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- Check into hospital quality ratings for the specific type of care you need (cardiac, orthopedic, obstetrics, cancer, etc.).
The hospital that’s best for one type of care may not be best for another. Fortunately, quality data is becoming easier for consumers to find. Start with the quality websites listed on the Learn More page.
Key quality measures include:
- Level of experience (how frequently the hospital performs the procedure you need).
- Complications rate among patients with your condition.
- Average length of stay among patients with your condition.
- Safety ratings (does the hospital follow proven steps for improving safety and quality, such as having all prescriptions ordered electronically instead of hand-written).
- Other quality credentials, such as whether the hospital complies with The Leapfrog Group and other organizations.
- Save the ER for real emergencies.
If you have a serious, life-threatening illness or injury such as chest pain, uncontrolled bleeding, difficulty breathing or loss of consciousness, head straight for the emergency room or call 911. Unfortunately, many people go to the ER with problems that could be treated at an urgent care center, “quick care” clinic or even their doctor’s office. That drives up medical costs, because the hospital emergency room (ER) is generally the most expensive place to receive care (and often involves long waits.) If it’s not a life-threatening problem, always call your doctor’s office first for guidance on where to go for non-emergency medical issues. Another great resource: the “nurse line” services provided by many health plans. See the Learn More page for more help deciding on where to seek care.
- Try to stay in-network.
Using in-network hospitals, doctors and other providers almost always saves you money compared with out-of-network. But don’t assume that all doctors who treat you at an in-network hospital are also in-network; they may not be. This applies not only to your attending doctor, but also to others working on your care - radiologists, anesthesiologist, pathologists, etc. You should always ask, and if in doubt, just call the number on the back of your insurance card.
- Check your health plan’s precertification requirements.
Many plans require that you call them to precertify your care before being admitted; otherwise you receive lower benefits and/or pay a penalty (except in a true emergency). Even for emergency care, many plans require that you call in soon after being admitted. Make sure you (and your spouse, if married) are aware of your plan’s precertification requirements before someone in the family needs inpatient or outpatient hospital care.
- If you’re going to the hospital, ask a trusted friend or family member to go along. Make sure he or she is a good listener.
If you are recovering from surgery or groggy from pain medications, your advocate can look out for your wellbeing when you are not able to do so for yourself. Having “an extra set of eyes and ears” along can be very helpful, especially to confirm your doctor’s instructions. Tell your advocate ahead of time what your concerns and questions are, so he or she can prompt you to ask when the time comes. Your advocate doesn’t need any special medical training. It’s just someone you trust who knows your medical history, pays attention to details, and isn’t afraid to ask questions. Note that you will be required to sign a HIPAA release form if you want hospital staff to discuss your care in front of anyone else.
- Take steps to make sure your wishes will be carried out in the event you can’t speak for yourself. That’s the purpose of advance directives. The time to do this is well before you need medical care. Go to the Learn More page and see the Put Your Wishes in Writing section.
- Bring a notebook. While at the hospital, write down all procedures you undergo and medications you’re given. Your involvement may help prevent medication errors and other preventable mistakes.
- Be ready to speak up. To the extent you’re physically capable, ask every hospital staff member you encounter what he or she is about to do. Show them your identification bracelet before taking medications or receiving treatments. If something doesn’t sound or look right, speak up.
- Be just as careful when you leave the hospital. Make sure you understand – and write down – your discharge instructions, especially if prescription drugs are involved. Ask about any bad interactions between your medication and other drugs, foods or drinks, even herbal supplements. Find out if there are any symptoms or problems that you should call your doctor about. For example, if your pain intensifies or you start running a fever.
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Hospital, ER, Urgent Care or Quick-Care Clinic: Where Should You Go?
How serious is the condition?
When your life may be at risk, or you have a sudden or severe pain, you have no choice — go to the nearest emergency facility, or call 911. However, when the situation is less severe, you may have choices that can save you money and be more convenient. So if you have time to ask What should I do?, read on…
Call your doctor first.
For less severe conditions, you should call your family doctor first—and speak them or with their “triage” nurse (pronounced “TREE-ahj”; rhymes with “tree-lodge). They can help assess how serious your condition is and help you decide which type of facility can provide the most appropriate treatment. Your doctor may be able to squeeze you in for an office visit. Or, if your doctor does send you to a quick care clinic, urgent care or ER, he or she can give them your relevant medical history, so you can avoid unnecessary tests and get the right care.
