Finding Helpful Doctors

This site does not recommend doctors, hospitals or anyone. It summarizes information, mostly from Medicare, so you can decide.

Objective Numbers, Collected by the Federal Government, on Doctors and Other Health Workers

This page helps you find doctors and nurse practitioners who spend a lot of time with each patient. Later, when you know specific treatments you need, you can use a different page to see which specialists have the most experience with each procedure.

Spreadsheets (xlsx) for the USA (129 megabytes), and for Maryland, DC and nearby Virginia (4 megabytes), show you:

• Doctors who give 45-60 minutes for a first appointment.
• Doctors who average 29 minutes or more for subsequent appointments.
  
• Appointment lengths for other doctors, including yours.
  
• Length of doctor visits in hospitals and nursing homes.
• Which doctors and nurse practitioners also go to assisted living or even home visits.
• The file is based on Medicare data for 2012-2014.

You may not always need long appointments, but doctors with long averages, and their schedulers, at least offer long appointments when needed. Longer appointments include more extensive medical history, cover more severe problems, with more complex medical decisions. 

To find doctors near you, in a specialty, and/or male/female, you can filter the spreadsheets (click an arrow in 3rd row). For example column G shows the state:

1. Click "Enable Editing" if it asks at the top of the screen
2. Click the arrow in the 3rd row of Column G
3. Unclick "Select All"
4. Click the state(s) you want
5. Click OK, and you will see providers in the state(s)

You can also filter on specialty, city, zip code, male or female. To help you find nearby areas, there are maps of 5-digit zip codes, the first 3 digits of zip code, and the first 2 digits, or here. On the map of 3-digit zips, move to new areas by clicking the N, S, E, W arrows, then zoom in; you can see anywhere in the country on their free demo. All of a doctor's appointments are listed at one address, which the doctor provided to Medicare, even if the doctor has multiple locations.

Length of office appointments is based on the typical face-to-face time. Hospital and nursing home visits include both face-to-face time, and time dealing with that patient's needs on the hospital floor or at the nursing home (as explained on p.18 of a presentation). Some audiovisual telehealth contact is also covered (p.31 of the same presentation). Time talking to the family with the patient not present is not covered. Length of appointments at home and in assisted living seems to be face-to-face time.

You can select male or female, but some specialties have few women.

Continuity of Care

The spreadsheets also help you find local doctors who give continuity of care by treating their patients in all 3 settings: office, hospital, and nursing home. If you've been hospitalized, you know the difficulty coordinating between your personal doctor and hospital doctors. Life is easier and care may be better if your personal doctor can treat you in the hospital. The spreadsheet shows which doctors and nurse practitioners do treat patients both in and out of hospitals:

• Number of office visits they did in 2012-2014 (for Medicare)
• Number of visits to hospitals in the same years
• Number of visits to nursing homes
• Number of visits to assisted living
• Number of home visits
  
• Psychotherapy visits are separate; their time is included in the averages

• Ob-Gyn (pelvic and clinical breast exams) are separate; time estimates are not available for these

You can click here to find which hospital the provider uses, to see if it will satisfy you. That site also gives you phone numbers, so you can call providers' offices to confirm the hospital, and find which nursing homes they visit. The spreadsheet also shows the few doctors and nurse practitioners who visit patients in assisted living.

On the other hand you can also see the much bigger numbers of providers who specialize and just provide hospital care, office care or nursing home care.

The spreadsheets have a web link for each doctor, to copy into your browser. It takes you to a consumer rating site, which also takes you to the doctor's website if they can find it. There are helpful hints for using large spreadsheets like this.

You can supplement these bare numbers with all the sources on patient reviews, malpractice, etc. discussed in STEP C of the specialists page.

Some patients want to know who is independent of the hospitals and Accountable Care Organizations (ACOs) which have been absorbing most practices, so they can have independent advice. Lists of doctors who are independent of the major health systems are at: aid-us.org/directory, Idaho, Georgia, New York City, Minneapolis-St. Paul, south Charlotte, . Some groups with "independent" in the name are ACOs with incentives to refer to each other. Insurers also pay incentives to doctors to meet financial goals.

