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Are Consumer/Provider Disconnects Diminishing?

by Scott MacStravic

There have long been serious disconnects between what healthcare providers are willing to promise and deliver, and what patients want to get from their healthcare encounters, episodes and relationships.  Providers have tended to focus on “doing the right thing”, i.e. using their best judgment, adhering to evidence-based-medicine guidelines, etc. while avoiding accountability for the clinical outcomes and health/life quality value of their services.  Patient satisfaction and loyalty to providers is certainly affected by the process of care, the “patient experience” that physicians and hospitals deliver, but are often much more concerned about the results they get.

On occasions when providers look at results, they often fail to recognize the full range of and variations among patients in results desired.  Surgeons at the New York Hospital for Special Surgery, for example, focused on the single outcome of pain reduction when assessing the success of their procedures.  Patients, on the other hand, looked for regaining ability to do normal activities of daily life, to resume favorite leisure and sports activities, improve their overall quality of life, not merely pain relief, and the specific outcomes desired varied by individual patient. [“Patients and Doctors Often Differ on What Constitutes Successful Surgery” Strategic Health Care Marketing 20:3 March 2003 p.12]

When patients have been the sole or main source of payment for care, however, providers have often been more sensitive to results.  Fertility clinics, for example, have frequently guaranteed results or offered patients some or all of their money back if they failed to become parents.  The 20/20 Institute in Denver offers a guarantee for its Lasik surgery: if patients do not achieve at least 20/20 vision in the treated eyes, they get a full refund of their payments. (www.2020institute.com/guarantee.htm)

Even hospitals have, on occasion, guaranteed results to some extent.  Shouldice Hospital in Toronto has long guaranteed that if hernia repair patients must return for a repetition of the procedure, the surgeon’s fees will be waived.  Hospital charges cannot be waived under Canadian law.  Geisinger Clinic recently introduces a “ProvenCareSM” program for its coronary bypass surgery, with a warranty covering all needed care during the 90 days post procedure. [A. Casale, et al. “ProvenCareSM: A Provider Driven Pay for Performance Program for Acute Episodic Cardiac Surgical Care” American Surgical Association 2007 Abstracts (www.americansurgical.info/abstracts/2007/20.cgi)]

What such guarantees and warranties tend to do, in addition to promoting patient confidence in getting the desired results, is to motivate providers to strive for the absolute best processes and outcomes of care they can achieve.  It alters the current “perverse” incentives in healthcare payment where providers who deliver worse care get paid more, as patients need more care for complications and repetitions or extensions of care, and payers add to their payment for individual episodes. [W. Lynch & H. Gardner “Getting Paid More for Doing Worse…Only in Healthcare” Health as Human Capital July 23, 2007 (hhcf.blogspot.com)

As Lynch and Gardner pointed out, this practice creates what amounts to pay-for-performance incentives for providers, self-imposed rather than offered by payors.  It figures to fit very well with the increasing burden that consumers are bearing as employers shift more costs to employees and insurers sell more health spending account plans.  It also figures to serve the providers well as they reduce the long-established disconnect between what consumers want to get out of healthcare, and what providers are willing to promise and deliver.

1 Comment »

  LasikExpert wrote @ July 27th, 2007 at 7:34 pm

Your example of a Denver Lasik clinic that offers a “guarantee” if the patient is not 20/20 raises some very important issues regarding these kinds of claims.

I work for a nonprofit Lasik patient advocacy. We do not provide Lasik, just Lasik information and certification of Lasik doctors who meet our patient outcomes requirements.

At first blush a Lasik 20/20 guarantee may sound good and it is reassuring to think that the doctor is so certain of the outcome that such warranty is available. The problem is these offers do have limitations and perhaps some surprises.

The Snellen 20/Whatever test is sharp edged well-known black letters on a white background being tested in a controlled lighting environment. This situation does not well represent the reality of everyday life.

Snellen is a valuable measurement system, but it is not the only consideration for quality of vision. A Lasik patient may have 20/20 vision in bright daylight, but debilitating halos emitting from light sources at night. Does the guarantee apply? A patient with temporary Lasik induced dry eye may be 20/20, but only with the regular use of expensive preservative-free eye drops. Has the Lasik doctor met the requirement? And of course, what if the patient was 20/15 before surgery?

Any warranty a patient is able to receive has value and is a sign of good faith by the Lasik provider, but these kinds of warranties may be of less value than originally assumed, open up a lot of questions, and give a false impression of the real probability of success.

Buyer be aware.

Glenn Hagele
Executive Director

I am not a doctor.

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