Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments

Accountable Care And Doctor-Patient Communication Go Hand In Hand

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*

You may also like these posts

Read comments »

Comments are closed.

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »