Evaluating Care Models at Top Hospitals to Fit an Individual Patient

Hi Jennifer,
What you went thru before Mayo is called being on a medical merry-go-round.
Glad you got off the merry go round, got answers, and are feeling better.
How are you doing with your ankle?
Funcountess

@tdrell Thank you, yes, my spine health is great since my Mayo surgery 4 years ago. My insurance was "in network" at all the places I consulted for my spine. I prefer not to name names or locations because I want to be able to be brutally honest in these discussions. I didn't make any public comments or review the prior surgeon, but I did send him a kind letter along with the medical literature I found in the spirit of sharing information. As you might expect, there was no response. His staff could have discarded it and not shared it and I'll never know. That doesn't matter because my Mayo neurosurgeon told me he will always be my doctor and that he will stay at Mayo until he retires, so there are perks to having a surgeon younger than yourself. If I need spine surgery again, I would only want to see my surgeon at Mayo because I respect his knowledge, expertise and talent. He was also very helpful to me in recommending an orthopedic trauma surgeon at Mayo after I broke my ankle 4 months ago and sent me to a surgeon he trusts for his own family. I had been asking around locally and had called a few surgeons, but some couldn't see me or would only see me in a downtown location with all the crazy traffic, covid risk, and I couldn't drive, and my husband wasn't good with aggressive traffic. I had to get an appointment so they could decide if they wanted to help and that makes no sense that I would need to supply imaging before they would agree to see me. I already had an emergency surgery while on a trip that cleaned the wound from the compound fracture and placed a fixator cage to stabilize my ankle that was screwed into my shin and heel. This provides a couple weeks to allow for swelling to decrease before bones are set with plates and screws, so this was perfectly obvious that I needed further surgical help. I did have the 2nd ankle surgery at Mayo and am currently rehabbing my leg. All I had to do was contact my spine surgeon, and he responded that he was sending my request to another surgeon who would reach out to me for an appointment, and they did within an hour. I had appointments right away for the surgery itself and to come 2 days earlier to be tested for Covid and get further imaging and have the surgical consult. That was so easy, no jumping through hoops (as if I could!) and I had another great surgeon. I think that the first doctor you see at Mayo is your contact for future visits and that they arrange other specialists for you. I also saw a pulmonologist on one of my visits, again recommended by my spine surgeon. It is wonderful to have that kind of relationship where all I have to do is ask, and I can get medical help.

One other consideration is that at many facilities, surgeons practice there, but they own their practices, so they own the risk of malpractice or negative reviews that could affect if their business is profitable. They want to cherry pick cases they know will have a good outcome because the success rate for specific surgeries is recorded for each surgeon and hospital. Insurance companies track this too. If you are the patient who comes in with a confusing case, or with other health problems that can affect recovery, it's easier to refuse an offer for surgery, or to treat symptoms to postpone surgery such as spinal injections in the case of spine surgery. At Mayo, everyone is an employee and not in private practice, so there is no incentive to do surgeries for extra profits, so the opinion there isn't colored by financial motives. Mayo is known for taking complex cases that others refuse. I am sure this was part of my problem with the surgeons who turned me down because they were afraid to ruin their reputation if my surgery wasn't successful, and because they didn't understand the complete problem, they backed out. They should have looked farther, but they didn't. There are lots of other patient dollars walking through the door and they didn't want to invest any more time. Some were doing 30 minute spine procedures in comparison to the 2 hour spine procedure at Mayo which for the surgeon was an hour and a half of his time for the same procedure. I would rather be the patient of a surgeon who isn't rushing through the job because he has ten patients on his assembly line.

As for your question about admitting patients so other specialties can also consult, I think insurance companies would frown on this. They are in the game for profit and can refuse claims that don't follow correct protocol. If there is a valid reason why a patient should be admitted to the hospital, that is different. I was in the hospital 2 days after my ankle fracture because I couldn't manage to navigate well enough with a walker or be able to go up and down stairs. I had to figure this out with the therapists while I was in extreme pain and so nauseous and dizzy from the pain medications. I did better on lower doses that were more frequent. The doctors need to know a patient can navigate safely at home after release. If I had been more functional, they would have released me after one night. The problem of being an outpatient and seeing multiple specialists is the waiting time in weeks and months to see those doctors. That is not an issue at Mayo because they have figured out how to do it efficiently and usually complete it within a week.

@funcountess Thanks for asking. I am getting better every day making small gains on ankle and foot function so it is forward progress. My injured leg is smaller since I had not used the muscles for 3 months, so it takes time to get it all working better, and it fatigues quickly and hurts. I was encouraged to wean off the crutches and I walk with a limp. I have pain and tightness in my hip which makes me short strided because my leg doesn't want to go backward. When I step out of bed, my foot doesn't want to support my weight, but gets better after I walk on it. I do have limits on how far I can walk before I tire out, and the little bit around the house is not bad. I am taxing my abilities when I visit my horse in the distance I have to walk to get him, keep pace with him as I lead him to the barn to work on his hooves and back to his paddock. I couldn't take care for his feet for 3 months when I could not bear my own weight, so now I am treating a thrush infection for him. He will be fine, but it takes a few weeks of persistence to clear it up by cleaning his hooves, disinfecting, and packing a disinfecting mud into the cracks and crevices. After standing for awhile, I just have to get off my feet. That being said, I am doing pretty well.

Hi again Jennifer,
You have some atrophy, which is normal after your ankle incident. It should go away after p.t. I have a very slight limp after my ankle/foot injury from years ago.
I get tired standing also, as we age, our ability to do what we once did goes bye bye.
You are such a wonderful painter/artist, please keep that skill going.
Your orthopedic problems are only one part of you, I hope you post more of your art work, as I’m sure it brings pleasure to whoever sees it.
As for horses, my speed is probably the miniature horses. Had a friend years ago who had a miniature horse who she would let in the house.
I found it interesting, as she said the horse was housebroken.
Could that be true?
The only thing I’d be willing to ride at my age is a 2 wheeler with training wheels.
Stay well,
Funcountess

@mpflood7- Good morning- Yes, this is my view as well from many of the members on Connect. I have also met some of the interns and doctors even if Mayo isn't my hospital.

@funcountess Yes, mini horses can have house manners. There is a group called Gentle Carousel that takes mini horses into hospitals and nursing homes for patient visits and bedside visits and they are house broken, trained in walking on slick floors and to receive attention and hugs. They also wear fun costumes sometimes. Horses can be very therapeutic.

When I saw my horse on Sunday, I saddled him and got onboard and walked him around in the arena. That is therapy for my back and hips because it's the same walking motion, and I compensate for the bigger hip movement of the horse. It builds core strength. I also rode my horse when rehabbing from my spine surgery a few years ago. There are therapeutic riding programs that provide this service to people. OK, now for everyone who just gasped and said wow, only 115 days after ankle surgery, are you crazy to get back on a horse.....you should know that I didn't get hurt with my own horse. He's an older calm guy that is "broke to death" so he doesn't spook at dogs, cats, mailboxes, traffic, etc. He's got enough experience to know those things won't eat him, and he trusts me and knows that I won't ask him to do something that is unsafe. He also knows how to unzip my jacket with his teeth just in case I stashed some carrots inside. I trained him to stop and stand still when I would be returning from a ride, and he would get rewarded with a carrot. That is for safety because you can't let a horse hurry home like they want. They are herd animals and prefer not to be out alone, but back home where they eat and have their horse friends. So when we were out on a trail, he would look back at me in the saddle just to check and see if it was time for a carrot. He follows me around like a big dog and he comes to the gate when he sees me or I call him.

I took the precautions of using a 3 step mounting block and had my husband hold him so he wouldn't move, and I tested stepping up into the stirrup with the good leg and then I swung the healing leg over and sat in the saddle. Same procedure for the dismount, so I didn't drop onto my foot. Some of the time I just had him stand and we walked around the arena. I got off after 15 minutes and untacked him, then cleaned each hoof. I had my husband stand right behind me with his hand on the horse's side to prevent him from side stepping and I made sure my feet were a foot away when I picked up his hoof. One time before, he started to step on my toe when I was working on his hoof and I pulled it out before he could get his weight on it, so I learned my lesson and stand as far away as I can.

Thanks for your kind words. You can find me on social media and online. I am feeling well enough to get back to painting again and it will be good for my spirit.

