Should Doctors Be Paid To Communicate With Patients?
I often hear from physicians that they would do a better job communicating with patients if they were adequately reimbursed for the time it took to do so. Given that certain types of physician-patient communications (patient education, care planning, etc.) can have quantifiable, therapeutic benefits for patients, I can see their point.
I have no problem with physicians asking to be adequately reimbursed for services they provide, as long as they are high quality and add value. For example, teaching chronic disease patients how to care for themselves at home takes time and is critical to effective patient self care. In this role, physicians are called upon to be a provider of necessary information as well as a coach to encourage and support patients.
But as evidence suggests, many physicians don’t communicate effectively enough with patients, chronic or otherwise, to seem to merit additional reimbursement.
According to the evidence:
- Physicians typically spend <1 minute of a 20-minute visit discussing treatment and planning with patients.
- Up to 5o% of patients leave office visits not understanding what their physician told them to do.
- Physicians do not ask patients if they have any questions in more than 5o% of outpatient visits.
- Physicians prescribing new medications did not give dosage and frequency instruction to the patient % and % of the time respectively.
- Physicians tended to underestimate their patient’s desire for information in 65% of encounters — and overestimated the patient’s desire for information in only 6% of encounters.
If we are ever going to see significant improvement in patient medication adherence rates, greater levels of control of patient A1C levels and blood pressures, we are going to have to find new ways to pay physicians. But in so doing, physicians will have to be held as accountable for the quality of their patient communications as they are for the quality of their clinical care.
Before primary care physicians can expect to be reimbursed for the time they spend communicating with patients, three things must occur:
- Quality standards must be established that define effective physician-patient communications.
- Physicians and patients must be provided with training and tools to more effectively communicate with one another.
- We will need to move beyond basic patient satisfaction surveys and develop more sophisticated approaches to measuring the quality of the physician-patient interaction.
REFERENCES:
Kaplan, S. et al. “Assessing the Effects of Physician-Patient Interactions on the Outcomes of Chronic Disease.” Medical Care, Vol. 27, No. 3. 1989.
Heisler, M. “Actively Engaging Patients in Treatment Decision Making and Monitoring as a Strategy to Improve Hypertension Outcomes in Diabetes Mellitus.” Circulation. 2008.
*This blog post was originally published at Mind The Gap*
Absolutely. Physicians should be paid for each breath they take each day. After all, they went to school for so many years that they have earned the right to be paid for inhaling oxygen. However, I am sure there will be complaints about the amount of uncompensated paperwork required to bill for the number of breaths they take (since they hold their breath while completing paperwork), so it will be necessary to raise the fee for each breath to enable the hiring of staff to tabulate breaths and bill appropriately.