Beruflich Dokumente
Kultur Dokumente
Richie Cobb
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
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
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
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
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
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
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
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
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
training is not a required continuing medical education (CME) course for most practicing
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
increase in patient consultation times, thus possibly serving as a negative motivating factor in a
Conclusion
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).
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.
PHYSICIAN COMMUNICATION SKILLS NEEDS ASSESSMENT 6
References
Centers for Medicare & Medicaid Services (CMS). (2014). HCAHPS: Patients’ perspectives of
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-
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
10.1377/hlthaff.2009.0450