@funcountess I am intrigued by your PT and proud of your functionality with your horse. I am sure he appreciates it! Have you ever tried walking backwards? I have found it to add an extra bit of challenge that improves my focus and quickens my healing. You should probably check with your doctor and therapist before trying it though. You wouldn't want to undo any of the hard work you have already done. I am always amused that such a simple thing can have such a profound effect.

@2011panc I think you were responding to me. I am officially going to PT for my ankle, but that doesn't involve my horse. I work with him on my own and need to care for him. There are different programs for therapy on horseback around the country. My horse does really appreciate my attention and is always happy to see me.

@mpflood7 Hi, and I too welcome you to Connect. You joined on my birthday! Sorry, I am a bit late in responding to you, I am not on Connect as much these days as I once was.

I live in southern NH and all of my care was here until I had an undiagnosed problem that went undiagnosed for almost a year and a half. It was finally diagnosed as non-alcoholic cirrhosis. My PCP here recommended me to one hospital but neither my husband nor I liked the doctor with whom we dealt so I researched and chose to go to Mass General in Boston. Now I have most of my care, other than my PCP there, except for my endocrinologist because I am certain I could not do better than him.

I chose MGH after looking at rating sites and learning about which hospitals are good for varying specialties, specifically transplants for me of course. You have had some great responses, and there are some excellent resources out there. I know US News was mentioned. I think their ratings are considered the gold standard for hospital ratings. Most years Mayo is #1 followed by MGH, and Cleveland Clinic in the #2 and #3 spots, with Johns Hopkins up there also, so none of those are too shabby. MGH has been tops in more specialities than any other hospital in the country also so that is also something you might want to check - how a hospital is rated in that discipline. Teaching hospitals tend to be the best I think if you live in an area where one is available to you.

Another resource that many people are not aware of is Medicare hospital ratings. You may not be old enough for Medicare but hospital quality is the same whether you are under or over 65. Looking at my own state, NH, and also Massachusetts, I think they are fairly accurate. I think that Mayo's MICT approach sounds great and tremendously helpful. When I had cirrhosis my symptoms were so varied I would have had no idea what type of doctor to go to. It sounds as if MICT would have been the best choice. I have a problem now also that has me befuddled and I am not sure what type of doctor to see. I think I will ask my transplant team if they have suggestions.

The other possible place to look is for ratings for specific types of conditions. There is a site that rates transplant hospitals, perhaps there are sites that rate other hospital specialities too.

I hope you can find a hospital that you really like and feel in which you feel confident. I think that's key, to feel confident of the doctors affiliated with a hospital. I very recently changed PCPs. I really like my prior PCP from a personal standpoint but I felt like he let me down a couple of times, that I had fallen through the cracks, so I changed. So far I am more confident in my new doctor. I will never have a rapport with her that I had with my prior PCP but my healthcare has to take priority.
JK

Thank you for the thorough reply JK. I hope you continue to get the best care and stay healthy.

2 Harvard / MGH professors each independentely recommended the Mayo Clinic, due to their Collaborative “MICT” approach. However, I still don’t really understand why MICT is unique to Mayo given it would seem to make sense that every hospital would follow such an approach. In any event, the earliest I could get in to see my local (Florida) doctor so as to call and make the referral is on November 11.

** What is really giving me major stress is the waiting - as I need to get healthy to work and make money to pay my bills. If you or anyone knows how to speed the process up, please let me know. **

In the interim, for example, I understand Clevelend Clinic has a MICT program modelled after Mayo. Their program, called “National Consultation Service” (NCS) can be googled and looks ideal. However, just this past Friday, they told me it would take 5-7 months to get the appointments (with various specialists) scheduled. 5-7 months !? That sounds crazy to me, as I don’t know who can wait that long for serious illness - and in my case, financially. Meanwhile, I haven’t learned of any MICT program at Johns Hopkins - a hospital that I find to be administratively a mess, though I understand that they have some of the best doctors. So right now, I am hoping on Mayo #1, Cleveland Clinic #2 and Johns Hopkins #3. Interestingly, I don’t know yet whether to really believe the rankings as to the quality of care but in my experience with the administrative staff, of those 3, Mayo Clinic is definitely #1.

Again though any tips on how to speed up the appointment process is appreciated. I just hope I can stay healthy and financially afloat while waiting.