Accountable Care Organizations (ACOs) figure prominently in the new Patient Protection and Affordable Care Act (PPACA). The concept behind ACOs is that by tying both physician and hospital compensation to outcomes via a bundled fee (say for pneumonia) we can expect to see an improvement in quality and value.
In principal, accountable care makes a lot of sense. Practicality speaking, however, doctors and hospitals must address a huge challenge before they can expect benefit financially. Before doctors can be held accountable for the care they deliver, they must first be held accountable for the quality of their communication with patients.
Take hospital readmissions, which are a big healthcare cost driver today. According to a recent study in the New England Journal of Medicine, 20 percent of all Medicare patients discharged from hospitals were readmitted within 30 days, and 34 percent percent within 90 days. The Joint Commission and others rightly believe that inadequate communication between physicians — as well as between physicians and patients — is a major contributing factor.
Here’s an example. In a small study of 47 patients surveyed at time of hospital discharge (commercial and Medicare), 72.1 percent of patients were unable to list all their discharge medications. Eighty six percent were unable to describe the common side effect(s) of all their medications, and 58.1 percent did not know the diagnoses that put them in the hospital in the first place. These trends are consistent with the findings from a number of similar studies, including studies of discharged ER patients.
Physician-patient communications shortcomings abound in the doctor’s office as well. Approximately 20 to 50 percent of patients do not take medications as prescribed. It’s not necessarily because patients are non-compliant. Patients don’t take medications out of fear of drug interactions, perceived lack of effectiveness, adverse effects, misunderstanding regarding necessity, or concerns about costs.
Patients who report better general communication with their doctor — for example, better instructions on how to take a medication — and who receive more medication information are more likely to take medications as prescribed.
The success of new financing and delivery models like ACOs and Medical Homes depends heavily upon significant address of the quality of the current state of physician-patient communications. I wonder when today’s physician and hospital leaders will get a clue.
Makaryus, A., et al. “Patients’ Understanding of Their Treatment Plans and Diagnosis at Discharge.” Mayo Clinic Preceedings, 2005.
Coleman, E., “Rehospitalizations among Patients in the Medicare Fee-for-Service Program.” New England Journal of Medicine, 2009.
Kripalani, S., et al. “Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians.” Journal of the American Medical Association, 2008.
*This blog post was originally published at Mind The Gap*