Compensation for rheumatologists and other physicians is increasingly tied to how satisfied patients are with the care they’ve received, given the Centers for Medicare and Medicaid Services’ Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and other burgeoning programs. Leah Binder, president and chief executive of Washington, D.C.-based Leapfrog Group, says she only sees that trend continuing. She recently spoke to The Rheumatologist about her views.
Question: HCAHPS is a program that directly ties payments under Medicare to hospital performance as it relates to patient satisfaction. Is that the only way the two areas intersect?
Answer: There are lots of indirect ties now that didn’t used to exist, and I think that’s an area in which we’re seeing a lot of attention. … For example, if people do not understand what the true [meaning of the] instructions for their medications are when they’re discharged, they are often readmitted because they are not taking their medications adequately. If they don’t feel like they had good communication with their physician or nurses while they were in the hospital, that’s correlated with readmission. So patient engagement is … not a direct tie to readmission, but it’s a clear indirect link that hospitals are paying a lot of attention to.
Some of [the indirect ties] are under the [rheumatologist’s] control. Another indirect link between reimbursement and patient satisfaction is market share because—and this is particularly true for physicians in practice—nowadays there has been a significant shift among the commercially insured population toward high deductible health plans. The numbers are pretty astounding. Many companies have moved to 100% high deductible plans. … So more patients are paying for the bill out of their own pocket, and their satisfaction is going to be directly tied to the payment of those bills. When you pay your own bill, when you actually pay for a service, you tend to be more sensitive to understanding what you are getting for that service.
Q: Often, you’ll hear concern from rheumatologists and others that a dissatisfied patient is not necessarily a patient that wasn’t incredibly well taken care of. How is a rheumatologist supposed to run that middle?
A: One of the toughest things that any industry has to grapple with is, how do you create a satisfied customer even though the customer may not always be right? You have to figure out a way to do it. And be willing to look at your practice with a critical eye and ask what you may have missed or whether you could do something differently. Or you need to say, ‘Well, some customers I just can’t satisfy, so I am not going to. I’ll take that risk.’ Then market to other kinds of customers. There are lots of different ways that other industries have grappled with this, but the bottom line is they lean toward listening to the customer to preserve market share.