Home Visits: Medicare and other insurance plans pay for home visits when there is a reason, such as letting the doctor assess the home situation, coordinating with home caregivers, or difficulty getting to the office. A doctor describes the emotional benefits he gets from even doing a few home visits per week. Doctors are paid more for home visits than office visits, so copays may be higher too. The spreadsheets described above show names and locations of 4,000 US doctors who do more than 2 home visits for Medicare per week (104/year), so you can find one near you. 1,300 of these doctors do more than 10 home visits per week (520/year). An association of doctors advocates for the service, and also has a referral list of about 300 doctors and groups. There are some experimental programs to save money by deterring seriously ill patients from going to hospitals.

Source: The spreadsheets use Medicare data. They are useful for non-Medicare patients too, since they show differences among doctors even if you are young or privately insured. Doctors who work only for managed care plans, like Kaiser or Medicare Advantage (Part C), are not included, so you will need to look elsewhere. Medicare does not release counts of 10 or fewer patients, to protect privacy, so there is little data on doctors who see few Medicare patients.

Earlier spreadsheets showed just 2013 data for the country (199 megabytes), or DC, MD, and nearby VA (7 megabytes).

Ranking Doctors

The first column has an overall rank you can adapt. It looks for the highest values on 5 items:

1. Average length of initial, subsequent and nursing home/hospital visits, to show which doctors spend time with you (multiplied by 6 to scale the minutes for comparability with other items).
2. Number of hospital visits, to show which doctors can follow you into the hospital.
   
3. Number of nursing home visits, to show which doctors can follow you into a nursing home.
   
4. Office visits as % of hospital visits. When this is over 100% or 200%, it highlights doctors whose primary loyalty can be to patients, not the hospital.
5. Office visits as % of nursing home, again to highlight doctors who focus on patients in the community, not just those in nursing homes.

The rank looks for doctors who are high on all 5 items. Change it if something else is important to you. An article in Becker's Hospital Review discusses how hard it is to get even 25 minutes from many doctors, but this list shows the doctors who regularly spend that much time with patients.

More Information on Doctors

The spreadsheet shows

• Average bills for doctors' appointments and visits, in case you need to go without insurance
• Average amount Medicare allows, which may be a guide to what you can bargain for, or what other insurers pay. Medicaid usually pays less, and many doctors don't accept Medicaid.

• Number of office appointments for new Medicare patients (col. V). This shows if the doctor is taking new patients. If it is less than 12 or 24 (1 or 2 new Medicare patients per month), the doctor may not have room to take you. You can also compare it to the total number of office appointments (col. O), to see if the doctor has a lot of turnover The number of new patients is high for doctors who see many patients just once, for consultation, or because patients don't like them. There are also some surgeons in the list who show primarily initial office visits, since follow-up care is covered by the surgical fee, and is not billed separately and not listed separately here. Surgeons with a lot of subsequent appointments may be trying non-surgical approaches first. For psychotherapy, new patients cannot be identified separately, so they are all listed as subsequent appointments. A new patient means the doctor has not seen the patient in the past 3 years, and neither has any other doctor in the practice who has the same specialty and subspecialty.
• The 2013 spreadsheets show total hours per week each provider billed to Medicare for these appointments and visits. If this is useful I can add it to the 2012-2014 file too. You can ask the provider's office how much non-Medicare work they do, to see if the total hours are reasonable. Up to 40 hours or so for Medicare may be reasonable if they have mostly Medicare patients, but could show an overloaded doctor if younger patients are also getting a lot of care. Remember they have many hours administering their practice and keeping up with knowledge, besides the billable hours. 62% of doctors spend less than 46 hours per week seeing all patients, Medicare and others; 82% spend less than 56 hours per week seeing all patients.
  

Some who bill very high hours may include other staff in their data. Then you won't know what to expect from the specific person you see; for example they could have separate staff for office and hospital work. Usually each doctor, nurse practitioner, etc has a unique number and a separate line in the spreadsheet. Multiple staff are more likely if the specialty is "Multispecialty Clinic/Group Practice" or if the name is ALL CAPS, which means Medicare called them an "office" not an "individual."