Know the advantages of a quick care clinic or urgent care center.
- They are available throughout the area.
- They usually open early, close late, and have weekend hours.
- You don't need an appointment, and you probably won't wait long to be seen.
- They are staffed with health care professionals who can deal with a wide range of conditions.
- Best of all, depending on your coverage, when you use a quick care clinic or urgent care center, you'll often pay less than if you had gone to the emergency room. And if you use an emergency room for situations that are obviously not an emergency, your plan may charge you a penalty or even make you responsible for the whole charge for the visit.
Is “quick care” different from “urgent care”?
Yes. “Quick care” clinics are a relatively new kind of facility offering walk-in diagnosis and treatment for minor illnesses, such as step throat, pink eye, bronchitis, sinus infections and other common ailments. Quick care clinics are usually staffed by nurse practitioners, who can write prescriptions. Patients are usually seen within 15 minutes, and no appointment is necessary.
A typical quick care visit costs the patient under $50 – less than most office visits and far less than urgent care. Quick care charges may not be covered by medical insurance but are eligible for reimbursement from Flexible Spending Accounts and Health Savings Accounts. For many people, quick care’s convenience and fixed cost are preferable to scheduling an office visit or incurring the high cost of urgent care, especially when they know their ailment is minor and easily treatable.
Don’t let the “urgent care” sign fool you.
Again, call your doctor first. If they instruct you to go to an urgent care center, understand that all centers are not created equal, and the difference can affect your wallet. To reduce your costs:
- Ask if it is licensed. (The answer you want is “Yes.”)
- Ask if they will bill you as “urgent care” or as an “ER” (If it is billed as an ER, you will pay much more.)
You have to ask!
This point is worth repeating. Some facilities will have a sign that says “urgent care” but they actually bill you as an emergency room. Generally, that means you will pay quite a bit more out-of-pocket. The only way to know is to ask—or check with your insurance company…
- Call your insurance company’s customer service. If you are a UnitedHealthcare customer you can call 800-752-1816.
- Go to your insurance company’s web site. If you are a UnitedHealthcare customer, go to: myuhc.com/.
And, remember, the best time to find out well in advance.
Know when to use the emergency room.
If you're facing a serious situation — stroke, heart attack, severe bleeding, head injury or other major trauma — have someone take you straight to the nearest ER or call 911 for an ambulance. Don't take a chance with anything life-threatening. The ER is the best place for these and other critical conditions, including:
- Severe abdominal pain
- Chest pain
- Sudden dizziness, weakness, or loss of coordination or balance
- Sudden blurred vision or loss of vision
- Severe allergic reactions that affect breathing
- Deep cuts/wounds or bleeding that won't stop
- Loss of consciousness
- Broken bones
Be smart. Think ahead.
It's smart to check out your options BEFORE you need medical services. Again, except for emergencies, your first call should be to your doctor’s office. If they instruct you to go to a quick care clinic, or an urgent care center, you’ll need to know the location of the best one for you (preferably in-network). Making an informed decision could save you time and money. Don't take chances with your health, and don't spend more than you need to for minor treatment. It's all a matter of knowing what's right for your situation. (Remember: Quick care clinics may be a more convenient and less expensive option for the urgent care you need).
Hospital Admission Checklist
Here are some items to take care of before you go to the hospital:
- Record your medical history - Write it down so you don't forget anything. Hospital staff will need to know about your current and past medical conditions and any previous medical procedures.
- List medications you take - Your doctors and nurses will need to know all the medicines, vitamins, and supplements you’re currently taking. Also write down any drug allergies or adverse reactions you’ve experienced. UnitedHealthcare members have an easy way to keep track of these details at in the personal health record section of the password-protected myuhc page where you can record, save, and print your personal medical information.
- Confirm surgery details - If you’re having surgery, make sure you understand what’s going to be done and the expected outcome. Be sure your doctor - and the doctor operating on you - are clear on the specifics.
- Bring your insurance card.
- Leave all valuables at home - Don’t bring rings, watches, large sums of money, credit cards or other valuables, since you won’t be able to keep them with you at all times. They could be misplaced or stolen.
