I Answer to You

One of the most persistently bothersome challenges in healthcare is how unresponsive medicine has become to patients.

Because payment is generally managed by a third party, like an insurer or government payer, there is little investment in keeping the customer happy–except as a means of increasing patient ratings, which can affect payments (http://healthjournalism.org/blog/2015/05/the-aca-and-patient-satisfaction-does-it-improve-care/ ). Hospitals and clinics may even parrot phrases from patient satisfaction rating scales in an effort to increase ratings, and thus reimbursement (http://kaiserhealthnews.org/news/patient-ratings-hospital-medicare-reimbursements/ ) which is not at all about your satisfaction, is it?

Handcuffed to third party payer
Handcuffed to third party payer

If you look at this professional article on patient satisfaction and payment changes  http://www.aaos.org/news/aaosnow/jun13/advocacy5.asp  there are ratings of your understanding and if you felt others listened to you (which begs the question, “Shouldn’t this be the bare MINIMUM you’d expect!?”)  But notice there is a stunning absence of any discussion of value: Did you feel your service was worth the cost? Are you happy with the decision to get this test/treatment? What would you do differently next time? Or how about in advance of any exam/treatment: What would YOU like to get from this appointment, and what’s the most important thing to you right now?

Instead, time and effort revolves around keeping the third party payer happy: filling out mountainous forms, billing using complex codes and modifiers, and spending time, money and staff resources arguing over billing errors, all of which serve only to take time away from patients.  From a patient’s perspective, there is often dissatisfaction with low-value evaluation: the cost and inconvenience far outweighs utility.

Screaming. Throwing hands in air.  Healthcare.
Screaming. Throwing hands in air. Healthcare.

I always wondered how things would be if patients could more easily decide how to direct their healthcare dollars, prioritizing the services that were most valuable and critical to them, and demonstrating satisfaction by voting with their feet.

As a consumer of healthcare services, you should expect the same things from doctors that you expect from the businesses in which your money is spent.  Expertise and quality.  Convenient location. Short wait time.  Fast and reliable communications.   Responsiveness to your questions.   Sensitivity and friendliness.  If a business can’t deliver on any of those, you go elsewhere.  Alternately, you may give more weight to some factors: you’re okay with a brusque doctor as long as the care is excellent.  Or maybe cost is paramount to you, and you will trade speed for lower price.

In the current healthcare system, a third party payer comes between you and those decisions.  In fact, the only way the current system can keep its financial head above water is to severely restrict choice and individual decision-making. (I’ve even read a paper purporting choice is BAD for you, and you should settle for mediocrity to avoid the stress of excellence!).

When I opened my clinic, based on an urgent-care direct pay model, I knew it would not be the single best answer for every patient seeking neuropsychological evaluation.  But for many, it’s a revelation: you call, make an appointment (typically within a day or two), and after a pleasant, informative and efficient experience in which YOUR specific concerns and needs are addressed, your report is immediately sent to your doctors.  I can’t tell you how many patients have expressed disbelief at the convenience and ease of evaluation here, which they felt was infinitely preferable to the insurer’s options (especially since in many cases, the cost was actually the same or less!).

The bottom line is that I answer to YOU, not any insurer or government payer.  That gives me the freedom to provide you with the personalized,  superior level of service you deserve.  As the customer, your satisfaction is my greatest concern.

Just because I like fish.
Just because I like fish.