When Dr. Jeff Foster, a clinical professor of psychiatry at the University of Colorado School of Medicine, and New Mexico-based Dr. Lawrence Lazarus sat down to write Insider's Guide to Quality, Affordable Healthcare, they knew it was timely. After all, one of the biggest issues in the run-up to the 2020 presidential election has been the cost of health care. But the COVID-19 outbreak has made their guidance not just helpful, but absolutely necessary.
The book, subtitled Practical Strategies to Navigate Our Complex System and Save Money, has gotten plenty of attention since its publication last year, making it to the quarter-finals in BookLife's competition for 2019's best self-help book — and BookAuthority recently listed it among the twelve finest offerings in the category for 2020. These plaudits acknowledge the ways in which the tome offers guidelines to help patients figure out ways to avoid pitfalls and financial disaster in regard to the way things operate now rather than waiting for a better future that will almost certainly be far different than any politician could have imagined prior to the virus's rise.
"As senior people in the field, we wanted to present the book to the general public to help them not just be passive and worried about health care," Foster says, "but so that they could be more active and knowledgeable health-care consumers." He notes that the website for the book, qualityaffordablehealthcare.net, is providing updates beyond the printed version to reflect the changing medical landscape, with the latest one headlined, "Coronavirus — Your Questions Answered." Additionally, the authors have connected with Boulder Medical Center and Boulder Community Health to offer some of their tips on the hospitals' own sites.
As a primer, here are eight suggestions from Foster about how Coloradans, and folks across the U.S., can improve their health-care situation long before anyone in Washington, D.C., will do so — followed by his take on best COVID-19 practices.
Number 1: Be your own health-care archive
"One thing we recommend is keeping your health records," Foster says. "That way, you're in charge and you have your medical records any time you need them if you're traveling or changing doctors. A new doctor can get them very quickly if you have them and can make them available."
A number of online resources offer the service, including this WebMD page cited by Foster and Lazarus.
Number 2: Learn more about the medical pro you'll actually be seeing
In Foster's view, "People need to understand the different roles of health-care providers and what their expectations of them are specifically. What's the difference between a nurse practitioner and a physician assistant? What is the skill set of a medical assistant? What, if anything, is the difference between a physician who is a medical doctor, an M.D., and a physician who is a doctor of osteopathy? There are surely overlaps, but there are also important distinctions. And the reason people need to know about them is because there will be so many different people playing roles as the health-care system evolves."
For example, he goes on, "the people running the so-called retail health clinics that are increasingly opening up in Walmarts and Walgreens chains are typically nurse practitioners or physician assistants, who are very reliable professionals, but they're not medical doctors. That's why it's so important to understand the differences."
This Boulder County Health post has the complete rundown.
Number 3: You have options when it comes to meds
"One of the blogs we posted on the Boulder Medical Center site has to do with seven ways to reduce your prescription drug costs," Foster points out — and the tips are extremely practical.
He suggests that you review your insurance coverage each year, especially if you're using Medicare Advantage or Medicare Part D, in addition to making a list of the medications you take, and then call your carrier's customer-service department to ask if the drugs are still being covered and if a price increase is expected. He also encourages people to consider switching from brand-name medicines to generics if possible; look into prescription discount cards offered by retailers such as GoodRx and at least 25 other vendors; check out patient-assistance programs of the sort that operate in many states; accept sample brand-name drugs at your doctor's office; compare pharmacy prices; and investigate buying medicine at a discount on the Internet from providers that are certified by the Verified Internet Pharmacy Practice Site.
Number 4: Prepare for hospitalization when you can
COVID-19 has brought most elective surgery to a screeching halt. But when it's allowed again, Foster has some tips. "Let's say a patient procedure is scheduled electively — not as an emergency," he begins. "You should prepare for entering the hospital so you know what to expect. Having friends, family or health-care advocates can be very helpful in communicating with the staff pre-operatively and post-operatively, so they can make sure everything goes as smoothly as it can. It's also important to understand some of the problems that can occur, including hospital infections and communication gaps with changes in shifts."
