Recently I wrote about empowerment and the importance of letting patients make their own health care decisions.Our job is to make sure patients are given information and then allowed to choose the best option for them. Maybe we should even embolden patients; give them confidence and encourage them to take more control. Physicians tend to feel more comfortable advising according to the “standard of care” and we struggle handing over the reins when we believe we “know” the safest path to take.
Every time I talk about building better metrics, I emphasize the significance of evaluating something physicians can change or control.The intent behind measuring patient satisfaction was likely to increase patient autonomy, however, as with many things; the devil was in the details.It turns out chasing higher patient satisfaction scores can result in higher costs and increased mortality.Overall, the most satisfied patients were more likely to be admitted to the hospital and total health-care costs were 9% higher. Most strikingly, for every 100 people who died over a four year period in the least satisfied group, 126 people died in the most satisfied group.At least they died happy and satisfied right? That notion can be difficult for some physicians to accept but might be more important than we realize.
In the past, the AMA published an article questioning the merits of patient portals — the primary tool for engaging patients. Rob Tennant, senior policy adviser with the MGMA-ACMPE, the entity formed by the merger of the Medical Group Management Association and the American College of Medical Practice Executives raised the fundamental issue: “The business case just hasn’t been made.” I’ll attempt to make it.
Perhaps the best evidence of the business case is when industry visionaries/organizations/leaders such as HIMSS (the professional association for healthIT), Aetna and Kaiser Permanente have made significant investments in patient engagement.
I’ve excerpted a couple sections of Pam Dolan’s article on the topic to set context and then I will address the business case. The patient portal benefits assume that it’s more than a simplistic silo’ed patient portal tethered to an EHR since they are broadly available. [Disclosure: My company, Avado, is one many patient engagement companies.]
This is why I would call it the patient portal & relationship management system or simply patient relationship management system to distinguish it from traditional limited patient portals.
“As a PCP, I’ve seen the morale in my area, and I see a major crisis coming if the complaints are ignored.”
“I’ve lived in the hell that is American health care…”
A devoted physician wrote these words in reaction to a recent blog post we wrote. And he is clearly not alone.
In our new book The Doctor Crisis, we report on the widespread unhappiness, frustration, dissatisfaction, and anger of so many American physicians.
We believe this crisis is real and growing; that it is an impediment to providing the care the American people need; that dealing with the doctor crisis is fundamentally patient-centered; and that the crisis has not been recognized for the fundamental threat it poses.
Our recent feature on The Health Care Blog elicited some powerful reaction:
Rob: ”In a certain sense, individual doctors ARE victims of a system that rewards over-consumption, ridiculous documentation, attention to codes over people, and bureaucracy over partnership…”
Jeff: “Can validate what Rob has said. I’ve spent the last three years listening to physicians about the possible alternative futures for their profession, and the overwhelming desire was exactly as Rob said- an overwhelming impulse to flee…”
Some commentators wrote that doctors shouldn’t complain because they earn a lot of money, drive fancy cars and own nice homes. But that theme – accurate in many cases but certainly not all — gets us nowhere.
We think the rubber meets the road with this warning from Dr. Rob, ”…As a PCP, I’ve seen the morale in my area, and I see a major crisis coming if the complaints are ignored.”
Is Dr. Rob overstating it? We don’t think so. In fact, we think he has it exactly right. How can our system function properly if the level of job satisfaction among doctors continues to spiral downward?
Harris Interactive research describes the profession as “a minefield’’ where physicians feel burned out and “under assault on all fronts.’’ Has such extreme language ever been used to characterize the medical profession? Have doctors ever faced a time as turbulent as this?
Doctors are certainly not blameless as both Brian and Rob noted in their comments:
Brian: “…I’m concerned that you have framed your argument as though physicians are victims of the system rather than partial drivers of its characteristics …”
Rob: “…physicians as a group have been complicit in building this system, and so should bear a lot of the blame…”
So what needs to be done?
A crucial first step is for health care stakeholders to recognize and acknowledge the existence of the crisis. Doing so will get the doctor crisis on the national health care agenda. Unfortunately, the matter is not currently a priority for many, if not most, provider organizations. That needs to change.
The problem of pain, from the viewpoint of British novelist and theologian C. S. Lewis, is how to reconcile the reality of suffering with belief in a just and benevolent God.
The American physician’s problem with pain is less cosmic and more concrete. For physicians today in nearly every specialty, the problem of pain is how to treat it responsibly, stay on the good side of the Drug Enforcement Administration (DEA), and still score high marks in patient satisfaction surveys.
If a physician recommends conservative treatment measures for pain–such as ibuprofen and physical therapy–the patient may be unhappy with the treatment plan. If the physician prescribes controlled drugs too readily, he or she may come under fire for irresponsible prescription practices that addict patients to powerful pain medications such as Vicodin and OxyContin.
As further evidence of her misdeeds, he says, first she “knocked me out with propofol–the same drug that killed Michael Jackson.” Wood uses his experience–which sounds as though it went smoothly, controlled his pain, and fixed his problem–to bolster his argument that doctors indiscriminately hand out pain medications and are entirely to blame for patient addiction.
But what happens to doctors who try not to prescribe narcotics for every complaint of pain, or antibiotics for every viral upper respiratory infection? They’re likely to run afoul of patient satisfaction surveys. Many hospitals and clinics now send a satisfaction questionnaire to every patient who sees a doctor, visits an emergency room, or is admitted to a hospital.
The results are often referred to as Press Ganey scores, named for the company that is the leading purveyor of patient satisfaction surveys. Today these scores wield alarming power over physician incentive pay, promotion, and contract renewal.
Patient satisfaction has garnered new attention as an indicator of provider performance and an important dimension of value-based health care under the Affordable Care Act (ACA). Defined in any number of ways, it is often publicly reported to help patients choose among health care providers.
This month, patient satisfaction takes on even greater importance as ACA provisions set to begin October 1, 2012, tie patient satisfaction to Medicare reimbursement, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. HCAHPS scores reflect patients’ perspectives on several aspects of care: communication with doctors and nurses, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of the hospital environment, and quietness of the hospital environment—and are estimated to place at risk an average of $500,000 to $850,000 annually per hospital.(1)There’s a lot riding on patients’ perceptions of the health care experience, our satisfaction with the care we receive. But what do we really know about patient satisfaction, its relationship to patient outcomes and cost—and just what is it we are rewarding?Continue reading…