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The Yin and Yang of Patient Empowerment in Healthcare 

October 11, 2013
Written by: Victor E. Battles, M.D.
Harmony and correctness are not at a position of extreme, but somewhere in the middle.

Yin Yang SymbolThe forces of patient empowerment which pervade the current healthcare reform movement are counterbalanced by yin-yang forces of healthcare-provider quality-of-care accountability.  The 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 costs. 

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 be."  

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 (ACOs).  

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 in 2017.

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 appease patients.

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.

Source: Proactive Health Outlet

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