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Concierge Medicine: The Cost Of Healthcare “Room Service” And Other Hospital Amenities

A per­spec­tive in [a recent] NEJM con­sid­ers the Emerg­ing Impor­tance of Patient Ameni­ties in Patient Care. The trend is that more hos­pi­tals lure patients with hotel-like ameni­ties: Room ser­vice, mag­nif­i­cent views, mas­sage ther­apy, fam­ily rooms and more. These ser­vices sound great, and by some mea­sures can serve an institution’s bot­tom line more effec­tively than spend­ing funds on top-notch spe­cial­ists or state-of-the-art equipment.

Think­ing back on the last time I vis­ited some­one at Sloan Kettering’s inpa­tient unit, and I mean­dered into the bright lounge on the 15th floor, stocked with books, games, videos and other signs of life, I thought how good it is for patients and their fam­i­lies to have a non-clinical area like this. The “extra” facil­ity is privately-funded, although it does take up a rel­a­tively small bit of valu­able New York City hos­pi­tal space (what might oth­er­wise be a research lab or a group of nice offices for physi­cians or, dare I say, social work­ers) seems wonderful.

If real healthcare isn’t an even-sum expense prob­lem, I see no issue with this kind of hos­pi­tal accou­trement. As for room ser­vice and order­ing oat­meal for break­fast instead of insti­tu­tional pan­cakes with a side of thaw­ing orange “juice,” chicken salad sand­wiches, fresh sal­ads or broiled salmon instead of receiv­ing glop on a tray, that’s poten­tially less waste­ful and, depend­ing on what you choose, health­ier. As for yoga and med­i­ta­tion ses­sions, there’s rarely harm and, maybe occa­sion­ally, good (i.e. value).

But what if those resources draw funds away from nec­es­sary med­i­cines, bet­ter soft­ware for safer CT scans and phar­ma­cies, and hir­ing more doc­tors, nurses or aides? (I’ve never been in a hos­pi­tal where the nurses weren’t short-staffed.)

As for employ­ees who clean — hos­pi­tal floors, nurs­ing sta­tions, patients’ TV remotes, IV poles, com­puter sta­tion key­boards and every­thing else that’s imper­fect and unster­ile — they should get more fund­ing, every­where. Clerks and trans­port work­ers are fre­quent tar­gets in hos­pi­tal lay­offs, but they’re needed just the same.

Two years ago when a fam­ily mem­ber was hos­pi­tal­ized, his doc­tor — a senior car­di­ol­o­gist — per­son­ally wheeled him in the stretcher from the X-ray area back to the emer­gency room bay where he waited for a room, so that he wouldn’t spend more than the half hour or so he’d already been in the hall­way, after the film was taken, wait­ing for the escort ser­vice. What’s wrong is not so much that the physi­cian helped with a menial task that isn’t his job; he’s a really nice and car­ing sort, and I believe he didn’t mind, really, except that he does have a wife and fam­ily at home who surely were wait­ing on that day.

The car­di­ol­o­gist might have used that time, instead, to exam­ine more closely someone’s neck veins or heart sounds, or spent a few more min­utes read­ing a jour­nal arti­cle, which would make it more likely he’ll make the right recommenda­tion to his patients about, say, a drug for con­ges­tive heart fail­ure or a new blood thin­ner. We can’t short-change hos­pi­tal work­ers in such a way that physi­cians fill in on ordi­nary tasks because there’s no one else to per­form those, while patients get first-class meals and art classes to make them happier.

I’m reminded of board­ing air­planes. I fly coach, and as I pass through the first class sec­tion I often think how nice it would be to sit in front and have pleas­ant flight per­son­nel attend my every need to max­i­mize my com­fort dur­ing what’s typ­i­cally a mis­er­able trip. But then, I’d be pay­ing per­haps $3,000 instead of $680 for the same flight.

As pas­sen­gers, maybe we’re not so dis­cern­ing about our pilots or the model of air­bus as we should. A pleas­ant, cheery place isn’t always the safest.

In the NEJM piece, Gold­man and col­leagues write:

…Why do ameni­ties mat­ter so much? Per­haps patients sim­ply don’t under­stand clin­i­cal qual­ity. Data on clin­i­cal qual­ity are com­plex, mul­ti­di­men­sional, and noisy, and they have only recently become sys­tem­at­i­cally avail­able to con­sumers. Con­sumers may be mak­ing choices on the basis of ameni­ties because they are eas­ier to understand.

The authors note the poten­tial value of ameni­ties in patients’ expe­ri­ences and outcomes:

One could argue that they’re an impor­tant ele­ment of patient-centered care. If ameni­ties cre­ate envi­ron­ments that patients, providers, and staff mem­bers pre­fer, then providers and staff mem­bers may give bet­ter care and ser­vice in those envi­ron­ments and patients may have bet­ter health outcomes.

Ameni­ties are costly, but they attract patients:

… the value of ameni­ties is impor­tant because our health care sys­tem cur­rently pays for them. Under its prospec­tive pay­ment sys­tem… Each hos­pi­tal receives the same amount of reim­burse­ment for each patient with a given diag­no­sis and is free to decide what mix of resources to devote to clin­i­cal qual­ity and what to spend on ameni­ties. In our research, we found that improve­ments in ameni­ties cost hos­pi­tals more than improve­ments in the qual­ity of care, but improved ameni­ties have a greater effect on hos­pi­tal volume.

I’ll remind my read­ers that healthcare costs in the U.S. total over $2.3 tril­lion per year, and that num­ber is growing.

Hos­pi­tal ameni­ties are really nice, and I believe they can help patients heal. But I don’t know if it’s right to spend limited healthcare dol­lars on more than essentials.

*This blog post was originally published at Medical Lessons*

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