The forces of patient empowerment which pervade the current
healthcare reform movement are counterbalanced by yin-yang forces of healthcare-provider quality-of-care
two forces are increasing in momentum and have significant implications for both patients
and healthcare providers.
At the patient end of the healthcare
continuum, the forces of patient empowerment are being propelled by the concepts of patient engagement and
patient-centered care, which are predicated on the premise that a greater focus on the patient and greater
involvement of the patient in the healthcare process will improve healthcare quality and lower
Patient-centered care is based on the
concept of patients rating and judging their healthcare providers based on the quality of healthcare
delivered, how care was delivered and treatment outcomes. Patient satisfaction
data are generated with respect to the patient's perceived quality of the provider/patient
relationship, physician empathy, communication and bonding. The Patient-Centered-Care Home is a model-of-care
spinoff from the patient-centered-care concept, which emphasizes coordination and communication of health care
between primary care doctors and specialists, so as to transform primary care into "what patients want it to
Central to the concept of patient-centered
care and the Patient-Centered-Care Home care model is the concept of shared decision-making, which is a process
in which patients and healthcare providers collaborate in deciding on a particular treatment modality when
there are various options. In addition to weighing medical evidence, the decision process also takes into
account patient values and preferences.
At the healthcare-provider end of the
healthcare continuum are forces which tend to hold in check the forces which propel patient
empowerment. Those forces ensure that patient-empowerment forces don’t run amok and that patients receive
reasonable, quality and safe healthcare.
Standards of healthcare set forth by
evidence-based-medicine guidelines, state medical boards, hospital-quality-assurance committees,
insurance-company-quality-assurance committees, and the courts are some of the well-established entities
overseeing the delivery of reasonable, quality and safe healthcare by healthcare providers.
Some newer entities which regulate physician
quality-of-care accountability, which are offshoots of healthcare reform, include the Physician Quality
Reporting System (PQRS), value-based modifiers and Accountable Care Organizations
The Physician-Quality-Reporting System will
impose reimbursement penalties on physician groups of 100 or more who don't meet certain
quality-of-care-measures in treating Medicare patients beginning in 2015, and will impose penalties on all
doctors treating Medicare and Medicaid patients but not meeting the standards beginning in 2017.
Value-based modifiers are part of a
Medicare-and-Medicaid reimbursement structure which will impose additional reimbursement reductions for doctors
not meeting quality standards, based on calculated quality scores. Again, penalties for physicians in groups of
100 or more will begin in 2015 and will apply to all doctors treating Medicare-and-Medicaid patients beginning
Accountable Care Organizations (ACOs) are
groups of suppliers and healthcare providers including doctors, hospitals, and other entities dedicated to
coordinating care and providing quality care to patients at a reduced cost. They have special contracts with
insurance companies which include reimbursement incentives for cost savings, but might experience reimbursement
reductions if there are cost overruns in treating the patient members. Quality measures such as
patient-centered care, shared decision-making and treatment outcomes also factor into reimbursement depending
upon the contractual stipulations of the organization.
Although the initial ACOs were formed by
Medicare, third party payers including major ones such as UnitedHealthcare, Aetna, and CIGNA have piggybacked
into, or leapfrogged, if you will, onto the concept and formed their own ACOs. ACOs are currently in a trial
stage but are expected to increase significantly in numbers in ensuing years.
The yang forces accompanying patient
empowerment bestow definite benefits to patients who have formerly been victims of the yin forces of
a physician-centered healthcare system in which many of their desires and preferences were ignored and
communication was minimal or virtually nonexistent. On the other hand, yang forces overseeing provider
accountability counterbalance the yin forces of patient-empowerment by opposing unrestrained
patient engagement resulting in untoward behavior such as healthcare providers deviating from established
standards of quality care in exchange for favorable patient satisfaction ratings or just to
Obviously, patient empowerment in healthcare is neither all yin nor all yang but is a union of
both. Counterbalancing forces within healthcare are in equilibrium with the forces of patient empowerment,
so as to favor quality improvement in health care and a reduction in healthcare
costs.Victor E Battles, M.D. is a board-certified internist with more than 30 years of
patient contact. He has served on hospital quality assurance committees and in October 1986 was certified by
the American board of quality assurance and utilization review.