Three Falsehoods Refuted (Obamacare)

The health care reform debate is littered with false statements. Truth is hard to come by. However, several recent news stories counter a whole series of mistruths and half-truths. Here are just three falsehoods -- there are many more, including one countered in our news release below -- and the new facts and findings that counter the false claims: FALSE: "Patient satisfaction" scores improve patient care. The scores have little to do with the efforts of doctors and nurses. A new study on "patient experience" found that only 3% of the executives at 1,072 hospitals said physicians or other clinicians have primary responsibility and direct accountability for the patient's experience. 26% said a "committee" is responsible. That's right. A committee. Patient care, cure or comfort wasn't even listed as a reason executives push for a "great patient experience." Texas physician Reid B. Blackwelder, M.D., spurns the entire concept: "Patients shouldn't have an experience. They have problems that need to be solved. The phrase is too slick and avoids what it's about, which is we take care of [patients] and minimize the risks." FALSE: Quality reporting improves patient care. Despite all assertions to the contrary, the paperwork burden of a growing list of government checklists and reporting requirements detracts from patient care. A recent letter from three hospitals affected by Hurricane Sandy to the federal government shows just how true this is. Although data reporting was waived for the Inpatient Quality Reporting (IQR) and Outpatient Quality Reporting (OQR) programs, the hospitals asked for a six-month reprieve from FOUR other federal reporting systems and TWO federal scoring systems to protect against "reputational and financial penalties" and to "ensure that hospitals have the flexibility to direct resources toward caring for patients who suffered during disasters, as well as toward internal disaster recovery efforts."

FALSE: "Patient satisfaction" scores improve patient care. The scores have little to do with the efforts of doctors and nurses. A new study on "patient experience" found that only 3% of the executives at 1,072 hospitals said physicians or other clinicians have primary responsibility and direct accountability for the patient's experience. 26% said a "committee" is responsible. That's right. A committee. Patient care, cure or comfort wasn't even listed as a reason executives push for a "great patient experience." Texas physician Reid B. Blackwelder, M.D., spurns the entire concept: "Patients shouldn't have an experience. They have problems that need to be solved. The phrase is too slick and avoids what it's about, which is we take care of [patients] and minimize the risks."

FALSE: Quality reporting improves patient care. Despite all assertions to the contrary, the paperwork burden of a growing list of government checklists and reporting requirements detracts from patient care. A recent letter from three hospitals affected by Hurricane Sandy to the federal government shows just how true this is. Although data reporting was waived for the Inpatient Quality Reporting (IQR) and Outpatient Quality Reporting (OQR) programs, the hospitals asked for a six-month reprieve from FOUR other federal reporting systems and TWO federal scoring systems to protect against "reputational and financial penalties" and to "ensure that hospitals have the flexibility to direct resources toward caring for patients who suffered during disasters, as well as toward internal disaster recovery efforts."

FALSE: Patients involved in "shared decision making" will cut costs. Shared decision making (SDM) was supposed to reduce health care costs. However, a new study finds that patients involved in SDM spend 5% more time in the hospital and incurred 6% higher costs. With 35 million hospitalizations each year, the 30% of patients interested in shared decision making would mean $8.7 billion of additional costs per year, according to the study.

NOTE: This is NO defense of any aspect of Obamacare. But it is a defense that paying attention to “the patient experience” IS a good thing, as the article wishes to disprove.

I am the most vociferous opponent of Obamacare that I know, but I will say that attempts by hospitals to improve the care that patients think they are getting DOES improve care.

(That hospitals are attempting a focused improvement in certain scores or metrics which will affect reimbursement just to maintain reimbursement is another issue altogether. That entire system is FUBAR in my opinion, but there are some positive side effects.)

I see it like the tail wagging the dog, but it occasionally forces hospitals to address things they might otherwise put on a back burner for expediencies sake.

For example, the concept of having a patient fill out a questionnaire when they are discharged where that questionnaire asks various set questions like (and I paraphrase here, because I don’t know the exact wording):

“Did the hospital provide a quiet environment at night?”

“Did your nurse and other staff communicate effectively with you?”

And so on. These questions are uniform between institutions, so the patients all see them the same way. Health care providers need to achieve a certain percentile level on a variety of metrics, and the scores they get from patients at discharge is just one of them. These metrics are going to determine how much reimbursement is given for services rendered.

It is a clumsy carrot and stick approach by the government, and I disagree vehemently with it. That said, it is also something I think the heath care industry should have been doing without any prompting. It is simply good business, and I have long said that if you do not run a hospital like an efficient business, you won’t be able to run it as a compassionate care provider. I have never thought that you had to treat patients like widgets to run an efficient hospital. You treat them as good CUSTOMERS, like any successful business does.

In the first example, many hospitals don’t do a good job a providing a quiet environment for patients to recover in, especially at night. It isn’t that they don’t think it is a good idea, it is just that being able to do that requires a concentrated and sustained effort to succeed, and it has been my experience that there are more pressing things, so that typically has not been a priority.

Now, as any of you know from being an inpatient at nearly any hospital, getting uninterrupted rest rarely happens. There is just too much going on in any busy hospital. Overhead pages of this and that, noisy beds being wheeled up and down passageways, monitors alarming and going off, people talking louder than they need to, etc. etc. etc.

If you can comprehensively attack this problem in a multitude of ways which result in a quiet environment (particularly at night) not only is is really good for a recovering patient, but they LIKE it and appreciate it. As a result, that patient may heal faster. Everyone wins. The downside is that there has to be a huge effort across all areas from nursing, housekeeping, telecommunications, staff, ancillaries such as radiology/lab and so on, and it isn’t just a one-time thing. Like a marriage, it has to be constantly worked on, monitored, tweaked and measured.

And the noise question is just one of many. Multiply the noise question by the number of other metrics that hospitals have to strive to improve so they don’t get penalized, and that is the downside: a huge administrative tail is now attached, and that medical staff is tasked with a stricter environment and processes to be followed to conform to the regulations in that administrative tail.

Watching this thread does confirm something I have thought for a while now: It is a lost battle.

The fact that nobody has responded to your thread but me suggests that people know it can’t be undone. We have crossed that rubicon. For several years now, the silent, behind the scenes cogs have been turning. Those wheels began moving long before the legislation was passed.

All that logistical and bureaucratic stuff, leases, office furniture, budgets, employee hiring, policies and procedures, org charts, all of that has been moving to get itself in place just as relentlessly as cement hardens, which is a good analogy.

Like a wooden post inserted into a hole full of wet cement, it can be removed quickly if you do it before the cement sets. After it sets, you have to bring in shovels, pickaxes, levers, chains or winches to get it out.

I think a lot of people see the cement as being set.

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