Gone are the days when physicians told patients what they were going to do. Gone also are the days when a physician's bedside manners and ability to communicate were not some of the most important criteria in evaluating a physician. The days when the physician was the real “Oz” are behind us, for the internet now allows patients to research medical conditions and physician ratings on their own.
To me, it seems that the single most important change with STAR ratings is not HEDIS or outcomes, since, in principle, they were always important, but the enormous weight given to customer satisfaction. When I started practicing medicine, it was common for physicians to discharge patients from their practices if they so much as raised a question about their medical care. We all know how healthcare was denied egregiously in the early days of managed care. Healthy patients were cherry-picked or unhealthy ones lemon-dropped, and providers would crassly let patients know how much their care cost the provider's bottom-line. Those days, I believe, are gone or, at least, are on their way out.
Patients have been given much more say as to their healthcare with the advent of Consumer Assessment of Healthcare Providers and Systems (“CAHPS”) and Health Outcomes Survey (“HOS”). Suddenly, we find that health insurance providers are bending over backwards to accommodate patients, sometimes overriding provider input or even medical necessity. Patient satisfaction and perception have begun to be an important component of the profitability of insurance plans.
We find much more plan involvement in patient care and patient engagement. IPAs, if they are to be of value to the plans and providers, must do the same. The biggest change in healthcare is the unmistaken emphasis on provider-patient engagement and relationships, communication, and patient satisfaction. It is very clear that providers who realize this turn in priorities will do better in the coming years.
Thus, we no longer have patients. Rather, they are seen as customers, or perhaps, I should say patrons. The medical office, including the front and the back operations, has to essentially be run more like the Ritz, Disney, or Starbucks where the customer comes first, and their experience is paramount.
Starbucks has always aspired to be the second home of its customers, as its motto clearly states. In the time of the Patient-Centered Medical Homes (PCMH), why should the healthcare motto be any different? The PCMH is not just about creating a model that emphasizes teamwork, patient communication and involvement and patient-centered healthcare, but also convenience, ambience, and great customer service. Thus, patients would do well to learn from the corporateleaders in how to provide excellent customer service.
As markets become saturated with managed care, the returns on marketing dollars are reduced. It is far easier and less expensive to retain membership than to get new members. It also makes sense to retain members since MRA-improvement initiatives take 12-18 months to show an increase in premium. Meanwhile, stable patients have less utilization and better HEDIS scores, and managed care profits improve with greater retention. For this to happen, it is critical that physicians realize that their smile is worthwhile, not only to communicate genuine happiness and engagement, but that it also affects their panel's expense ratios.
However, customer service does not stay restricted to offices. In hospitals, we see an even greater need for communication with patient and family, coordination of care, proper planning, and a service-oriented philosophy. A higher patient satisfaction will result in less readmissions, visits to the emergency rooms, and malpractice lawsuits.
How do you create an organization that thrives on greater customer satisfaction? In my opinion, it is not a matter of red-carpet welcomes, ritzy waiting rooms, limousine transportation, or cosmetic services being provided to the patient; it is a shift in culture. This shift must become ingrained in the processes of training, selecting, and evaluating employees, for an organization to thrive.
It is important to ensure that employee satisfaction and morale are at a high and that employee satisfaction be considered as important as patient satisfaction. Questionnaires for patients and employees can be created for feedback and action in specific areas. Patients who are no- shows or cancellations need to be called so that the office can accommodate to their needs. Patient advocates and liaisons must be part of executive teams in any healthcare organization. Organizations must take immediate action to address genuine patient concerns.
There are limitations to what we can do to ensure patron satisfaction. We cannot write off charges without documenting financial hardship or extend professional courtesy, since these are not part of compliant behavior. However, the manner in which things are said and even disagreement conveyed, whether with a smile and with concern in one's whole bearing, whether one is actually listening to the patron or simply ignoring them, is of far greater consequence than acceding to their sometimes unjust demands. Employee empowerment within the parameters of CMS regulations must be encouraged.
It is also important to realize that an upset customer may give us a great opportunity to demonstrate our sincerity of intent and purpose. Furthermore, it is also the time to evaluate and fix what is wrong with the organization's processes. Unfortunately, an upset customer will communicate his poor experience to friends and family more readily than a pleased patient will communicate his great experience. Thus, an upset patron is worth the time and effort invested in resolving any issues and it is far cheaper to attend to his needs and spare no effort in addressing his concerns than any amount of advertising and market outreach used to clean up after the bad publicity.
Eventually patients must become partners in their care. It is true that the best person to coordinate care in hospital or nursing home settings is an informed customer. It is worthwhile to develop lines of communication via care coordinators, customer representatives, or case managers to ensure that patients and families are assisted in navigating through their traumatic experiences.
The nature of healthcare is healing. This is why we chose this profession. A kind word, a genuine smile can heal far beyond a prescription or a referral. It is the sine qua non of excellent healthcare and good medical practice. It is imperative that we realize that CAHPS is the single best thing that has happened to healthcare in the last decade, even more than any new technology or pharmaceutical.