In principal accountable care makes a lot of sense. Practically speaking however, doctors and hospitals must address a huge challenge before they can expect benefit financially.
Before doctors can be held accountable for the care they deliver, they first must be held accountable for the quality of their communication with patients.
Take hospital re-admissions which are a big cost-driver today. According to a recent study in the New England Journal of Medicine, 20% of all Medicare patients discharged from hospitals were readmitted within 30 days, and 34% percent within 90 days.
The Joint Commission and others believe rightly believe that inadequate communication between physicians, as well as between physicians and patients, is a major contributing factor.
Here’s an example. In a small study of 47 patients surveyed at time of hospital discharge (Commercial and Medicare), 72.1% of patients were unable to list all their discharge medications. 86% were unable to describe the common side effect(s) of all their medications, and 58.1% did not know the diagnoses that put them in the hospital in the first place. These trends are consistent with the findings from a number of similar studies, including studies of discharged ER patients.
Physician-patient communications shortcomings abound in the doctor’s office as well. Approximately 20–50% of patients do not take medications as prescribed. It’s not necessarily because patients are non-compliant. Patients don’t take medications out of fear of drug interactions, perceived lack of effectiveness, adverse effects, misunderstanding regarding necessity, or concerns about costs.
Patients who report better general communication with their doctor, i.e., better instructions on how to take a medication, and who receive more medication information, are more likely to take medications as prescribed.
The success of new financing and delivery models like Accountable Care Organizations and Medical Homes depends heavily upon significant address the quality of the current state of physician-patient communications. I wonder when today’s physician and hospital leaders will get a clue.
Makaryus, A., et al. Patients’ Understanding of Their Treatment Plans and Diagnosis at Discharge. Mayo Clinic Preceedings, 2005.
Coleman, E., Rehospitalizations among Patients in the Medicare Fee-for-Service Program. New England Journal of Medicine. 2009.
Kripalani, S., et al. Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians. JAMA 2008.