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Value-based purchasing is good news for physicians

December 3rd, 2012

by Carla Rotering

There's a lot of chatter these days about how unprepared we are to meet the challenges of CAHPS (Consumer Assessment of Healthcare Providers and Systems ) survey scores and other patient experience assessment tools as factors in the pay-for-performance reimbursement model.

Hospitals and physician groups are scuttling to bring our "patient experience skills" up to par--and designing processes to assess how we are doing and who is doing well.

As a young physician, I did not anticipate this frontier. I was, at minimum, idealistic, innocent and remarkably naïve as I entered medicine. My vision for the future consisted of simply doing my good work, and in return I would enjoy a rich personal and professional life and a rich bank account. I had stars in my eyes.

Years later, facing a stern practice manager with completely starless eyes and a stack of formidable financials before her, I was humbled. She looked me square in the eye and said "You need to work harder--to see more patients, do primarily hospital work, do more bronchoscopies and spend less time with patients."

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I did the only thing most of us have known how to do. I trimmed appointment times, added patients before and after hours, worked through meal breaks and always said yes to the "one more consult" request at day's end. I did more and more--and then some more.

As physicians, we have operated by some form of volume-based "fee for service" since the time of Hippocrates--whether we traded our services for chickens or currency. The only way we could enhance reimbursements was to see more patients, add more highly-reimbursed procedures, or confine our work to specific high-revenue service areas.

We have suffered the loss of relationships with our patients, and our patients have suffered the loss of our attention and our caring. We have long lamented this system, and pined for a model that would favor value over volume--one in which our wisdom, critical thinking, caring and compassion held the same worth as procedures and numbers.

Good news at last.

These days are days unlike any we have known before. The value of our work certainly continues to be measured by clinical metrics. Yet now--for the first time in our history--in the value-based purchasing model--the quality of the relationship we create with patients has been elevated. We know that now the experience we choose to create with our patients also will be reflected in our reimbursement.

Never before have we had a model that says "Your caring is important--and we will demonstrate that financially" as strongly as what is being offered to us right now.

At a recent Banner Health System Language of Caring for Physicians event, a young physician leaned over and whispered "Oh! This is what you used to call bedside manner!" He reminded me of what I already believe--that we are innately prepared to strengthen the patient experience.

We need only tap into the memory and mystery we have all experienced at countless bedsides--and give new life to the qualities that formed those experiences. This is the heart and the art of our profession. This is our humanity.

Carla Rotering, M.D., is a pulmonologist at Banner Thunderbird Medical Center in Phoenix and the director of Physician Services for the Leebov Golde Group. She can be reached at crotering@quality-patient-experience.com.

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