Besides averages, the 2013 spreadsheets show the number of visits by length: 10 minutes, 30 minutes, 60 minutes, etc. Medicare does not estimate time for the annual wellness visit, so I estimated the time based on what they pay, compared to what they pay for regular visits of 25, 40 or 60 minutes. These estimates are 48 minutes for an initial wellness visit and 29 minutes for a subsequent one, and appear separately in the spreadsheet, so you can use other estimates if you wish. There are also physical exams in the first 12 months of Medicare enrollment, which are grouped with the initial wellness exams at 48 minutes. ProPublica shows graphs of how many subsequent appointments at each length each doctor gave in 2012, though one cannot search for doctors who give long appointments. They consider long appointments a cost problem, not a patient benefit.

Each column in the spreadsheet summarizes several billing categories. A summary page lists all the detailed categories, how common each is, national average costs, and Medicare's estimate of how long it takes.

Types of Medicare Patients Seen by Each Doctor

In October 2015, Medicare released information on types of Medicare patients seen by each doctor, to show which doctors are most familiar with these types of patients. The information can be added to the doctor files, but would make the files even bigger. A private insurance app suggests that some patients do want to find doctors who treat patients who are similar by age and gender. Comments are welcome below.

Patient age is calculated at the end of the calendar year or at the time of death.

• Average age of Medicare patients.
  
• Medicare patients with disabilities under age 65.
  
• Number between 65 and 74.
• Number between 75 and 84.
  
• Number over 84.

Number female.
Number male.
Race is based an algorithm that uses Census surname lists and geography to improve the accuracy of race/ethnicity classification, particularly for those who are Hispanic or Asian/Pacific Islanders.

• Number of non-Hispanic white beneficiaries.
• Number of non-Hispanic black or African American beneficiaries.
• Number of Asian Pacific Islander beneficiaries.
• Number of Hispanic beneficiaries.
• Number of American Indian or Alaska Native beneficiaries.
• Number with race not elsewhere classified.

Number who had no Medicaid benefits in the calendar year.
Number who had Medicaid sometime in the year
Conditions (based on algorithms used at http://ccwdata.org/index.php)

• % with Alzheimer’s, related disorders, or dementia.
• % with Asthma.
• % with atrial fibrillation.
• % with cancer. Includes breast cancer, colorectal cancer, lung cancer and prostate cancer.
• % with chronic kidney disease.
• % with chronic obstructive pulmonary disease.
• % with depression.
• % with diabetes.
• % with heart failure.
• % with hyperlipidemia.
• % with hypertension.
• % with ischemic heart disease.
• % with osteoporosis.
• % with rheumatoid arthritis/osteoarthritis.
• % with schizophrenia and other psychotic disorders.
• % with stroke.

Average Hierarchical Condition Category (HCC) risk score of beneficiaries. Beneficiaries with score over 1.08 are expected to cost more than the Medicare average, and vice versa.

• Risk scores are based on age, sex; use of Medicaid, whether a disability before 65, qualified for Medicare, in institution (usually a nursing home); and diagnoses from previous year. The risk model was designed and is more accurate for large groups, such as the enrollees in an HMO.
• CMS uses HCCs to determine the diagnosis-related portion of the risk score. For example, the HCC system for 2010 included a total of 189 conditions, with related conditions grouped into 70 disease hierarchies. One hierarchy had three different diseases that affect the liver: end-stage liver disease, cirrhosis, and chronic hepatitis. Each condition had a weight that reflects its marginal contribution to a beneficiary’s total expected Medicare costs.
• Under the HCC system, CMS calculates the diagnosis-related portion of a beneficiary’s risk score by adding up the weights for the most severe diagnosis that the beneficiary has in each disease hierarchy. Continuing the example above, a beneficiary with both cirrhosis (weight = 0.406) and chronic hepatitis (weight = 0.406) would receive credit only for the cirrhosis diagnosis. The researchers who developed the HCC system adopted this approach after finding that having multiple conditions within a hierarchy did not increase overall patient spending substantially.

 
To protect the privacy of Medicare beneficiaries, the number of beneficiaries fewer than 11 have been suppressed and the percent of beneficiaries between 75% and 100% have been top-coded at 75% .