I've written here often about how seriously flawed the government fixation on belligerence is as a way to fix healthcare fraud, real or imagined. On the other hand, there are many sites which offer help and guidance on how to prepare healthcare organizations for government belligerence. These companies, rather than question government belligerence, provide guidance in dealing with it. A phrase often used in the promotion of these services is patient-centered care. The implication is that these companies will teach you how to make your healthcare services patient-centered. My problem with this phrase is everyone talks about it, but the public relations notion of patient-centered care is not what most doctors would consider patient-centered care.
One such company offering help with patient-centered care is RELIAS. There are many companies offering similar services and I am not critical of RELIAS offering these services. Only in its use of the phrase "patient-centered care." This is a healthcare buzzword with little substantive meaning. RELIAS bills itself as a company for "Healthcare Workforce Enhancement Solutions." If you look over the history of the company, it has acquired company after company and been acquired itself:
Our identity is a tapestry woven from the mergers and acquisitions of numerous organizations across the healthcare continuum.
Relias promotes itself as "simplifying complex healthcare challenges…with a platform of connected solutions." They offer over 3000 courses on subjects such as validated assessments, competency evaluations, onboarding, obstetrics, emergency department, recruiting and staffing, learning and performance, and compliance management. I have no doubt that these courses may offer options for improving care and dealing with the complexity of our dysfunctional healthcare finance system. But can they really say their courses offer improved patient-centered care? The term patient-centered care is tossed about by numerous organizations trying to justify what they do. But I strongly suggest the patient-centered care from a physician's perspective is very different from the patient-centered care bandied about by the public relations department of large healthcare organizations.
For example, RELIAS emphasizes that the U.S. maternal mortality rate is three times higher than in other high income countries, but their recommendations for reducing this maternal mortality rate rely primarily upon mental health issues and social determinants which should be addressed in standard prenatal care. These are certainly factors in maternal mortality, but they are not the basis of patient-centered care.
If you look up the definition of patient-centered care, you will find the main components are treating a patient with respect and involving the patients in all their healthcare decisions. Let's face it. Patient-centered care goes a lot deeper than that.
Primary care physicians provide patient-centered care. They see you when you need an appointment and they know you and your family well. They don't need an electronic medical record to tell them that the patient's sister died at an early age from a stroke, something that is not likely to be in an electronic medical record anyway. And even less likely for the doctor to be able to find this information in the 15 minutes now allowed for an appointment. Patient-centered care does not magically arise out of the 15 minutes talking to a patient you may well have never met before.
If we want to have quick, easy, and effective methods to return to patient-centered care, we need more time to see each patient. That means better reimbursement per patient and much less prior authorization to take us away from the important work that we have to do with patients and their care. Electronic medical records only interfere with patient-centered care. Really.
Hans Duvefelt writes often on his Substack page about how he works with patients and solves their problems. As he says, no two patients are alike and many patients do not fit into the standard of care check lists. A physician would have to know the patient to be able to provide patient-centered care.
Most doctors don’t need to be threatened by The Centers for Medicare and Medicaid Services (CMS) or insurances to practice good medicine. They actually want to do well. They certainly don't need advice from the Centers for Disease Control and Prevention (CDC), or even RELIAS. Just stop interfering with the good care that physicians could give if they were allowed to practice medicine without organizational interference. Just allow it to happen...everybody would breathe a sigh of relief. The last thing we need is to have “robust programs” put in place to meet the needs of an increasingly complex healthcare environment. I’m afraid that an increasingly complex healthcare environment is exactly the opposite of what we need to have good patient-centered care.
Real patient-centered care is critical to obstetrics. Prenatal visits should be done by the physician, not nurse practitioners, and the deliveries should be done by physicians, the same physician the patient saw on every prenatal visit. With the revolving door of caretakers a patient sees in obstetrics today—considered normal—the team approach is extremely detrimental to good prenatal care. The practice of obstetrics works best—and saves maternal lives—if the patient has the same provider with every visit and if that same provider does the delivery.
