Improving physician payment, post-hospital syndrome, and is more expensive medicine better?
July 24, 2014
The RightCare Weekly is a newsletter that helps you stay on top of important news in the ongoing quest to move the U.S. health care system toward delivering the right care to all patients. We’ll bring you the most important stories, news articles, and opinion pieces of the week, along with our interpretation of why they’re important for patients, doctors, and communities.
Vox reported earlier this week that 48 percent of Americans believe that higher healthcare costs are equated with better quality care, but that’s far from the truth. This troubling statistic almost certainly contributes to the problem of overuse. Since most health care costs are covered by insurers, patients who believe that higher costs equal better care are unlikely to be conservative about medical intervention. The post continues, discussing the way costs are determined based on many factors other than quality. With the push for greater transparency in health care pricing, some experts worry that transparency of price, when not paired with quality metrics, could result in even greater abuse of healthcare resources.
Sandeep Jauhar, a cardiologist, penned an editorial this week for the New York Times, arguing that the way doctors are compensated makes it difficult for them to provide patient-centered care. Jauhar explains that low reimbursement for doctors creates an incentive for them to see more patients. This leads to rushed and overworked doctors, increasing the risk for malpractice, expensive tests and unnecessary referrals to specialists. Rather than paying doctors for individual service rendered, Dr. Jauhar suggests using bundled payments or hiring doctors as salaried employees. He also urges patients to be more involved in medical decision-making, thus decreasing the likelihood of unnecessary tests and treatments.
Peter Ubel’s latest piece in the New Yorker highlights the challenging conversation that occurs between a doctor and patient when making end-of-life medical decisions. For Elizabeth, a breast cancer patient, the drawbacks of chemotherapy outweighed the benefits. Her oncologist, frustrated by her decision, continues to push for the only treatment he believes could save her life. To respect the patient’s autonomy while providing expert advice, the physician must strike a delicate balance between “dispassionate information provider” and fear-mongering persuader. Ubel asks “Is modern medical practice all about ‘patient knows best’? Or do physicians still need, on occasion, to cajole their patient into doing the right thing?”
A while back we wrote about “post-hospital syndrome,” where patients take a long time to recover from a hospitalization or get sick again due to the stress of their hospital stay. This week in The Guardian, Dr. Aseem Malhotra shared his mother’s experience with post-hospital syndrome. When Dr. Malhotra’s mother was admitted to the hospital with life-threatening pneumonia, he became concerned about her condition several days into her stay. Though her symptoms improved, her psychological condition deteriorated from eating hospital food and having her sleep constantly interrupted for various tests and checks. After bringing his mother home-cooked food and her own clothes to wear and asking the nurses not to disturb her sleep for unnecessary checks, her condition improved and she was discharged a week later. Dr. Malhotra provides us with a valuable reminder that over-treatment is not just expensive, but can actually have detrimental outcomes for patients’ health.
In Hippo Reads, University of Chicago medical student Laura Christianson discusses the potential, though controversial, role of complementary and alternative medicine (CAM) in modern medicine, including Dr.Lown’s foundational work on the mind-body connection. Mitigating psychological stress has been shown to improve clinical outcomes for patients with cardiovascular disease and improve pregnancy rates in women undergoing in vitro fertilization. Incorporating CAM stress-reducing techniques, like acupuncture and meditation, into patient care may therefore help complement traditional allopathic practices. As Christianson notes, “Treatments that are cost-effective and have minimal to no side effects are not ‘complementary’ or ‘alternative’–they’re simply powerful treatments.”
An overdue homage to Dr. Ernest Amory Codman, now considered the father of outcomes assessment and quality measurement in health care, was published in the The Boston Globe on Tuesday. Over a tumultuous surgical career spanning more than four decades, Dr. Codman pushed relentlessly for the public reporting of patient outcomes and medical errors. His work inspired the conception of weekly morbidity and mortality conferences, as well as the establishment of the Joint Commission.