Chapter 12

Patient Empowerment Tools

This chapter provides miscellaneous resources that patients can research for specific issues

Miscellaneous Examples:

Barron’s Article

Artificial intelligence-powered symptom checkers are revolutionizing healthcare, empowering patients to perform “self-triage.” Wearables, sensors, and other tools are capturing real-time biometric information, while practitioners can perform genomic analysis and rapid point-of-care diagnostics to identify potential infections quickly. These technologies are putting the power in the hands of individuals, allowing them to take control of their care, and leaving hospitals and clinics available for those needing medical interventions and in-person monitoring.

https://eprognosis.ucsf.edu/decision_aids/Mammography_75-84.pdf

Are Mammograms Worthwhile for Older Women?

Some might be better off not knowing they have breast cancer because they are likely to die of other causes long before breast cancer threatens their health.

N.Y. Times: Published Aug. 17, 2020 Updated Aug. 17, 2021

*Breast Cancer, Metastatic Hers-2 treatment advance:

In patients who took trastuzumab deruxtecan, tumors stopped growing for about ten months, compared with five months for those with standard chemotherapy. The patients with the experimental drug survived for 23.9 months, as compared with 16.8 months for those who received standard chemotherapy.

Right now, two relatively new classes of cancer drugs are displacing traditional chemotherapy for many types of cancer and giving metastatic patients, in particular, more time. Many of these advances employ a person’s immune system to eliminate cancer cells rather than using chemotherapy or radiation to do the extinguishing. These are modern immunotherapy drugs and antibody-drug conjugates, or A.D.C.s, e.g., Trodelvy in breast cancer.

Non-small lung cancer treatment advance:

The Adaura trial, a significant international study, involved patients aged between 30 and 86 in 26 countries. It looked at whether the pill could help non-small cell lung cancer patients, the most common form of the disease.

Everyone in the trial had a mutation of the EGFR gene found in about a quarter of global lung cancer cases and accounts for as many as 40% of cases in Asia. An EGFR mutation is more common in women than men and in people who have never smoked or have been light smokers.

After five years, 88% of patients who took the daily pill after removing their tumor were still alive, compared with 78% of patients treated with a placebo. Overall, there was a 51% lower risk of death for those who received osimertinib compared with those who received a placebo.

Rectal cancer with local spread: It was a small trial, with just 18 rectal cancer patients, every one of whom took the same drug-Dostarlimab.

But the results were astonishing. The cancer vanished in every single patient, undetectable by physical exam, endoscopy, P.E.T. scans, or M.R.I. scans. This suggests a potential breakthrough in the treatment of rectal cancer with local spread.

Dr. Luis A. Diaz Jr. of Memorial Sloan Kettering Cancer Center, who wrote a paper describing the results published in the New England Journal of Medicine ( GlaxoSmithKline sponsored the trial), said he knew of no other study in which a treatment completely obliterated cancer in every patient

Dr. Schonberg and colleagues devised a decision aid available in English and Spanish to help women decide whether continuing to get regular mammograms after age 75 is in their best interests.

Maria Kannikova, Psychologist: Human minds don’t like uncertainty, and they especially do not like ambiguity.

SURPRISE BILLING: Dr. Chhabra’s work finds that 71 percent of ambulance rides can generate a surprise bill, with an average cost to the patient of $450. (Whether an ambulance company chooses to pursue this bill is something his research cannot determine, which is why it is merely potential.) Both private and public ambulance departments send surprise bills, which leaves patients with $129 million in potential surprise ambulance bills each year.

How to Dispute Surprise Medical Bills

NYT 6/30/22- Melina Wener Moyer

-Kaiser Family Foundation: 1 in 5 ER visits in 2020 resulted in surprise billing

Jan 2022 new Federal Law took effect- No Surprises Act

-Marshall Allen, the founder of Allen Health Academy, a health literacy organization, and the author of “Never Pay the First Bill.”

( Obtain the billing codes for a procedure in advance

Write in an appropriate treatment clause before signing financial documents)

Once you have received a bill, ask them for the billing codes used; HIPPA requires providers to give this information to the patient or the patient’s representative. Ask for a corrected bill from the provider if the provider used the wrong code for complex care—Cross-check with the Fair Health Consumer website for average prices in your area for codes used.

If your hospital’s billing is in violation of the No Surprises Act, write to the hospital’s billing department and ask them to settle your health insurance company’s bill.

Ask your Insurance company for an Explanation of Benefits statement; if the Insurance company rejected the initial billing because of the wrong codes used, the provider should resubmit it with the correct codes.

Relief is just a call away. Karen Pollitz, the co-director of the Kaiser Family Foundation’s Program on Patient and Consumer Protections, points out that the Centers for Medicare & Medicaid Services has a new help desk and hotline . Anyone can use this to ask questions and file complaints, making it an excellent place to start. Seeking assistance can alleviate the stress of dealing with medical billing issues.There may be a consumer assistance program in your state.

Dr.Marty Makary has mentioned the following resources in his writings:

www.choosingwisely.org

www.improvingwisely.org

www.hvpaa.org– high value health care

www.vezhealth.org

Consumer reports.org

www.kff.org

www.thelancet.com

wacommunitycheckup.org

www.ownyourhealthwa.org

RestoringMedicine.org

Iora Health- a relationship-based Health coach