Do we need “rules” to do what is “right”? And are ACOs and Value-Based Purchasing reasons to now take action?

Accountable Care Organizations and Value-Vased Purchasing RulesWe have all heard the quote “what gets measured, gets done”.  What this reveals is how leaders have been conditioned to act, yet this has not always led us to our desired results.

This quote also touches the very issues facing patient experience. For years we have discussed patient-centered care, domains have been identified that define patient-centeredness, and patient satisfaction measurement is now not only an accepted practice, but also a growing and profitable industry. These standards and measures have helped remind us who our customers are and provided data on which to act. Yet, even with this information, while some have tackled this important issue, many have not.

Now with the emergence of new policy measures such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey in the U.S. and the Excellent Care for All Act in Ontario, Canada, as well as efforts in other locations around the globe, a patient’s experience is now a variable in not just ratings, but also a component of individual and/or organization compensation formulas. Even more so, these scores are being publically reported in an attempt to provide transparency (or is it to truly capitalize on the competitive nature of the healthcare business – see my blog from November 2010)

Even with the advent of the HCAHPS survey, when we conducted a survey of The Beryl Institute’s membership last summer (almost 4 years since the launch of HCAHPS), just over 50% of the respondents had a comprehensive patient experience strategy. So can we say what gets measured, gets done?

But perhaps now, specifically in the U.S., the stakes and implications have been raised with the introduction of the proposed rules on both the measurement and payment process for Accountable Care Organizations (ACO) and Value-Based Purchasing (VBP). The headline of these rules in relationship to patient experience is simple – perform well on the standard metrics, specifically HCAHPS, and you will reap the “benefit” of maintaining reimbursement dollars (VBP) or of obtaining payments resulting from the new shared savings arrangement (ACO). Simply stated, patient experience is now a measure that equates to dollars lost or gained.

This leaves me with the question, why the frenzy now when we have always been in the business of delivering care to patients? Has health care become something we simply do to people for revenue? I am not saying we do not need effective financial performance, as this is critical to sustaining services.  What is disconcerting is that it seems we have carefully crafted our processes and practices, structures and systems to accommodate us – meaning the deliverers versus the recipients of our services.

Perhaps it has been a harmless oversight on our part, though I have heard many healthcare leaders emphatically say, “We are not in the hospitality industry”.  With that I can agree. People do not usually choose to spend their hard-earned dollars with us, but rather circumstances, some dire, bring them to our doors. I do suggest instead that we are in the service business. We always have been and always will.  Care is not the privilege of a few (though with the current systemic issues it could be perceived and even experienced as such by some) – care is a service we provide – be it in our medical practices, long-term care facilities, outpatient centers or hospitals.

I am not advocating for or against the measures or processes put in place, rather I am holding up a mirror to ask why it has taken these policies and programs to truly see action and activity on improving patient experience. What has been our motivation to act now? Perhaps more importantly what slowly had us move away from service to process, from relationships to transactions, from patient to diagnosis?

During my recent On the Road visit with the UCLA Health System, both CEO, Dr. David Feinberg and CMO, Dr. Tom Rosenthal said a key to their success was helping their staff uncover and rediscover the passion that brought them to healthcare in the first place – the care and service of others. My hope is that while we may now be motivated by measures to get things done, this is not the fundamental reason we respond to this expanded commitment to the patient experience. Let’s use this as an opportunity to exceed expectations and provide quality care, not because it is in the rules (or being measured), but because we know it is fundamentally the right thing to do.

What are your thoughts on the implications of these new rules around Accountable Care Organizations and Value-Based Purchasing?  And how can continue to do what is right for our patients regardless of what we may be required to do?

Jason A. Wolf, Ph.D.
Executive Director
The Beryl Institute