Menus Subscribe Search

Follow us


xrays

Should Patients Determine How Much Hospitals Get Paid?

• January 31, 2013 • 8:56 AM

Op-ed: Talking openly with patients is necessary to improve medicine, but what happens when a tough conversation gets factored into payment?

This past October, the Centers for Medicare and Medicaid Services started linking hospital reimbursements paid to how well they perform on the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS, survey. HCAHPS measures how satisfied patients were with a broad range of items which supposedly reflect the overall “hospital experience.” Among these are the quality of communication with the different healthcare providers; how clean (and quiet) the hospital was; and how responsive the staff was to the patient’s needs.

The rationale behind tying reimbursements to patient satisfaction is simple: healthcare is, after all, a service, and providers and hospitals should be rewarded for providing excellent service to consumers, in this case, patients.

Focusing in on the portion of the survey which assesses communication, there is a broad body of research demonstrating a connection between good communication, especially between patients and physicians, and better health outcomes. These include fewer adverse events within the hospital setting, such as medication errors and errors of medical care (for example, having an unnecessary procedure done). In the outpatient arena, better communication between doctors and patients is also linked to higher rates of medical adherence, which in turn leads to better outcomes, fewer hospitalizations, and lower costs overall.

But is tying reimbursements to this kind of a survey really the best way to go about improving communication between physicians and patients? And are patients the most reliable in determining the quality of this communication?

A fascinating study by Dr. Janet Weeks of the Dana Farber Cancer Institute and colleagues, published in the New England Journal of Medicine in July 2012, demonstrated that some patients have a tendency to conflate the message with the messenger (as many of us do). The researchers interviewed almost 1,200 patients with advanced, incurable, cancer and asked them about their expectations from chemotherapy. Those patients who characterized the communication between themselves and their physicians as “very favorable” were more likely to believe that they could be cured by the chemotherapy than those who did not.  (Our Kevin Charles Redmon wrote more about Weeks’ study here.)

This is concerning, because it indicates that being firmer with patients about following best practices and not pursuing unrealistic treatments, or tests that are not cost-effective such as MRI scans for lower back pain (avoiding unnecessary imaging studies in patients with lower back pain could save as much as $300 million annually), could actually result in lower patient satisfaction scores, and thereby to reduced payment for services rendered.

Quality improvement in healthcare is important, as are the savings which would presumably follow. Improvement in physician-patient communication is a central part of that, especially surrounding discharge instructions, where studies have shown significant gaps between patient comprehension of physicians’ discharge instructions and what the patients themselves understood. With almost one-fifth of Medicare patients being re-admitted to the hospital within 30 days of discharge, costing an estimated $17.4 billion annually, this is clearly an area which needs a lot of work. Improving communication between physicians and patients at the time of discharge might be accomplished by training physicians and other healthcare providers in better communication skills, perhaps in workshops that utilize simulated patient encounters, in which the participants are observed by and receive real-time feedback from trained facilitators.

This is likely to prove more effective, and more long-lasting, than merely determining the quality of communication through arbitrary assessments made by patients that may not accurately reflect the true measure of physician-patient communication as is hoped for. Providing financial incentives to create (and sustain) such workshops will almost certainly prove to be cost-effective if, as anticipated, bounce-back hospitalization rates decline as a result. This is certainly something which can be measured.

In my own practice I care for lots of asthmatic children, many of whom are referred to see me following an acute hospitalization. I am often struck by the gaps between the discharge instructions pertaining to when and how medications should be taken as they appear in the patient’s discharge summary (which may have been issued at any one of the 20-plus hospitals in the area), and what the child is actually being given. Despite good intentions on the part of the child’s parents and the discharging physician there were still misunderstandings which, had they not been identified sooner, would likely have resulted in a readmission later. This is an area which certainly needs to be addressed, but constructively, rather than punitively, as seems to be the choice that has been made.

Dennis Rosen

A weekly roundup of the best of Pacific Standard and PSmag.com, delivered straight to your inbox.

Recent Posts

October 31 • 4:00 PM

Should the Victims of the War on Drugs Receive Reparations?

A drug war Truth and Reconciliation Commission along the lines of post-apartheid South Africa is a radical idea proposed by the Green Party. Substance.com asks their candidates for New York State’s gubernatorial election to tell us more.


October 31 • 2:00 PM

India’s Struggle to Get Reliable Power to Hundreds of Millions of People

India’s new Prime Minister Narendra Modi is known as a “big thinker” when it comes to energy. But in his country’s case, could thinking big be a huge mistake?


October 31 • 12:00 PM

In the Picture: SNAP Food Benefits, Birthday Cake, and Walmart

In every issue, we fix our gaze on an everyday photograph and chase down facts about details in the frame.


October 31 • 10:15 AM

Levels of Depression Could Be Evaluated Through Measurements of Acoustic Speech

Engineers find tell-tale signs in speech patterns of the depressed.


