The Person at the Center

I just finished reading an opinion piece from Fox News consumer reporter, John Stossel, detailing his experience being treated for lung cancer. He gives thanks for the excellent medical attention he has been receiving but calls out his doctors, the hospital and the health care industry as a whole for what he feels is poor customer service. Sadly, it’s likely his comments resonate with a good number of readers. His piece serves as a wake-up call for those in health care who haven’t realized we must do a better job of focusing on the person at the center of our care.

Given our society’s emphasis on consumerism, the patient’s experience in our care is critical. In my opinion, it needs to be one of the top priorities of every provider. We must take a holistic approach to caring for people. Our responsibility is not limited to providing the best medical advice and interventions; patients’ feelings about, and satisfaction with, their health care journey are every bit as much our concern. I do not look at the medical care someone receives as something separate from their experience; they are invariably linked.

Historically, our industry has organized around doctors and other providers of care—not the patient. While this is changing, the pace of this evolution has to be accelerated. People should enter a health system that is patient-centered and focused completely on their needs—from where they park their car to how they are treated at the registration desk, all the way through the entire care continuum.

As Stossel suggests, as more patients become responsible for the cost of their care and have the ability to shop around, service will become a bigger part of the business equation. But even under the current payment models, more and more patients are realizing they can and should be empowered consumers.

I take issue with Stossel when he compares health care to retail industries—as though selling cars equates with the complexity of delivering medical attention. I think that’s an over simplification. But it’s true that no matter what is being purchased, the experience matters to consumers every bit as much as price and quality.

It’s a simple equation, really: take care of the customer, provide a great product and value… and your business will be successful.

A Value Added Proposition

This past Sunday morning, while at home reading the Palm Beach Post, an article immediately caught my attention. The piece, How Medicare Penalizes Hospitals for Being Too Careful, was a reprint of an article that had appeared in the New York Times earlier in the week. I suddenly wondered; “could hospitals actually be penalized for being too safe?”

As I read the article, I quickly realized that the title was a play on words and even though a few hospitals referenced in the piece believe they are being penalized for doing the right thing, there is much more to this story. The reality is that as the health care industry shifts its focus from volume to value, the government is looking at ways to pay for appropriateness of care rather than the volume of care. Like any new program, it takes time for folks to adjust and an industry to absorb the paradigm shift.

The government is now beginning to penalize the industry for unnecessary readmission for certain conditions and as a result, the health care industry is being rewarded—or penalized—for utilization of certain tests, among other things. Is this bad or good?

While the article suggests that this shift in focus might be less than ideal, I disagree. I believe it is important that we, as an industry, shift from volume to value as quickly as possible in order for the health care consumer to receive the best value for their dollar. The threat of being penalized for unnecessary readmissions or prescribing unnecessary tests is critical in our ability to reduce cost over the long term.

When health care providers complain, “their patients are sicker or present with more complex symptoms,” the government should review the complaint. And they often do and adjust for complexity of care or other organizational differentials. This is commonly referred to as a risk adjustment.

There is no question that teaching hospitals operate differently than community hospitals; however, in all health care environments the practice of medicine needs to be evaluated to determine where protocol and clinical pathway development makes sense. I realize that there are some growing pains and adjustments, but I believe that we need to create an environment where physicians and other care givers can determine what is appropriate for their patients while at the same time managing the unnecessary testing that often occurs. 

The article also suggests that health care organizations are intentionally gaming the system. For the most part, I do not believe that hospitals are deliberately trying to get away with anything. To think this is happening as a matter of standard practice is wrong. You have to remember that these measurement systems are relatively new and very complex, and that it takes time for organizations to adjust to the new protocol. In addition, this new mode of operation is creating an environment that is making organizations think about new approaches to care - which is a good thing.

The bottom line is that we have good people from health care organizations, payers and the government all trying to make the necessary adjustments in the industry to improve service, outcome and cost. We all need to work together so we can create a safe, reliable and reproducible system of care for our health care consumers. 

Tying it All Together

Everywhere you turn, headlines proclaim that health care is changing at the speed of light. That’s why I was intrigued at a recent article that asked, “Is hospital management stuck in the stone age?”

The blog post raises a topic that many hospital leaders struggle with today: effective care coordination. The writer emphasizes the need to bridge the gap between acute and post-acute care. Unfortunately, if that’s the whole of an organization’s care coordination strategy, they may find they’ve evolved only as far as the medieval times.

  

I believe that we need to look at the coordination of care holistically. We need to link the outpatient environment with both the acute care and post-acute care environments. 

Our industry leaders need to thoughtfully strategize about how we keep people healthy and out of the hospital. Our ability to take care of a community is tied to their home and work environments and we need to coordinate health and wellness services that focus on teaching people how to make better decisions in their lives — from exercise to diet to monitoring their health status on a regular basis. Of course, when a patient comes into the hospital, management of their care will begin immediately. However, it needs to be recognized as part of a much larger patient-centered system of care.  

My hope is that our industry moves away from a vertical and segmented approach of care coordination to a community of providers that tie together the outpatient, inpatient and post-acute care environments.