Managing Patient Expectations: Personalized Medicine

March 29, 2012

Tending to the patient’s health in partnership with their fiscal health is the training ground for the inevitable shift from fee-based services to hybrid forms of reimbursement.

There is a lot of attention given to personalized medicine in broadcast media, cable television, popular press, and Internet. Subjects range from customized gene therapy, to patient-specific therapy programs, to new technology that can be adapted to an individual’s needs. This steady stream of real and prospective advances fuels patient perceptions and expectations that medical science has a cure for them, earning it sixth place on a list of 10 new patient expectations, which I introduced in January.

Last week’s article focused on patient and peer communication strategies and tactics. This week, communication still plays a central, and more challenging role. The flood of advances has put science to the forefront in many patients’ minds, commoditizing clinicians, diluting the importance of personal responsibility, and distracting from the reality that medical science has limits. Failing to manage the patient and family expectation that there is a customized, affordable cure with fewer side effects and a better outcome - particularly when patients demand medically unnecessary treatments - can lead to failed expectations, challenges with patient compliance, financial crisis, and even lawsuits.

This makes managing expectations, patient responsibilities for self-care, and costs as important as managing treatment. More on this further on.

Successfully managing these new challenges will also have a lot to do with how well a practice performs. Along with the expectation that medical advances and technology will see people through, is the perception that it is the technology - not the skill of the operator and judgment of the physician - that is most important. This perception deemphasizes the provider and accentuates the science. In economic terms, it makes clinicians more of a commodity. With commodities, price and value trump credentials and training.

The emphasis of the new era is cost. The winning strategy will be value.

To many patients, the value of a procedure is its perceived end-result - regardless of the financial or physical cost. Just because a treatment is available, or the patient insists on it, does not mean that it is appropriate, covered by insurance, or otherwise affordable. Using your experience to counsel patients on the financial impact of providing quality care (which leads to good outcomes), versus the impact of the care that they think they need, creates value, referrals, loyalty, and mitigated risk.

Deductibles are increasing to the point of many patients being self-insured for the first $1,000 to $10,000. Copays cause continued exposure to as much as 20 percent of future costs. These factors often make discussing the cost of diagnostics, procedures, and medications as central as the treatment plan itself.

Here’s a real life example: A highly respected neurosurgeon does neck fusions. He performs the surgery in a hospital and has his patients spend the first day in intensive care and the second on a surgical floor. Whether by abundance of caution or defensive medicine, the cost to the patient can be, and often is, a nasty surprise, particularly if their insurer deems the stay in intensive care as medically unnecessary. The patient can easily be on the hook for thousands of dollars over and above their full deductible. The outcome may be good and the safety is as good as it gets, but following best practices delivers both, at far less cost.

In years past, the price of treatment was the insurance company’s concern. Today, it is increasingly the patient’s. Tending to the patient’s health in partnership with their fiscal health is the training ground for the inevitable shift from fee-based services to hybrid forms of reimbursement.

In today’s healthcare world, partnering with patients by discussing treatment options and financial impact, following established guidelines for medical necessity, and providing quality service, results in solid value and protects the healthcare system for everyone.

Value - not volume - builds loyalty, patient satisfaction, referrals, and better clinical outcomes while limiting liability. Patients are partners in their care when clinicians make decisions for and with them.

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