Telling the Patient No

“Where you have two approaches to treating a patient population in which the evidence is roughly the same, it would be rational in policy to do the cheaper of the two,” says Keckley. “Hospitals will be caught in the crossfire between a policy and the expectations of doctors and patients,” he adds.

So far, says Keckley, many doctors and patients are successfully blaming the legislation for almost any sense of dissatisfaction with healthcare, adding that polling suggests most consumers associate these themes with health reform legislation.

 “There’s a certain amount of Teflon on the surfaces of local docs and hospitals,” Keckley says. “Consumers will think this is just Washington.”

But that doesn’t mean hospitals and doctors will be entirely off the hook with the public.

Not surprisingly, many leaders on the edge of the changing dynamics are encouraging an ownership culture among their physicians such that they determine the best protocols based on the available evidence, and then hold themselves to that standard, says James C. Sams, MD, medical director of Piedmont Physicians Group, a mostly primary care practice owned by Piedmont Healthcare, a four-hospital system based in Atlanta. Despite the fact that many of the regulations they will have to follow are yet to be implemented, they’re preparing the right mind-set in their physicians by proactively implementing evidence-based guidelines for care. But the standards aren’t being forced upon the physicians—rather, physicians are being asked to author them.

Guidelines in the outpatient arena are what have seen most of Sams’ attention lately.

“With our employed primary care group, we not only get them to agree to guidelines, but to comply with them,” he says. “That’s not a problem if you show them the value, that it’s what’s best for patients. But the next challenge will be doing this with the nonemployed physicians. Our employed physicians are all on the same EMR, which makes a lot of these decisions easy. When we move to the nonemployed, we’ll see a half dozen different EMRs and paper charts.”