- Pack house shoes with non-slip soles - Socks and shoes with slick bottoms can cause you to fall.
Hospital Quality Links
- Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
- Wisconsin Collaborative for Healthcare Quality (WCHQ)
- Wisconsin Hospital Association - Checkpoint
Put Your Wishes in Writing
If you become unable make decisions or to communicate, someone else will have to make health care decisions on your behalf. By choosing a health care agent, you grant the person you want to make these decisions the legal right to do so. This helps avoid conflict, uncertainty and stress for your loved ones during a difficult time. Also, your health care agent can act as your advocate, helping others to understand your wishes.
The time to choose a health care agent is before you actually need one. The legal form that states your choice of a health care agent is usually called a durable or medical power of attorney for health care, but it may be called by other names in some states.
An advance directive is a document in which a person either states choices for medical treatment or designates who should make treatment choices if the person should lose decision-making capacity. The term can also include oral statements by the patient.
Advance directive is a general term that includes two kinds of documents: living wills and durable/medical power of attorney. Each state regulates the use of advance directives differently.
A living will is a document in which you can stipulate the kind of life-prolonging medical care you want if you become terminally ill, permanently unconscious, or unable to communicate. Each state has its own living-will requirements. It is possible to use a standard form from a stationery store, draw up your own form, or simply write a statement of your preferences for treatment, as long as you follow the state’s witnessing and signature requirements. You should discuss the living will with your physician, family and clergy, and ask your physician to make it a part of your permanent medical record. Although you do not need a lawyer to draw up a living will, you may wish to discuss it with a lawyer and leave a copy with your family lawyer. (Source: American Hospital Association, Put It in Writing brochure.)
Durable Power of Attorney for Health Care (DPOA)
This is an advance directive in which you name someone else (your “agent” or “proxy”) to enforce your Living Will and make health care decisions in the event the you become unable to make them or to communicate. This type of advance directive may also be called a health care proxy, medical power of attorney or appointment of a health care agent. Sometimes this person may be a spouse or relative, but not always. It is important that you choose someone who knows your wishes and who you feel will be able to carry through with them should the time come. (Source: American Hospital Association, Put It in Writing brochure.)
HIPAA Privacy Rule
The Health Insurance Portability and Accountability Act (HIPAA) includes a Privacy Rule, which protects individuals’ medical records and other personal health information. Among other things, the Privacy Rule establishes safeguards that health care providers must follow to protect the privacy of patients’ “protected health information.” Generally, doctors and hospitals are prohibited from releasing your health information to friends and family (other than your spouse) unless you have specifically authorized the release in writing. By legally designating a health care agent with medical power of attorney, you ensure that person will have legal access to your health information.
How to Put Your Wishes in Writing
- Advance Directive Forms for Your State, which you can download and use for free at the Caring Connections website, www.caringinfo.org.
- Put it in Writing, an American Hospital Association website to help you understand and create advance directives.
- Writing an Advance Directive, helpful information at myuhc.com.
- Specifically for Wisconsin Residents, you’ll find advanced directive information from Wisconsin’s Department of Health and Family Services.
Prices at Wisconsin hospitals
- Wisconsin Hospital Association PricePoint facility-specific info on services and charges
- myHealthcare Cost Estimator UnitedHealthcare members can also call a customer service representative for help at 800-752-1816
Health care quality ratings
- Wisconsin Hospital Association CheckPoint
- Joint Commission Quality and Safety Ratings
- The Leapfrog Group hospital safety ratings
- Wisconsin Collaborative for Healthcare Quality
- Wisconsin Health Information Organization
Health risk assessment
- How's Your Health? 10 minute questionnaire gives you health report, forms for you and your doctor, and other choices. (Select city/region on right-hand side)
- UnitedHealthcare Need to register first with myUHC. It's easy.
- NIH Estimate: Your 10-year Risk of Heart Attack
Why are health care costs rising?
In simplest terms, spending on health care is the product of two factors: price and utilization.
- Prices charged by hospitals, physicians, drug companies and other health care providers have risen dramatically – more than the cost of goods and services in general (inflation).
- Utilization of health care services is up. Despite rising prices, demand for services remains high. More of us are using health care services more often, for more conditions – including some that were not even treated in the past.
