denied his request, without giving a reason. They eventually agreed to the Pittsburgh option after Kassam sent them a letter outlining the likelihood of a faster recovery and a shorter?and cheaper?hospital stay. Freedman's treatment was a success, and it reinforces one of the most important aspects of choosing a hospital: while your doctor's guidance is important, this shouldn't be the only measure. Follow Freedman's example and ask each doctor you're considering for hard numbers on success and complication rates on the treatment he or she is proposing. Also look at the hospitals' statistics-based ratings on sites such as Hospital Compare. As Robert Krughoff, president of CC, points out, a small difference in mortality rates can mean a big difference in the total number of cases. "Two percent sounds like a small number, but if you told me that two out of one hundred people who stayed at a certain hotel died, I wouldn't go to that hotel." If all this sounds daunting, that's because it can be. Remember that it's a fluid process; you can change your mind. And no one can make the decision better than you can, once you are armed with the facts. When it comes to choosing a hospital, there is no right answer for everyone, only a right answer for you. Sandra G. Boodman writes about health for The Washington Post. Can You Afford To Travel? Insurance companies frequently approve?or even recommend?out-of-town travel for difficult cases. After all, it's less expensive to treat a serious illness right the first time than to have it linger. But understand your coverage before you go, to avoid any surprises. Different plans have different requirements, says Erin Moaratty, chief special-projects officer at the Virginia-based Patient Advocate Foundation. For example, you might need to prove that your condition can't be treated within your insurer's network before it'll agree to pay for out-of-town care. Also, check with the hospital's billing office to make sure it accepts your coverage. If your insurer denies your request to travel and you are convinced that you can't get the care you need at home, you can appeal the decision to an external review board. This process varies by state, but your insurer's customer-service reps can tell you where to begin. Even if insurance will cover your hospital stay, out-of-town travel?airfares, hotels, car rental?can be expensive. But if you ask the right people, you can often get help. Many hospitals have admissions professionals, resource specialists, or social workers to help visiting patients handle logistics and sometimes find ways to help pay expenses. Peter Coleman, a medical social worker at the Mayo Clinic in Rochester, Minnesota, has led patients to foundation grants, hospitality programs, and religious groups willing to help with lodging. Many hotels near hospitals offer lower rates for patients. One underutilized source of help: friends. They can lift the burden at home, whether it's by walking the dog or taking the kids for a week. Social workers say most people want to help?if only they are asked. ?Alissa Ponchione Link to comment Share on other sites More sharing options...
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