The Side Effects of a Better-Informed Patient

Philip Betbeze, February 22, 2016

While shared decision-making for elective procedures could negatively affect volumes, leaders need to consider that, like value-based reimbursement, it's coming. So is it better to get ahead?

This article first appeared in the January/February 2016 issue of HealthLeaders magazine.

Healthcare leaders routinely mention the importance of patient engagement and experience. And a solid majority (85%) considers the patient-as-consumer trend to be an opportunity, according to the 2016 HealthLeaders Media Industry Survey. But it's pretty clear that provider organizations don't always share with these consumers all the information they need to make an informed decision. Why not?

Well, it's complicated. The industry has only recently begun to retreat from the paternalistic model that put the physician clearly, and solely, in charge. Another reason is a problem endemic to healthcare under fee-for-service: Screwy financial incentives mean healthcare providers are paid for intervention, not nonintervention. Yet to some, serving the patient's best interests means educating him or her about all the possible repercussions, from a decision to pursue, for example, elective surgery, even if that means the patient ultimately decides to pass on the procedure, leaving the provider with little reimbursement, if any.

David Arterburn, MD

David Arterburn, MD

As the payment system slowly changes, so does institutional interest in shared decision-making, a concept by which care teams help patients understand the potential impacts they may face from an elective surgery, essentially helping them decide?based on their own goals, the rehab time and effort, and the likely outcome of the procedure?whether they ultimately will decide to go through with it. Under a capitated system, the incentives to engage patients align nicely. Under fee-for-service, which is still the majority payment system for most providers despite a recent push toward value-based purchasing, not so much.

Weighing considerations
For the provider, whether it's a hospital, a surgeon, or a health system, there are many concerns with implementing a shared decision-making program, not the least of which is the potential financial impact. If implementing such a protocol for patients considering elective surgery cuts volumes significantly, all but the most integrated health systems would suffer financially. It's also a cost to staff such a program, even if it consists of just a few people. But if shared decision-making is in the patient's best interest, all other concerns should be secondary, right?

Philip Betbeze

Philip Betbeze is the senior leadership editor at HealthLeaders Media.

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