Patient Empowerment in Perspective
Patient empowerment and health care hang in the balance. Patient empowerment is an important phenomenon accompanying health care reform. The forces of patient centered care which fuel it are counterbalanced by forces of quality assurance, professionalism, ethics, and cost containment in a symbiotic yin-yang manner.
With the advent of health care reform the time-honored yin forces of physician centered care are now counterbalanced by the yang forces in which more focus is on the patient. Treatment based on the rigid dogmatic authoritarianism of the physician is no longer the order of the day.
The yang of patient centeredness is based on treatment principles and recommendations which consider cultural traditions, lifestyles, values, personal preferences and family situations of recipients of care. The premise of the concept is that unwanted and unneeded services can be reduced when care is centered on the patient.
The Patient Centered Care Home
The Patient Centered Care Home is a model of care which is a spinoff from the patient centered care concept. Shared decision-making on the part of healthcare providers and the recipients of care is a central component of this care model. It also emphasizes communication and coordination of health care between primary care doctors and specialists. It also encourages teamwork with collaboration between family members or other loved ones and healthcare providers.
The Yin-Yang Dynamic in Healthcare
The yin-yang of patient empowerment flies in the face of any notion that M.D. means majestic deity or D.O. means deified other. It encourages patients to rate or judge their healthcare providers via satisfaction surveys. Judgments and ratings are made based on perceived quality of care, treatment outcomes, and intangibles such as physician empathy, communication skills, rapport and bonding.
There are yang forces of healthcare which counterbalance or hold in check some of the untoward yin forces of patient empowerment. Examples are agreement by a physician to an unreasonable request by a patient in order to obtain a good survey rating or the authorization of treatment which is unsafe or not scientifically based in order to appease family members. The yang forces of healthcare regulate the quality, appropriateness, affordability and safety of medical care.
Healthcare regulatory yang forces which counterbalance the yin forces of empowerment include official treatment guidelines based on medical research, state medical boards, hospital quality assurance committees, insurance company quality assurance committees and the courts. Some newer entities are the Physician Quality Reporting System (PQRS), value-based modifiers and Accountable Care Organizations (ACOs).
Newer Yang Regulatory Entities
The Physician Quality Reporting System is a reporting program which will impose reimbursement penalties on physician groups of 100 or more who don’t meet certain quality of care measures in treating Medicare recipients beginning in 2015. It will impose penalties on all doctors treating Medicare recipients but not meeting the standards beginning in 2017.
Value based modifiers are part of a Medicare reimbursement program which will impose additional payment reductions for doctors not meeting quality standards based on calculated quality scores. This system will also impose payment penalties based on the cost of care provided to Medicare patients. Again, penalties for physicians in groups of 100 or more will begin in 2015 and will apply to all doctors treating Medicare recipients beginning in 2017.
Accountable Care Organizations (ACOs) are groups of suppliers and healthcare providers dedicated to coordinating and providing quality care to patients at a reduced cost. Groups include doctors, hospitals and other entities. They have special contracts with insurance companies which include reimbursement incentives for cost savings. They might experience reimbursement reductions however if they spend too much money treating the beneficiaries. Quality measures such as patient centered care, shared decision making and treatment outcomes also affect reimbursement depending upon the specifics of the contract.
Although the initial ACOs were formed by Medicare, third party payers including major ones such as UnitedHealthcare, Aetna, and CIGNA have piggybacked into, or leapfrogged, if you will, onto the concept and formed their own ACOs. ACOs are currently in a trial stage but are expected to become more prevalent in ensuing years.
The yin-yang forces of patient empowerment and healthcare delivery are not mutually exclusive. Yang forces of patient empowerment negate yin forces of healthcare delivery. Yang forces of healthcare delivery negate yin forces of empowerment. It is the counterbalancing of the forces that establishes the equilibrium necessary for quality healthcare which is appropriate, safe, and affordable.