“We’ve been sitting in rooms like this for a very long time talking about how we need interoperability and better medical records but when I see my internist we still go through a whole set of papers,” said Alice Rivlin, PhD, director of the Brookings Institution’s Health Policy Center, speaking at the Agency for Healthcare Research and Quality Research Conference.
This slow progress means “we’re not involving clinicians and patients in a serious way yet,” she added. In smaller practices, the language of alternative payment models is foreign to those clinicians. “We’re not as far along as we ought to be.” Patients ought to be actively deciding to enroll in an ACO or a patient-centered medical home and engaged in their care rather than just being on the roll somewhere, she said.
Rivlin said she’s concerned that payment reform is all about payment. “We’re reaching out to clinicians and others with the promise that there will be savings but not appealing to the reasons they went into healthcare in the first place which was to have the satisfaction for making their patients better and improving the quality of their health.”
“Hospitals are under the gun in a way they never were before,” Bruce Siegel, MD, MPH, president and CEO of America’s Essential Hospitals. They’re being required to do less with less. When providers see payment reform linked to evidence there are breakthrough results such as fewer readmissions.
Workforce capacity is an issue, said Beverley Johnson, president and CEO, Institute for Patient- and Family-Centered Care. Providers “aren’t trained to partner effectively. They don’t have the communication skills to partner with patients and families or across disciplines or with community health workers and coaches.
Another issue is that more than half of hospitals restrict family presence, said Johnson. “We isolate patients at the most vulnerable time from the people who know them best and then wonder why we can’t get them out of the hospital safely. We need to work on this.” A broader definition of family would help, she said. For some patients, it might be their neighbor. The research community could help improve this in a meaningful way, she said.
A lot of healthcare stakeholders have initiative fatigue, Johnson said, so “rather than adding more burden, having patients and families as our partners at this critical time can help us get to what’s really important to focus on. Bring new energy and inspiration to the work.
“Health isn’t just about medical care,” said Rivlin. And, patients must have some responsibility to learn about nutrition and exercise. She suggested adjusted the payment system so that patients have some incentive to do that.