Number 5: Choose the right facility for your condition
"If you're traveling and you need to get some attention, you need to make your choices based on relative severity," Foster advises. "Let's say you've got a bad cold or some milder symptoms. Then it might make sense to get care in a retail health environment. Urgent care would be looked at as intermediate in terms of the level of care it can provide, and it would be at a higher level than a retail health clinic. The third choice would be to go to the emergency department of a hospital." Concerns about COVID-19 will definitely need to be factored into these choices.
Depending on where you are, these options may be limited, Foster acknowledges. "If you're in a large urban center, there could be a number of urgent-care providers available, and if you know you're going to be visiting there and have an ongoing medical issue, you could even visit websites in advance to find out which ones take your insurance and sort of plan in advance if you need care. That will give you preliminary exposure to a health-care provider in a community where you're heading."
Number 6: Ask the right network questions
Just because a hospital is part of a certain insurance network doesn't mean everyone who works there will be, Foster warns. "Sometimes people will go to the emergency room, and even though the hospital might be covered by their insurance, some of the doctors and staff that are providing care in the emergency room might not be, and could send you a separate bill for their services. This is called 'surprise billing,' and it can also happen when there's a specialist who might not participate in a particular plan. They have every right to bill the patient, but the patient may be surprised, because they thought it would be covered."
There's no simple solution to this dilemma. Last year, a measure to fight surprise billing was signed into law by Governor Jared Polis. But that's not the case everywhere, and no matter how much research individuals do, Foster still sees it as "an ongoing problem."
Number 7: Price check
"There has been a recent push toward hospitals in particular being much more transparent in posting for the public their fee schedules," Foster says. "This, in theory, is a very good and positive step" — one that is becoming standard-operating procedure nationwide. Earlier this year, the U.S. Department of Health and Human Services enacted a rule that sets up "requirements for hospitals operating in the United States to establish, update and make public a list of their standard charges for the items and services that they provide. These actions are necessary to promote price transparency in health care and public access to hospital standard charges. By disclosing hospital standard charges, we believe the public (including patients, employers, clinicians and other third parties) will have the information necessary to make more informed decisions about their care. We believe the impact of these final policies will help to increase market competition, and ultimately drive down the cost of health care services, making them more affordable for all patients."
Not right away, though. The edict won't go into effect until January 1, 2021, and in the meantime, Foster has heard some anecdotal references to "difficulties with the transparency not being as transparent as it's intended to be. So it's a work in progress rather than a completed thing. But patients should definitely look to see if it's offered at hospitals near them."
Number 8: Stand up for yourself
"It's very important that you understand your legal rights as a patient," Foster believes. "For example, you have the right to your own records — and copies of those records are typically available at no cost. You also need to understand the role of legally engaging patient advocates or designating health-care proxies. There are certain documents available to officially designate a health-care proxy, and it's something you can take care of when you're well, not when you're sick. That way, you can say, 'This is my official health-care proxy. If I'm not able to make health-care decisions" — perhaps you're unconscious or critically ill — "my health-care proxy will know what I would decide if I was able to."
"The first thing we want to promote is education, so that if one does have to react, one knows how to react," Foster says. "So in addition to staying tuned to local TV and radio news, it's a good idea to follow particular websites that have the latest information." Two of notable value, in his view, are sites operated by the federal Centers for Disease Control and the Colorado Department of Public Health and Environment. The information available there will help people "keep informed and respond accordingly, but with knowledge," he adds.
Those who develop respiratory or other symptoms associated with the virus, especially if they're age sixty or older, "should certainly be in touch at least by phone with their medical provider, if they have a relationship with one, to inform them about their symptoms and ask their advice about what to do next."
Such outreach should be done long before the symptoms become severe. That's key not just for individuals who may have "underlying health conditions, such as heart or other related problems," Foster goes on, "but also the younger population," whose members may not suffer life-threatening effects but could pass them on to folks for whom they could be fatal. "They need to know what the symptoms are that might or not be indicators of the coronavirus."
In the meantime, Foster encourages people to "take personal safety precautions recommended by the CDC and others in order to stay safe, and to practice social distancing. That's very important for older people at higher risk. They need to stay out of crowds and limit their exposure, because people may be carriers who may not be aware that they are."
At present, testing for COVID-19 can only move forward if ordered by a doctor, and since it's being done at no charge, Foster sees no reason to balk. "If there's no cost, hopefully people will have that reassurance."
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