Blog | Friday, July 30, 2010

Should doctors be paid to communicate with patients?

This post by Steven Wilkins, MPH, appeared at Better Health.

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 less than minute of a 20-minute visit discussing treatment and planning with patients.
--Up to 50% 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 50% of outpatient visits.
--Physicians prescribing new medications do not always give dosage and frequency instructions to the patient.
--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:
1) Quality standards must be established that define effective physician-patient communications.
2) Physicians and patients must be provided with training and tools to more effectively communicate with one another.
3) We will need to move beyond basic patient satisfaction surveys and develop more sophisticated approaches to measuring the quality of the physician-patient interaction.

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 post originally appeared on Better Health, a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.