Patient Centered Care: Tastes Great, Less Filling

Healthcare has been evolving away from a “disease-centered model” and toward a “patient-centered model.” In the disease-centered model, physicians would make almost all treatment decisions based on clinical experience and data from various medical tests. In the patient-centered model, patients become active participants in their own care and receive services designed to focus on their individual needs and preferences. In fact, the IOM (Institute of Medicine) defines patient-centered care as a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients’ wants, needs, and preferences and that patients have the education and support they need to make decisions and participate in their own care.

Sounds wonderful.

So how do patient centered models of care wash with ObamaCare? The answer is, not very well. For example, take the $3.8 billion allocated to “comparative effectiveness research” (CER). The goal seems harmless enough –to find out what treatments are most effective for the largest group of people. But it’s a recipe for cookbook medicine, where reimbursements will be driven by a doctor’s willingness to prescribe treatments according to established “averages” rather than an individual patient’s needs and preferences. After all, it’s all about eliminating physician variance, right?

The government has a genuine dilemma on its hands here. How does it encourage patients to get smarter, to take more effective control and articulate their individual preferences when it is dedicated to identifying groups and standardizing pathways? For example, families who aren’t prepared to deal with matters such as end of life care needlessly cost the system –and themselves– hundreds of billions. But now, there are popular online tools (e.g. www.mydirectives.com) that do an outstanding job helping us express and document our end of life care preferences. It’s a fabulous idea. But what if I don’t self-select into a group (or pathway) that the government has identified and/or considers statistically valid?

These are tough questions.

So what do we get instead? Hospitals are now focused on improving the patient experience. And that’s really what patient-centered care is currently all about. Hospitals are taking actions ranging from hiring greeters to hiring executives charged with ensuring each visitor to the hospital has a positive experience. Cleveland Clinic was one of the first academic medical centers to create an Office of Patient Experience and appoint a Chief Experience Officer, and other hospitals are following its lead. Patient surveys are also being used to measure how well caregivers communicate with patients and identify areas for improvement.

There can be no doubt that the new models of healthcare are having an impact on the patient experience. The idea behind bundled payments and Accountable Care Organizations (ACOs) is that a flat rate is paid to the provider regardless of services provided and that care is actually centered on the patient experience. The model requires physicians to have more personalized discussions with their patients and encourages them to take a more active role in their health. But at the same time, we’re enacting policies that best reward care “networks” that adhere to the most popular recipes.

Patient-centered care models are evolving, but not on a trajectory that is about a more personalized approach to the practice of medicine. Yes, hospitals are paying more attention to the patient experience, likely as a result of increased competition, but they’re also driving their physicians to standardized pathways.

Can these two opposing directives coexist with integrity? It will take some time, but we’ll find out soon enough.

—Tom Finn

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