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Wednesday, April 21, 2010

Valuing patient time

I found an interesting article written by Alan B. Krueger last year in the NYT, entitled:

A Hidden Cost of Health Care: Patient Time

http://economix.blogs.nytimes.com/2009/02/09/a-hidden-cost-of-health-care-patient-time/

The basic premise of the commentary was that there is a time cost associated with the delivery of health care which is under recognized and this time cost is not only large, it is MASSIVE.

There are so many aspects of this observation that warrant comment and reflection. It is hard to know where to begin. Perhaps it is best to view this in terms of blind spots and there are many of them. From the perspective of the medical community, there multiple blind spots. My specialty deals with high volumes of patients and treatment regiments which require substantial investment of patient time to comply with our direction. We also deal with uncommon conditions which require substantial patient travel. In some cases, in office treatments occurring up to three times weekly may require an investment of up to 10 hours weekly to make this work. This is a time investment which begins to rival that seen with dialysis. Yet nowhere in our professional literature is any sort of recognition to this substantial time cost.  Dollars may be counted but time does not appear to be important.

The letters which were written in response to this piece were of two basic bents. One thread was one of complete resonance. The other thread was highly defensive. Both actually miss the point. Both patient and provider are victims of a system which is designed to produce exactly what we get. Calendars filled with agenda less meetings brokered by poorly trained clerks ill-equipped to actually fulfill the triage task of directing patients to the correct provider allocated the right amount of time. Furthermore, the actual purpose of these encounters is often a surprise to the physician,  and often the need simultaneous face to face interaction of is simply a function of this requirement to drop a bill.

The best way to value patient time is to turn our focus to why we do things which waste patient time. What I think we will find is all roads lead to the payment scheme. Themes which are consistent in the letters describing their time consuming interactions with their physicians described an odd mix of waiting for something to happen followed by an extraordinarily brief encounter with the physician. To value patient time, it would make sense to invest in all types of infrastructure which might be used to collect important information while the patient was waiting to see the physician, or to create interactive learning tools which could excel at informing and teaching patients.

The administrative payment system with it defined set of "valued" services all set at artificial, non-market based prices places a value on innovative tools which can save patients time at zero. Thus they do not exist. Ultimately, administratively set prices and services compensated fail to consider patient time in any of their various equations. This is simply the case of the objective school of value run amok and is living testimony that inputs do not define value.

2 comments:

  1. I wonder how many hours per week in my practice I devote to vacuous tasks that don't help living breathing patients.

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  2. This is unfortunate but true. There are a lot of tasks that doctors do not get compensated for. Medical offices today must now be very cost conscious. As a former triage nurse, I made sure my providers had enough time to see the patients I was scheduling that truly needed to be seen, to give good telephonic advice for those that did not need to be seen and route emergencies to the ER where they needed to be. But there are always those patients that push back and demand to be seen by the medical provider when it is obvious they didn't need to be. I think there are going to be new medical models that are born from health care reform. Patients are going to have to realize that they cannot see their doctor for every little ailment. They may need to see an NP or PA for their sore throat or broken toe. That they cannot have an MRI for 1 week of knee pain. That is what Americans have heartburn with. And our doctors feel pressured to give them what they want and don't have time to argue with them. There has to be some sacrifices made. Changing a population who in the past has gotten pretty much anything they wanted is going to have to change. And it is not going to be pretty.

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