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The Medical Professionalism Blog

Less is More But Will Patients Buy It?

The September 12th issue of Modern Healthcare reports on Thomson Reuters’ study of the 100 Top Hospitals that analyzes the relationship of financial performance and quality. Like results from other studies, higher quality was associated with lower costs – the “less equals more” drum beat continues.

The Thomson Reuters’ study points to 6% less spending in high-performing hospitals. Possible reasons for lower spending included the efficiency of team-based decision-making and the effective use of electronic medical records, but it’s actually more complicated than that.

The report found that lower-performing hospitals spent more money on pharmaceuticals and had fewer re-admissions within 30 days for pneumonia and heart attacks. Hospitals that dispensed fewer drugs had lower satisfaction scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCHPS).

I wonder how this will impact the behaviors of hospitals under the value-purchasing model from CMS. Scheduled to take effect in 2013, this model is based on quality measures and HCHPS scores.

  • Will hospitals be slaves to the market gods and seek to shine on publicly reported measures and ignore areas of patient care that actually need to be improved?
  • Will working toward higher scores to better the reputation of hospitals and health systems be secondary to what actually matters to patients?
  • Will some hospitals dispense more medications in order to do better on HCHPS scores to affect their value-purchasing bonuses and keep their beds filled?
  • Will re-admissions penalties set by the CMS work against that kind of volume incentive?

What is truly at stake is how to solve the patient satisfaction around overuse of pharmaceuticals. One way is to change the patient belief that receiving more services or more medication is equal to better care. Persuading patients through education is often the recommended approach. This attitude of “more is better” will most likely change when patients hear it from individuals or sources they trust, such as organizations like Consumer Reports and AARP as well as some other print and broadcast media sources.

But it’s the patient-practitioner relationship that serves as the foundation for creating a shift in thinking. Incentives and signals from leadership are needed to help all practitioners understand the importance of prudent use of pharmaceutical use. Communication skills are needed to skillfully communicate with patients about appropriate use of medications and other physician services.

Can clinicians such as nurses, nurse practitioners, patient educators or discharge planners employed by the hospital also be trusted sources and good communicators? Do they have the time and proper incentives to provide this advice and counsel?

Ultimately, patients’ attitudes will be shaped by their experiences, both good and bad. But their trust in their practitioners and the quality of those relationships, including the communication skills of the practitioner they encounter, will be large factors in their satisfaction. Instead of focusing on the bottom line, hospitals and health systems might want to focus on building relationships and communication skills to improve the quality of care and patient experiences.

2 Comments to Less is More But Will Patients Buy It?

  • October 8, 2011 at 8:58 am | Permalink

    “The report found that lower-performing hospitals spent more money on pharmaceuticals and had fewer re-admissions within 30 days for pneumonia and heart attacks.”

    I’m confused. If these hospitals had fewer re-admissions wouldn’t that make them higher-performing?

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