October 31 • 8:00 AM

Who Wants a Cute Congressman?

You probably do—even if you won’t admit it. In politics, looks aren’t everything, but they’re definitely something.


October 31 • 7:00 AM

Why Scientists Make Promises They Can’t Keep

A research proposal that is totally upfront about the uncertainty of the scientific process and its potential benefits might never pass governmental muster.


October 31 • 6:12 AM

The Psychology of a Horror Movie Fan

Scientists have tried to figure out the appeal of axe murderers and creepy dolls, but it mostly remains a spooky mystery.


October 31 • 4:00 AM

The Power of Third Person Plural on Support for Public Policies

Researchers find citizens react differently to policy proposals when they’re framed as impacting “people,” as opposed to “you.”


October 30 • 4:00 PM

I Should Have Told My High School Students About My Struggle With Drinking

As a teacher, my students confided in me about many harrowing aspects of their lives. I never crossed the line and shared my biggest problem with them—but now I wish I had.


October 30 • 2:00 PM

How Dark Money Got a Mining Company Everything It Wanted

An accidentally released court filing reveals how one company secretly gave money to a non-profit that helped get favorable mining legislation passed.


October 30 • 12:00 PM

The Halloween Industrial Complex

The scariest thing about Halloween might be just how seriously we take it. For this week’s holiday, Americans of all ages will spend more than $5 billion on disposable costumes and bite-size candy.


October 30 • 10:00 AM

Sky’s the Limit: The Case for Selling Air Rights

Lower taxes and debt, increased revenue for the city, and a much better use of space in already dense environments: Selling air rights and encouraging upward growth seem like no-brainers, but NIMBY resistance and philosophical barriers remain.


October 30 • 9:00 AM

Cycles of Fear and Bias in the Criminal Justice System

Exploring the psychological roots of racial disparity in U.S. prisons.


October 30 • 8:00 AM

How Do You Make a Living, Email Newsletter Writer?

Noah Davis talks to Wait But Why writer Tim Urban about the newsletter concept, the research process, and escaping “money-flushing toilet” status.



October 30 • 6:00 AM

Dreamers of the Carbon-Free Dream

Can California go full-renewable?


October 30 • 5:08 AM

We’re Not So Great at Rejecting Each Other

And it’s probably something we should work on.


October 30 • 4:00 AM

He’s Definitely a Liberal—Just Check Out His Brain Scan

New research finds political ideology can be easily determined by examining how one’s brain reacts to disgusting images.


October 29 • 4:00 PM

Should We Prosecute Climate Change Protesters Who Break the Law?

A conversation with Bristol County, Massachusetts, District Attorney Sam Sutter, who dropped steep charges against two climate change protesters.


October 29 • 2:23 PM

Innovation Geography: The Beginning of the End for Silicon Valley

Will a lack of affordable housing hinder the growth of creative start-ups?


October 29 • 2:00 PM

Trapped in the Tobacco Debt Trap

A refinance of Niagara County, New York’s tobacco bonds was good news—but for investors, not taxpayers.


October 29 • 12:00 PM

Purity and Self-Mutilation in Thailand

During the nine-day Phuket Vegetarian Festival, a group of chosen ones known as the mah song torture themselves in order to redirect bad luck and misfortune away from their communities and ensure a year of prosperity.


October 29 • 10:00 AM

Can Proposition 47 Solve California’s Problem With Mass Incarceration?

Reducing penalties for low-level felonies could be the next step in rolling back draconian sentencing laws and addressing the criminal justice system’s long legacy of racism.


October 29 • 9:00 AM

Chronic Fatigue Syndrome and the Brain

Neuroscientists find less—but potentially stronger—white matter in the brains of patients with CFS.


October 29 • 8:00 AM

America’s Bathrooms Are a Total Failure

No matter which American bathroom is crowned in this year’s America’s Best Restroom contest, it will still have a host of terrible flaws.


Follow us


Levels of Depression Could Be Evaluated Through Measurements of Acoustic Speech

Engineers find tell-tale signs in speech patterns of the depressed.

We’re Not So Great at Rejecting Each Other

And it's probably something we should work on.

Chronic Fatigue Syndrome and the Brain

Neuroscientists find less—but potentially stronger—white matter in the brains of patients with CFS.

Incumbents, Pray for Rain

Come next Tuesday, rain could push voters toward safer, more predictable candidates.

Could Economics Benefit From Computer Science Thinking?

Computational complexity could offer new insight into old ideas in biology and, yes, even the dismal science.

The Big One

One town, Champlain, New York, was the source of nearly half the scams targeting small businesses in the United States last year. November/December 2014

Copyright © 2014 by Pacific Standard and The Miller-McCune Center for Research, Media, and Public Policy. All Rights Reserved.