My friend Lisa Suennen recently posted a blog lamenting her experience as a patient rather than a healthcare investor. Her experience was, to say the least, not ideal. Jostled, poked and prodded, cajoled to undergo treatment, she seemed more like a luxury cruise liner undergoing repairs than a passenger being cared for.
Lisa’s experience seems all too commonplace. And, it is only going to get worse. The Affordable Care Act (ACA) promises healthcare to millions more Americans. However, the legislation offers little to expand the number of nurses, doctors, and other ancillary personnel expected to take care of these folks. Regrettably, the end result will likely be already overtaxed healthcare workers becoming a bit more harried and a bit less compassionate to the patients in their care.
Those searching for a solution to this problem would do well to look outside the present healthcare system. Take the restaurant industry. Tom Frank built a national restaurant chain (PF Chang’s) on the idea that corporate governance and culture should be at the center of customer experience. First and foremost, he believes that a business needs to be a place where people want to work. If the employees don’t want to be there, it is unlikely the customers will either.
Tom spends a great deal of time teaching other industries how to have a good corporate culture. Recently he and I talked about why healthcare is so difficult to fix. I told Tom that for me, it comes down to confusion about who the customer is.
Every time I go to PF Chang’s, I’ve been asked to pay. Naturally. I’m the customer. However, in healthcare the customer is largely the insurer. It’s the insurer, after all, and not the patient, that decides on rates and access, as well as on where the patient can go. It is the insurer that pays.
In Tom’s world, it would be as if the patron had a coupon from work for a free meal. The restaurant would cater to the person’s employer, who, looking at the bottom line, might care more about the price of the coupon than the quality of the experience at the restaurant.
Of course, this is a bit of an exaggeration. If the meal was really bad, coupon or not, no one would go. But you get the idea. Hospitals cater more to insurers than they do to patients, knowing that as long as the service is reasonable, more patients with more coupons will come.
Most Americans recoil at the idea of paying for care. That is something handled by their employer or, in the case of Medicare, through their taxes. What they don’t realize is that they are already paying beyond this initial arrangement. We are all seeing higher deductibles and co-pays. And try seeing a specialist who takes Medicare; it’s not so easy.
True, a growing number of people have opted out of the traditional deductible or co-payment system. Instead, they have sought out concierge physician services. With this arrangement, the patient pays—often $150-$200 a month—for a doctor who agrees to have fewer patients in the practice. In essence, the patient buys time and attention from the physician. But it also benefits the physician, who is no longer running from room to room. More significantly, the patient is now a customer, one who must be served and encouraged to return. As all businesses know, once customers leave, they aren’t so easily replaced.
Unfortunately, this solution doesn’t work for the average American; most people don’t have the cash to invest in a concierge. However, although I can’t prove it, it may be that the overall cost of care, some of which falls to the patient through co-pays, may actually be less under such an arrangement. How many additional ER visits or hospitalizations (in a system offering less than optimal care, over the course of a year) does it take to balance out the monthly physician stipend? Sadly, we don’t really know. And there’s the crux: As patient/consumers we tend to not think about the cost of care per year, but rather the cost today.
Medicine is a great and noble profession. As providers, we have an opportunity to intimately participate in the lives of others. However, the current system of payment leads to untenable relationships where neither the patient nor the provider feels good about the experience. I believe the current payment model may, at least in part, be at fault. Coupons are simply not a long-term strategy for any business.