Over the past five years, we’ve been bombarded with accusations that greedy physicians misuse the fee-for service payment system and this results in poorly coordinated health care, resulting in high cost hospital admissions. The oft-repeated solution to all this is “integration” of physician practices into larger systems and employment of physicians by hospitals.
Just a few days ago, a paper by Casalino et al, in the journal Health Affairs clearly showed that compared to practices with 10–19 physicians, practices with 1–2 physicians had 33 percent fewer preventable admissions, and practices with 3–9 physicians had 27 percent fewer. Physician-owned practices had fewer preventable admissions than hospital-owned practices. Those of us who remain fiercely independent and in small practice, do so at our own peril, in the interests of the patient-physician relationship. This study confirms our belief that best quality care occurs when a physician knows her patient as an individual, not just a number. Metrics and big data be damned! This also debunks the Zeke Emmanuel concept that bigger is better when it comes to physician practices.
Private non-profit organizations like the American Board of Medical Specialties (ABMS) and its franchisee “Boards” frequently flood the media outlets with the notion that patients demand Board Certification and Recertification as a marker of physician quality, as though it is a self-evident truth. Far from it. A recent study by The Associated Press-NORC Center for Public Affairs Research at the University of Chicago found that “when it comes to what being a quality health care provider means, there is a disconnect between how experts and consumers define it“.
Further, “Americans report that they would trust word-of-mouth and personal recommendations from doctors far more than provider quality data coming from the government or third parties”. My own survey of over 760 patients from 2013-14 showed that nearly 60% of patients choose their doctor based on personal experience (“listens to me & helps solve my medical problems”) and another 25% based their choice on another doctor or friend/family recommendation, as compared to 5% who used the ABMS Certification to guide them.
And finally, this statement from the AP-NORC survey says it all “When asked to describe a high-quality provider, most Americans focus on the doctor-patient relationship” – how simple, yet profound! Now that American patients and their doctors have spoken, it is it is time for them to unite and create a patient-centric, physician-guided health care system from the bottom-up. A resurrection of the Hippocratic Physician.
Arvind Cavale MD is an endocrinologist in private practice, you can follow Dr. Cavale on Twitter @endodocPA.