Part One: When one sneeze can create national ‘influenza’
The Centers for Medicare and Medicaid Systems (CMS) insures nearly one-third of all Americans. When CMS sneezes, it is not an exaggeration to say that other health insurers grab a Kleenex, such is the influence that CMS has on the direction of health care trends in the United States, including reimbursements for services. Health systems that depend on payments from CMS to serve their patients have been on the alert for the past several years that CMS is moving away from a fee for service payment to one that demands greater accountability, including patient satisfaction and outcomes. CMS refers to this as value-based programs versus volume, focused on improved performance linked to quality measurements leading to better care for individuals, better public health overall and lower costs.
Patient satisfaction and terms such as ‘patient engagement’ and ‘patient centered care’ are the core of the recent CMS movement, which is challenging! How is this best measured? Ask a university professor about the online ‘Rate my Professor’. If only a handful of students rate a professor, and each of the students has a grudge – they did not show up for class, failed to hand in assignments and performed poorly on the final exam – and thus rates the professor as ‘the worst I ever had’….is this a fair appraisal? If a patient gets mad at one’s primary care physician for refusing to refill an opiate for pain – for the third time in as many months! – and rates the physician as ‘the worst I ever had’ and this gets viewed by the public on line…….is this a fair appraisal?
Who is defining ‘patient centered care’? It seems a lot of politicians are attempting to do just this via legislation, driven by special interest groups, lobbyists, insurance companies….and of course…. health systems who want to get paid by the insurance companies, including CMS. Where is the patient? The consumer of health goods? Too often we are not doing much more than filling out surveys. While about a third of patients complete a survey – which is respectable survey response! – too often those who complete surveys have – like the failing student or the patient in pain who wants opiates – are angry. Are these fair appraisals? Better than no response, but in the long run, not a very meaningful or sustainable way to gauge patient satisfaction.
So what are the hospitals doing, across the spectrum, and country? Part Two: Patient Family Advisory Councils, coming up!