Coaching Physicians to Communicate with Patients

By Dr. Michael G. Cassatly

I think it is safe to say that most patients feel physicians are not good communicators. In fact, many patients even feel that their own physician’s communication skills just plain stink! So, beginning in fiscal year 2013, how will Physicians capture the incentive bonus mandated by the Affordable Healthcare Act, when 30% of it is based on physicians and nurses communication skills? Let’s take a closer look at the incentive bonus and then, I will present a blue print for your hospital to maximize the incentive.

There are two important elements of the incentive: the source of the funds and the metrics determining if your hospital receives the incentive. The money to pay the incentive comes from a corresponding 1% holdback reduction in payments by CMS to your institution. Yes, you read that correctly. CMS is cutting back your inpatient reimbursement by 1% and then, may return it to you as an incentive for meeting predetermined benchmarks! So to even receive a 100% of the full Diagnosis Related Group (DRG) payment, you better reach the benchmarks. But wait, it gets better. The incentive and the holdback increase by yearly .25% increments to reach a full 2% in 2017. Falling short will result in a failure to capture the incentive with a full 2% decrease in reimbursement. Let’s assume your healthcare system’s total reimbursement from CMS is $100 million, then, 2% is $2 million dollars……….not money any medical center can afford to leave on the table. And, since private insurers uniformly adopt CMS payment models, the potential revenue loss will be even greater once private insurers enact similar incentive payment plans.

The metrics determining the incentive payment are called the Total Performance Score (TPS). 70% of the TPS will be determined by clinical processes of care. What I call “hard data” because it is quantifiable. Along with the urgency for electronic medical records, this quantifiable data is driving the resources going into healthcare information technology. The remaining 30% will be based on eight patient experiences of care measures from the HCAHPS survey. I call this “soft data” because it is based on your patients’ subjective opinions. This patient’s opinion poll measures the communication abilities of your physicians and nurses, as well as overall responsiveness of the hospital staff. It is this soft data I want to discuss.

First, recognize it for what it is: a HUGE culture change. And like any culture change it will take some time. So Rule #1 is to start the change now. Rule #2 is to start from the top down. That means the physicians; the leaders in your chain of command must become “change agents” by modeling effective communication with patients and staff. Rule #3: because changes in a culture must be system-wide, get all your hospital personnel on board. It will do no good to have your physicians connecting with patients if nurses and the other staff do not. And Rule #4 is to have your physicians undergo business coaching with an experienced coach who understands physicians. A hospital HR employee calling her or himself a ‘coach’ after a day of training can do more harm than good by not fully engaging your physicians. An experienced and certified coach who knows physicians is the requisite to a fundamental culture change. As mentioned in my previous posts, clients of executive business coaching report an improvement in relationships, communication skills, interpersonal skills, and work performance by greater than 70%. So don’t delay begin your culture change today!