Most people gave up beating children decades ago because it was cruel and ineffective. It’s hard to believe that supposedly intelligent government people can think that beating-up a healthcare system is a wise or effective plan of action. So, besides being cruel and ineffective, criminalizing or weaponizing treatment of healthcare systems and providers is a huge waste of time and money.
The problems with these so-called “criminal investigations” are significant and numerous. They have an extremely damaging and expensive effect on the quality of healthcare, not only for the doctors, but especially for the average consumer. Malcolm Sparrow criticizes much of what the government fraud units call "audits." He says that unless the investigating unit actually talks with the patient to verify whether or not the patient received the care in question, there is no real audit of supposed violations.
A Medical Review audit (which accepts all documents as true, and focuses on their medical significance) would seldom reveal claims as false. Only a more rigorous fraud audit would do that. A fraud audit would have to include…substantial efforts to contact patients or their relatives to verify the services were delivered.
License to Steal, p. 93
Sparrow also notes that these efforts to verify whether or not a patient has received the care in question should happen before the physician is contacted.
The weaponization of healthcare by CMS is not a deterrent and the whole healthcare system is traumatized. This is the equivalent of beating your five-year-old for not eating their peas.
If the CMS wants to improve healthcare, a simple “Let’s do it this way” would be much better. Being bullies has a higher priority for CMS and associated fraud units than actual healthcare improvement. It is extremely unlikely that any actual improvement will happen anytime soon. In addition, what CMS calls criminal activity is anybody’s guess since they have their own definitions. When we see the awful stories about these so-called criminal investigations, there’s never any real definition of a criminal investigation or even an audit, nor is there any attempt to give the accused victims the opportunity to tell their side of the story. We are supposed to be living in a country where evidence matters and draconian punishments are few and far between. Stop beating the healthcare system up for not eating the peas.
The government loves to brag about how much Medicare and Medicaid “fraud” there is and how important their work is. The MA (Medicare Advantage) plans create a debit of $88 billion a year. Bragging about collecting $3 billion for supposedly criminal activity is literally a drop in the bucket of MA debt. Therefore, if saving money and saving Medicare is our goal—and it should be—eliminating $88 billion debt is a much more reasonable way to save $85 million then complaining about imaginary crime. In my experience as a doctor, I have never found MA to be high quality.
Money talks, and nowhere does it talk louder than Washington DC. The MA plans are simply terrible for consumers on many levels. These plans, more than anything else, are responsible for Medicare insolvency. So, it’s either stupidity or greed that continues this exorbitant funding, and I’m going to say greed.
I hold out little hope that our legislators will do anything accept to rubberstamp the MedPAC dogma. They’ve done it for 30 years.
The only way to get patient-centered care is to find an independent physician, a physician you will see every time you visit the doctor's office. Corporate medicine has managed to put the primary care doctor out of business by taking away their hospital privileges and replacing them with hospitalists—doctors their patients have never seen before. The growing group of Direct Primary Care physicians offer an alternative to corporate medicine.
Critics of Direct Primary Care try to portray it as concierge medicine, implying it is extremely pricey. After all, many have watched the show Royal Pains. Direct Primary Care is not only for the rich and famous. Because Direct Primary Care practices do not accept insurance, but rather charge a monthly subscription fee, the insurance industry has portrayed physicians practicing Direct Primary Care as selling insurance without a license. Because of this action by the insurance industry, states have to pass legislation declaring that the physicians are not selling insurance. Some states have still not passed legislation to prevent the insurance industry from keeping Direct Primary practices out of their states.
If you want real patient-centered care, try to locate a Direct Primary Care physician near you. If you live in a state which has not passed legislation to allow Direct Primary Care practices, consider contacting your state representatives and requesting your representative pass legislation to remove this unnecessary roadblock to consumers who want access to genuine patient-centered care.