In this edition of The Wired Practice video, originally published for MedPage Today, 乐鱼体育 CEO Ron Harman King discusses how healthcare systems and practices often promise a great patient experience but often fall short.
By Ron Harman King, MS, JD, CEO
When healthcare systems & practices promote a great patient experience, do they deliver it?
If you were to conduct an ethics poll of healthcare providers, my guess would be that lying to patients about their health would rank among the top three worst offenses. In fact, it can be against the law, for which doctors聽, as can a聽
So, if healthcare providers can be severely punished for fibbing, how can healthcare systems get away with it openly?
“Patients come first,” “We listen to you”
I鈥檓 talking about how American hospitals and healthcare systems describe themselves in billions of dollars鈥� worth of advertising and promotions. Peruse their websites and advertisements and you鈥檒l see the same messages ad nauseum. They promise that 鈥減atients come first, 鈥渨e listen to you,鈥� 鈥減atients are our first priority,鈥� 鈥渉uman kindness,鈥� and 鈥渄edicated to caring for you,鈥� among other flowery assurances.
The first problem to point out is that simply promising to be nice to patients does little to recruit them. The golden rule of marketing is to stand out from competitors with what marketers call it a strategic differentiator.
In healthcare, nice doesn鈥檛 cut it. Patients already expect it. Promising them niceness is like a car maker guaranteeing that every model comes with four tires and a steering wheel. It鈥檚 anything but a differentiator.
Much, much worse, however, is how often the failed differentiator is an outright lie. Or I should say, perhaps overly charitably in some cases, a half-lie.
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Healthcare system accused of $73 million in wrongful charges
Not long ago the聽New York Times聽uncovered a notable example. Two of the newspaper鈥檚 investigative journalists reported that the聽聽of violating state law by pursuing 55,000 patient accounts for an alleged $73 million in wrongful healthcare charges.
Providence is one of the largest health systems in the country, with more than 50 hospitals and 900 clinics. The system鈥檚 revenues聽exceeded $27 billion in 2021. Its nonprofit status allows Providence to avoid more than $1 billion in taxes, according to the聽Times.
The attorney general sued Providence and three other health systems, plus two collection agencies for聽allegedly mishandling of hundreds of millions of dollars聽in medical debt affecting tens of thousands of patients.
According to the聽Times, the overpayments were a result of a program known as Rev-Up designed by Providence management with the help of the consulting firm McKinsey & Company. The program allegedly included instructing employees that their obligation to solicit money 鈥渋s part of your role. It鈥檚 not an option.鈥�
Let鈥檚 not overlook the fact that Providence was founded by nuns in the 1850s and proclaims its mission as 鈥渟teadfast in serving all, especially those who are poor and vulnerable.鈥� In addition, the system boasts on its website of a dedication to 鈥渃ompassion and humanity at the heart of every interaction.鈥�
Defense of unintended errors
In its defense, Providence cooperated with the 罢颈尘别蝉鈥�聽investigation and聽聽to refund their payments. The system also reported聽a combined operating loss of more than $1 billion in 2020 and 2021. A spokeswoman additionally said Providence had halted some of its debt-collection practices months earlier and that Providence was the largest provider of charity care in Washington state.
The spokeswoman further told the聽Times聽that an 鈥渦nintended error鈥� caused misidentifications of those eligible for charity care. That explanation, however, does raise questions about how such an error might be a larger contributor to wrongful charges than the Rev-Up program.
If Providence runs its own venture capital fund as the聽罢颈尘别蝉鈥�聽reports, I also would like to know the rate of unintended errors in management of its reported $10 billion of investments, which the聽Times聽says generated $1.2 billion in 2021 profits.
But most of all, I leave it to you to decide whether the totality of alleged treatment of low-income patients by the聽New York Times聽and the Washington state attorney paints the picture of a health system dedicated to 鈥渃ompassion and humanity鈥� particularly to the 鈥減oor and vulnerable.鈥�
Anecdotes of living the healthcare systems’ half-lies
Even if so, each of us likely has ample anecdotal evidence of healthcare鈥檚 biggest half-lie. For example, a friend of mine has suffered a multi-year urinary condition that led her to her state鈥檚 largest healthcare system. This system has flooded roads with billboards and the airwaves with broadcast ads promising the ultimate in compassionate care tailored to each patient.
My friend鈥檚 first visit to a clinic in the system was to provide a urine sample. She wound up driving around a sprawling medical campus with a full bladder for more than an hour in search of a parking space. In tearful desperation, she avoided a liquid disaster only when a security guard moved his vehicle for her. From then on, she paid an Uber $50 a pop to deliver her to appointments.
Next came encounters with phlegmatic physician assistants who challenged her diagnosis and physician orders. 鈥淲ho told you you had a urinary infection?鈥� asked one. Answer: her primary care physician, based on lab results. Turns out the PA hadn鈥檛 scrolled down far enough on her EMR screen to view the relevant entry.
Another curt PA described an order from a physician in the same system for a PAP smear 鈥渁n unnecessary medical procedure, but we can waste everyone鈥檚 time and money if you want.鈥�
Ultimately, my friend switched to a solo specialist in private practice, where a聽weekly treatment would cost her $310 each week. Cost of the same treatment at the previous health system was $800. She has since experienced no parking problems, no long waits for the doctor, and unsurpassed kindness from the doc and staff.
Rampant miscommunication
A professional associate of mine has suffered a life-threatening condition since childhood and has spent decades seeing specialists. For her, hospitals and healthcare systems suffer rampant internal miscommunication among providers, labs, and other ancillary services, sometimes forcing her to repeat tests at her expense.
Although insured, whenever she inquires about unintelligible bills, the response is often a demand to just pay her bill immediately or risk being taken to collections.
Our research validates her complaints, even among healthcare鈥檚 biggest brand names. Online data shows that nearly 9 of 10 online criticisms of the nation鈥檚 twenty top-rated hospitals cited nonclinical, service issues as the main source of dissatisfaction.
How healthcare providers can stop the half-lie of service
So, what can providers do about the half-lie? First, fight the urge to scapegoat. Yes, practicing medicine is becoming ever more frustratingly bureaucratic and controlled by bean counters. But that鈥檚 no reason to take it out on the customers who ultimately pay your salary and who are rarely to blame for systemic chaos.
Second, for the dwindling numbers of doctors still in private practice, resist the temptation to sell out to hospitals and health systems. Sure, the temptation to delegate the headaches of practice management is huge. But the tradeoff is harm to quality of care and increasingly unhappy patients.
Third, for employed providers, push to establish or serve on patient-experience committees with real responsibility and power. Speak and act out for improvements in logistics, communications, and billing.
Fourth, never forget that big organizations need you as much or more than you need them. My firm鈥檚 research has found that聽two-thirds of online reviewers give four- and five-star reviews on rate-your-doctor websites.聽You鈥檝e got clout. Use it to press for ending the biggest half lie.
Tell your employer that if you can be imprisoned for falsehoods, the least the boss should do is to can the big half-lie.