Patient rights mean more customer focus
May 1, 1998
Patient rights mean more customer focus
When President Bill Clinton proposed the Patients' Bill of Rights in February, many practices didn't see how it would affect them. But Fred Abbey, a partner at the national accounting firm Ernst & Young, and its national director of legislative and regulatory affairs in Washington, DC, says practices have to see it as part of a general trend toward consumerism.
"People want to make more health care choices, and so success will be predicated on organizations responding to customer demands," he says. "This is a real sea change for physicians. Accepting the Bill of Rights is accepting that the doctor is no longer the sole decision maker in patient care. We are moving to a coaching model not a directing model."
The Bill of Rights will soon apply, via executive order, to Medicare, Medicaid, Indian Health Services, Department of Defense, Department of Veterans Affairs, and Federal Employees Health Benefits. A bipartisan bill to make similar provisions for all Americans awaits action in Congress.
The Bill of Rights includes provisions for:
· Greater information disclosure.
Chris Rolle, JD, an attorney with Broad and Cassel in Orlando, FL, says that means information on all treatment options in a culturally competent manner, including the option of no treatment at all. It also means that all the risks, benefits and consequences of treatment or non-treatment must be discussed.
Information on health care professionals is also included in this section, such as the education, experience, and certification of the doctor; how the physician is compensated; ownership of or interest in health care facilities; and any matters of conscience that could influence advice or treatment decisions. This section also calls for an end to gag clauses and includes the following:
· Choice of providers and plans.
· Guarantees of access to emergency services.
· Participation of patients in treatment decisions.
· Respect and nondiscrimination against patients. Rolle says this includes race, ethnicity, nationality, religion, sex, age, mental or physical disability, sexual orientation or source of payment.
· Confidentiality of health information.
· Method for complaints and appeals.
· Consumer responsibilities.
The latter includes provisions that patients must work with health care providers to develop and carry out agreed-upon treatment plans and disclosure of all relevant information. They must also avoid knowingly spreading disease, make a good-faith effort to meet financial obligations, and report wrongdoing and fraud to appropriate legal responsibilities.
"What this means to practices is that while the physician can continue to practice medicine, the office is going to have to respond to patients in a more customer-focused way. There will have to be better hours and locations, better advisory services. Health plans will have to limit the number of places a patient has to go to get care." Offices that don't catch on won't succeed, says Abbey.
Perhaps the scariest aspect of the bill of rights for most practices is the information disclosure proposal. "You have to have the administrative structure to do this without it costing you a bundle," Abbey explains. A practice will have to not only provide charts for patient review, but provide a place for the patient to look at the charts, a way to copy the charts, and a way to ensure patients don't walk off with them.
But all the news isn't bad. The Bill of Rights should improve access of patients to specialist services and improve the flow of information between physicians.
"The message practices should get out of this is that they have to develop something we call `forever customers.' To do that, you have to understand not just what they are going through clinically and procedurally, but in a deeper way. For instance, if you have a patient who is having surgery, it isn't enough to do the procedure, but you will have to care about who will look after the kids and do the shopping. You have to have the kind of relationship that will help patients get through what they are going through. You have to live the life of the patient. If you see this as an opportunity and do what you have to bring your practice to that point, then you will develop those forever customers."
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