Last week, Healthcare Dive took an in-depth look at the controversial evolution of the "patient" into today's "healthcare consumer," and how that shift continues to fundamentally change the business of providing healthcare in ways that are both positive—and incredibly risky. Industry experts, including sources from the Cleveland Clinic, the NYU School of Medicine, primary care clinic One Medical and others weighed in on the drastic impact of healthcare consumerism on both providers and patients.
We received a tremendous amount of feedback to this piece from professionals across the industry. We wanted to give other readers the chance to explore some of the fascinating responses we received on this important debate.
Stephen Bolles, consultant at Consumer Health Union, former non-profit exec
I've had spirited debates with colleagues who defend the term—and mindset and values and needs—of 'patient.' I don’t disagree that many people want to be taken care of in times of need, but I think the choice between consumer and patient is an often false dichotomy. There’s good reason for them to want to preserve the term: it validates their role, purpose and sense of value, and it’s a powerful mindset that’s inculcated in many types of health care training. But it's increasingly misplaced, and provider education systems are not aware of how much the ground has shifted under their feet.
What my work and results from programs I've developed for other clients affirm is that people want a shared locus of control, and that because the vocabulary really comes from providers and their educational culture, the reality is that that culture creates a very different paradigm, so what makes sense from inside that paradigm doesn’t necessarily make sense outside of it. 'Empowered' doesn’t mean in charge, though some think of it that way.
That cultural approach isn't often used, but I think it has immense value in looking at these relationship dynamics. It's aligned with an anthropological approach, because the two cultures—providers (system/supply side) and consumers (demand side) don't hold equal power. That's going to change quickly, but until the retail supply/demand dynamic normalizes in healthcare what people expect in retail, it's going to have aspects of a power struggle. The supply side has already lost the battle, but just doesn't know it yet.
A local health system just underwent a thorough re-imagining of their primary care delivery system, and reformatted provider response teams, etc. Interestingly, they didn't include a single consumer representative in the planning effort.
Dr. Kenneth Croen, Scarsdale Medical Group
I am a healthcare provider and the managing partner of a medium-sized practice (45 doctors) in the NY area. I have a different take on the impact of consumerism.
Patients have traditionally been passive consumers of healthcare. They knew their doctors well and had confidence in his/her expertise. The third-party payer model made it easier for the consumer to take no interest in tests being ordered since they do not pay. Even now, patients with good insurance coverage ask for extra testing, and say "I don't care what it costs, I'm not paying for it." I tried to convince a patient to have their colonoscopy in my office where his insurance reimburses $700 instead of at our local hospital where the insurance pays $4,900. He did not care.
Everyone wants to blame the greedy doctors for spending too much on healthcare. The truth is, the system is broken. Patients have not cared about the costs and even if they did, they have had no access to the data.
But times are changing. Now many have high deductibles. Now the costs do matter. Now patients are feeling the pain of paying high prices out of pocket. Your statement that the reason that patients are now interested in shopping is "because the bills were simply too high to seem legitimate" is probably exactly right. And money is the most potent motivator of most people—especially for the 99% that have to control their spending to survive.
A healthy doctor-patient relationship lies at the epicenter of quality healthcare. Consumerism is not a threat to that relationship if the doctor is willing to participate in the discussion. High-quality care should include a discussion about costs of care. A physician that sends a patient down a path of high-cost care is doing the patient and their family a huge disservice if they do not alert them to the high costs, and the costs/benefits of alternative approaches.
The real threat to the doctor-patient relationship is coming in the form of consolidation, dilution of access to the doctor by "team" care and bureaucratic obstructions, the increasing trend for MDs to be salaried, and the alteration of incentives that are coming with the ACO model of care. When doctors are constantly reminded of their spending behavior, they will use cost of care in their decision tree with the patient, but will not disclose their thinking to the patient since they will not be able to offer some of the more expensive alternatives. When a sick patient with pneumonia is sent home instead of the hospital by an ACO doctor, the patient and family will wonder whether that was a wise decision or a financial decision. When patients begin to understand the incentives of the ACO model, they will learn not to trust their provider.
A frank discussion of costs will not hinder the doctor-patient relationship. A lack of transparency will.
David Usher, chief financial officer at Kimball Health Services
Takes me back to an earlier time when I was operating primarily as a Credit Manager in a major drinks company in the UK. Long story short:
We called our "consumers" customers and like many over the years were trained along the "customer is always right" line—when you are trying to collect money in any business you need to be confident and firm and we were finding that that made people back-off and tread softly in many situations and as a result they were much less effective and that was detrimental to our cash flow!
We formulated a plan—everybody that owed us money was now called a "debtor" by the collections team! That little change had the effect of adjusting the mindset of those on the front line, they were immediately more assertive and more effective.
I know that is not healthcare related but it does go to the point that sometimes you need a different perspective in order to do the job better. I'm not sure at what point in a facility we need to stop calling them patient and start calling them consumer (or even customer) but I believe there are clear benefits in adopting that idea for a healthcare entity.
Kurtis Smitko, chief executive officer at Wolverine Health Plans
There is certainly some place for paternalism in healthcare. For one thing, most consumers have almost no knowledge or understanding of anatomy, biology, pathophysiology, so how much can they truely be involved in the decision-making process? Unfortunately, it is because of this focus on "consumer-driven healthcare" that we are seeing physicians have to work longer hours, for less pay.
One of the basic assumptions underlying market effectiveness is a perfectly-informed consumer. But in healthcare, consumers don't know pricing, alternatives, best-practice, etc. So, when they make a decision on where to go get their knee replaced, for example, the biggest determinants tend to be things like private rooms, flat-screen TVs, fancy food, and almost everything that has no bearing on the outcome of their procedure, but everything to do with the costs. This means that hospitals have to invest and promote the creature comforts, and try to dazzle people with the latest and greatest technology, rather than invest in what will truly provide the best medical outcomes, and that is great clinicians providing the best, most effective, and cost-effective, interventions.
James Dodds, independent cardiovascular technologist
Focus on the relationship—this is what is often lost in the "modern" health care setting. There is more emphasis on decreased length of stay, productivity, and outpatient, short stay settings. Patients frequently crave to be seen as individuals, to have their questions answered (in a face-to-face setting), and being seen as having value (as an individual). As the article points out, the Mayo brothers focused on patient relationships as their "brand." No one, in any industry, wants to be treated as just another number, or feel like they are a means to generate revenue. Healthcare providers should make time to personalize the relationship with their patients. This often takes a little effort, and a few extra minutes. The benefits of this type of care is priceless.