Good Conversations Lead to Good Health
By David Martin, President and CEO of VeinInnovations
In the mundane interaction with the barista at a coffee shop, or a life-altering moment like proposing to your future spouse, effective communication is essential. The quality of our relationships with friends, coworkers, employers, strangers and loved ones depends on how well we communicate with one another. Nowhere is communication more important than at the doctor’s office – increasingly, we’re learning that the quality of communication between providers and patients has a significant impact on health.
In October 2012, the Centers for Medicare & Medicaid Services (CMS) implemented a quality payment program for Medicare patients in hospitals. CMS hopes the result will be improved overall health for patients (and a lowered medical costs in the long run). The payment program, Value-Based Purchasing, scores hospitals using two sets of measures: process and patient satisfaction. The first component, process measures, rates how often hospitals adhere to 12 clinical guidelines. The “measures of timely and effective care” include:
- Percent of patients that received an antibiotic within an hour of surgery
- Percent of heart attack patients given medication to avert blood clots within 30 minutes of arrival at the hospital
- Percent of pneumonia patients who had a blood culture taken before they were given antibiotics
- Percent of surgery patients who received an appropriate treatment to prevent blood clots
Patient satisfaction is determined through the use of surveys completed by Medicare patients who have recently left the hospitals. The survey asks patients to rank their experience in eight areas including:
- How well nurses communicated with patients
- How well doctors communicated with patients
- How responsive hospital staff were to patients’ needs
- How clean and quiet the hospital room and hall were
- How well caregivers explained medication to patients before giving it to them
70 percent of the hospital’s overall score is composed of process measures, and 30 percent of the total score is composed of by patient satisfaction. In the first year of the program, hospital scores determined whether they would lose or gain up to one percent of their regular Medicare reimbursements. Over the next four years, the amount of money at stake will rise incrementally to two percent. Current data and hospital scores are available on the CMS “Hospital Compare” website.
In response to the new compensation rules, med schools, insurance providers and hospitals are providing communication training programs for students as well as seasoned practitioners. (Abraham Vergese, a Stanford medical doctor, creatively used Google Glass to provide students with a first-person demonstration on how to talk to patients.) The Wall Street Journal recently wrote about Marietta-based WellStar Health System’s approach to improving doctor’s communication. WellStar began using “service coaches”: professionals who work directly with doctors, training them to avoid using words or phrases that have a negative impact, to ask permission before entering a room, to introduce themselves and be clear about what they are doing and why. WellStar reported increased patient satisfaction since beginning the training (from 77.5 percent in November 2012 to 86.2 percent in January 2013).
Not all providers are convinced that tying payments to patient satisfaction is wise. On The New Yorker website, cardiologist Lisa Rosenbaum considered the challenge of telling patients what they don’t want to hear. Difficult conversations and medical practice go hand in hand – they’re an often necessary step on the path to good health. If doctors are paid based on how well their patients like them, will doctors stop telling patients uncomfortable truths? She concludes that “Good medicine, it seems, does not always feel good.”
CMS is such a massive provider that when it changes payment programs, health systems are forced to adapt whatever their objections may be. One to two percent of Medicare reimbursement has a huge impact on a hospital’s budget. Whether or not increased patient satisfaction will further the goal of lowering health care costs remains to be seen, but we do know that better doctor-patient communication improves outcomes for health. Do you feel your doctor is a good communicator, even when they’re dispensing bad news or tough love? Have you switched providers searching for someone who makes you feel at ease? Are you hopeful that the new guidelines will have a positive impact on the American health care system?