Telling the Patient No

Behind the scenes when patients are not coming in, the care team looks for patients who are perhaps not doing the work on their own that will help keep them out of the hospital in the future.

“They might need to come in and see us, and we let them know about things like that,” she says. “Most patients really like that. In the middle of this whole thing, we woke and discovered that we had built, without knowing it, the core of what people are calling a medical home.”

When you have a true medical home, and patients feel like there is a group of people that is genuinely concerned about helping keep them healthy, they are much more motivated, says Walters. Also important, they are unlikely to question doctors about the recommendations they make. The kinds of activities involved in creating the medical home ultimately increase the trust factor between patients and their caregivers, she says.

The law front-loaded the initial reforms in the area of healthcare insurance, Keckley says, because that’s the way to get the attention of the consumer. But as the provider pieces of the law kick in, doctors and other members of the care team had better be prepared to help explain some of it to the patient.

“That creates a backlash toward docs, who are getting questions that they’re not accustomed to,” he says. “We’ve got to educate frontline staff, as well as docs, not just to what’s in the law, but what’s likely in the rules and regulations yet to be written.”

The reason the educational effort must take place, he argues, is because “most docs and medical practitioners are learning about reform filtered through the lens of one medical society’s view.” They don’t see all the moving parts of the law. That tends to lead to myopic thinking, he argues.

“The hospital has to bring the full scope of the set of laws to the attention of docs so they are better informed objectively, while also providing a set of tools so docs can communicate rationally,” he says. “It does no one any good to have docs dismiss this as cookbook medicine and socialized healthcare.”