Why are medical prices going up, and why are we using more care? Here’s where things get complicated. Experts differ in their conclusions about what – or who – is most to blame, but there’s widespread agreement that certain cost drivers are at work.
Key Cost Drivers
Americans’ lifestyle choices are partly to blame. Unhealthy eating, lack of exercise, smoking, not getting enough sleep, alcohol abuse all put us at higher risk for a host of costly illnesses including heart disease, diabetes, cancer, arthritis and more. Obesity rates in adults and children, while showing signs recently of leveling off, still remain high and suggest health care costs will continue their upward climb. In 2011-2012 approximately 17% or 12.7 million children and teens in the U.S. were obese. Extra pounds put children at an increased risk of developing type 2 diabetes, high cholesterol, heart disease and other expensive health problems for their lifetime. (Source: Journal of the American Medical Association, February 26, 2014, Vol. 311, No. 8.)
Advances in medical technology have led to amazing breakthrough treatments. The research and development costs behind these new technologies must be recovered somewhere – typically through the general cost of medical goods and services. And we’re all paying the high price. Still, Americans want the latest treatment at their disposal, whether it means an expensive bone marrow transplant that may be yet unproven as treatment, or a heart bypass operation at age 85. Our society’s devotion to technological discoveries ensures that costs will continue to rise. No matter what employers do to manage costs, the impact of technology on spending will continue.
Prescription drug costs are rising even faster than medical care overall. Some of the most exciting – and most expensive – developments in medical care involve prescription drugs, specifically specialty drugs. Specialty drugs now account for approximately 20-25 percent of pharmacy spending and the cost of these drugs is expected to quadruple between 2012 and 2020.
Many claim that direct-to-consumer drug ads are prompting patients to request the newest (most expensive) brand-name drug, even when a generic or over-the-counter drug may work just as well. Another concern is that drug ads rarely mention the lifestyle changes or other, non-drug solutions, which are often just as important as drug therapy in improving outcomes. For example, a patient may resist when his physician insists on discussing a low-fat diet, stress management, or allergen avoidance rather than writing a prescription.
Whatever the reason, employees’ usage of prescription drugs, and the cost of those drugs, has significantly increased recent years and is expected to continue rising.
Did you know?
The U.S. and New Zealand are the only countries that allow direct-to-consumer drug advertising that includes product claims.
Source:Abel GA, Penson RT, Joffe S, et al. Direct-to-consumer advertising in oncology. Oncologist. 2006;11(2):217–226
An aging population needs more care. In 2010, there were 40.3 million people aged 65 and older, 12 times the number in 1900. By the year 2030, the older population will number approximately 73 million.
Source: U.S. Census Bureau, report issue June 2014.
What’s the significance of these statistics? Often, as people age, health problems increase. There are more people getting treatment for the types of one-time problems that accompany middle age, such as gallbladder surgery. Just as important, more people now need ongoing care for the types of chronic conditions that may develop with age, such as back problems or adult-onset diabetes. Often, that treatment includes expensive prescription drugs.
The costs associated with older people will not diminish anytime soon. Today’s youngest Baby Boomers will still be in the workforce 15 years from now. As a demographic group, their health costs will balloon as they age and use medicine to live long, active lives. Advances in health care are part of the reason we’re living longer, which in turn is driving our national health care spending even higher.
Did you know?
Approximately one-third of health care treatments, costing $750 billion annually, are unnecessary. Millions of patients receive unnecessary treatments each year, leading to complications, reduced productivity, and significantly higher costs.
Source: Institute of Medicine Report, September 2012.
Consolidation in the health care marketplace means less competition. That gives employers less leverage to negotiate favorable pricing. As a result of consolidation, many health care systems have transitioned services from a not-for-profit to for-profit status, adding the cost of “profit” to medical charges. In addition, there continues to be a great deal of opportunity to streamline the wide range of administrative processes used today in order to eliminate waste from the system.
Governmental factors also play a role in health care cost inflation. Hospitals and doctors receive limited reimbursement from Medicare and Medicaid for patients in those systems. To keep operating at a profit, they must recover those “losses” through the prices they charge commercially insured patients, most of whom have coverage from their employers. Ultimately, it’s the employer and covered employees who end up footing the bill for low reimbursement levels by Medicare and Medicaid and the uninsured.
Additional Consumer Resources