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Running head: PHYSICIAN COMMUNICATION SKILLS 1

Physician-Patient Communication Skill Training Needs Assessment

Richie Cobb

California State University, Monterey Bay

September 12, 2017

IST522 Instructional Design

Dr. Jeanne Farrington


PHYSICIAN COMMUNICATION SKILLS NEEDS ASSESSMENT 2

Physician-Patient Communication Skill Training Needs Assessment

To address performance deficiencies in patient care, the Patient Protection and

Affordable Care Act (PPACA) ties patient satisfaction to reimbursement. The law offers

incentives, such as enhanced reimbursement rates, for physicians who provide patient centered

care (Davis, Abrams, & Stremikis, 2011). A key component of determining reimbursement rates

are patient satisfaction scores determined by Hospital Consumer Assessment of Healthcare

Providers and Systems (HCAHPS) surveys (CMS, 2014). To achieve high rankings on the

survey, it is critical that physicians have “patient-centered communication skills”; yet according

to Levinson, Lesser, & Epstein (2010), physicians are not adequately trained in these skills

(p.1310). With this needs assessment I set out to determine if a) there is a problem worth solving

and b) if there is a lack of knowledge and skills requiring training. If so, a training module for

physicians will be made available through the American Medical Association (AMA) for

continuing medical education credit (CME).

Needs Assessment Plan

To conduct this needs assessment on physician-patient communication skill training, I

performed research on the topic using a combination of web-based articles from government

agencies and peer-reviewed journal articles. Since the PPACA has been in effect for several

years, there are many journal articles, research studies, and other literature available on the

provision regarding reimbursement and patient satisfaction. I utilized Google Scholar, California

State University Monterey Bay (CSUMB) library’s online database of academic journals, and

Google web searches to gather the information to make this assessment.


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Data

Research shows that communication skills are a critical component of providing patient-

centered care, as directed by the PPACA. According to Levinson et al., not only do these skills

affect patient satisfaction, they also impact the patient’s willingness to follow prescribed

treatment plans and the management of their diseases (2010).

There is a growing trend that policy should be implemented that ties payment for services

(under federal healthcare programs such as Medicare and Medicaid) to performance and skill

development (Levinson, 2010). Currently there are provisions in the PPACA that allow for

higher percentage payments to physicians who meet certain standards, such as establishing

patient-centered medical homes for their patients (Davis et al., 2011). This cannot be achieved

without high quality patient-physician communication, empowering the patient with the will to

follow the physician’s medical advice and continue to receive care from the same clinic or

provider.

HCAHPS surveys are randomly given to patients after being discharged from the

hospital; among the topics covered is communication with physicians (CMS, 2014). It is

important to draw attention to the fact that patient surveys reveal a poor perception of physicians

showing empathy to patient concerns. Patients also feel that they are not thoroughly explained

their diagnosis and treatment (Levinson et al., 2010). As of 2017, these survey scores directly

determine a 2% loss or gain in Medicare reimbursement for hospitals (Letourneau, 2016).

Deficiencies

In the United States, all medical students are taught basic patient communication skills

typically by lecture in the classroom followed by observation. However, this instruction is most
PHYSICIAN COMMUNICATION SKILLS NEEDS ASSESSMENT 4

predominant during the early years of medical training and not reinforced during clinical

rotations where medical students begin to have their most interaction with patients (Levinson et

al., 2010). Additionally, it is not very common for post-graduate physician training to cover

communication skills (Levinson et al., 2010). As such, many physicians in practice today are

likely to be lacking in these skills.

Need for Training

Teaching communication skills such as emphatic listening and how to express sympathy

can be a difficult task given that they are trained to think mechanically to diagnose and treat

disease processes. During a patient interaction, physicians must perform multiple communication

tasks; to do so effectively requires “personal engagement and emotional involvement” (Levinson

et al., 2010, p. 1311). Doing this effectively requires more than leaving the physician to learn

these skills on their own. The Accreditation Council for Graduate Medical Education (as cited in

Levinson et al, 2010), requires that physicians be taught “interpersonal and communication

skills” (p.1312). However, not all medical schools place teaching these skills as a high priority

which results in poor training outcomes in this area, further strengthening the need for continued

training in this area post-graduation (Levinson et al, 2010).

There is no mandate that requires additional communication training post medical school

graduation, but as the trend of reimbursement tied to patient satisfaction continues, some

professional organizations, hospitals, and clinics are offering it. For example, Kaiser Permanente

provides a training program for their physicians (Levinson et al, 2010). However, outside of

large medical groups and a few professional organizations, patient-centered communication

training is not a required continuing medical education (CME) course for most practicing

physicians (Levinson et al, 2010).


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Other Causes for Deficiencies

Another cause for deficiencies in physician patient-centered communication skills is time

cost. While most training programs can be delivered in less than three days, time away from

seeing patients in clinic means lost revenue (Levinson et al., 2010). Some physicians also believe

that utilizing additional patient-centered communication in their practice would result in an

increase in patient consultation times, thus possibly serving as a negative motivating factor in a

physician’s decision to participate in further training (Levinson et al., 2010).

Conclusion

Based on my research into patient-centered communication skills among physicians in

the United States, additional training in this area is necessary to meet the demands of evolving

health care policies. Not only do physicians and health organizations benefit by protecting their

reimbursement rates (or in some cases increasing them), patients experience better health

outcomes (Levinson et al., 2010). The effects of poor communication skills between the

physician and patient already have a negative financial impact, and based on current trends this

will most likely continue to increase (Davis et al, 2011; Letourneau, 2016; Levinson et al., 2010).

To address deficiencies, I propose an American Medical Association CME module in patient-

centered communication skills for physicians. Making this training module required for AMA

membership (both for initial joining and subsequent renewals) would help overcome the time

cost barrier.
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References

Centers for Medicare & Medicaid Services (CMS). (2014). HCAHPS: Patients’ perspectives of

care survey. Retrieved from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-

Assessment-Instruments/HospitalQualityInits/HospitalHCAHPS.html.

Davis, K., Abrams, M., Stremikis, K. (2011). How the affordable care act will strengthen the

nation’s primary care foundation. Journal of General Internal Medicine, 26(10), 1201-

1203. doi: 10.1007/s11606-011-17120-y

Letourneau, R. (2016, September 28). Better HCAHPS scores protect revenue. Retrieved from

http://www.healthleadersmedia.com/finance/better-hcahps-scores-protect-revenue

Levinson, W., Lesser, C.S., Epstein, R.M. (2010). Developing physician communication skills

for patient-centered care. Health Affairs, 29(7), 1310-1318. doi:

10.1377/hlthaff.2009.0450