Health Literacy Needs a Place in Physicians' Practices

I was invited to sit in on a presentation by Mark Dumoff, an expert on patient communication and health literacy, to the chief medical officers of a large private insurer a few weeks ago.

It struck all of us, as we struggle to adapt to legislation that attempts to set our healthcare system on the right track with new taxes, mandates, and regulation, that fundamentals are falling to the wayside. Failing to master basics like doctor-patient communications is hugely expensive in terms of quality of life, time and money.

The statistics Dumoff outlined are a wakeup call:
• 90 million adults have low health literacy levels
• Cost to the U.S. economy : $106 billion to $238 billion/year
• $1.6 trillion to $3.6 trillion burden to future generations in today’s dollars
• White, native-born Americans are the majority group

This happens because one out of three patients can’t understand instructions for self-care, after-care, and transitions in care from one setting to another. Another one out of three struggles with them. As a result, patient transitions and coordinated care are adversely affected, which researchers say caused $25 billion to $45 billion in wasteful spending in 2011, mostly due to avoidable complications and hospital readmissions.

The cycle is as familiar as the solution seems to be elusive:
1. Patient seeks medical help
2. Patient is asked to complete complex, confusing forms
3. Doctor explains patient’s condition and treatment plan using medical jargon
4. Doctor writes multiple prescriptions and referrals for tests
5. Doctor does not confirm patient’s understanding
6. Patient goes home with complicated, generic instructions
7. No one follows up with patient
8. Patient takes medications incorrectly and does not follow up
9. The cycle begins again - patient seeks medical help

Those with chronic conditions such as diabetes, hypertension, and asthma are at the highest risk of disease progression and co-morbidity while patients in transition from acute to sub-acute care for conditions such as CHF, COPD, pneumonia, and AMI are at the highest risk of unnecessary hospital readmission.

As of Monday, Medicare will start fining hospitals for having too many patients readmitted within 30 days of discharge due to complications. About two-thirds of the hospitals serving Medicare patients, or about 2,200 facilities, will be hit with penalties averaging $125,000 each this coming year according to government estimates. The likely response will be to focus on discharge instructions and to initiate quality and patient experience measurements for their admitting physicians as a barometer of risk.

In an emerging era of shared risk and performance-based remuneration, getting fundamentals such as effective patient communication right is especially important to survival and success in medical practice.

It takes some work to change embedded habits and practice culture, but, once done, the rewards keep paying dividends far into the future.

These simple changes to the treatment cycle can make meaningful improvements in outcome:
1. Patient seeks medical help
2. Scheduler sends simple forms and offers help in filling them out
3. Staff collects forms and asks patient if they need help in completing them
4. Doctor explains patient’s condition and treatment plan using simple terms
5. Doctor writes multiple prescriptions and referrals for tests and doctor or staff explain what they are for, what to do, and what to expect
6. Doctor or staff or both confirm patient’s understanding
7. Patient goes home with clear, simple instructions
8. Staff follows up with patient to ensure compliance, answer questions, and ensure patient returns for follow-up visits
9. Patient’s condition is being well managed
In the end, everyone gains:

Practice/Physician Impact:
• Enhances patient engagement in self-care
• Promotes positive behavioral change
• Improves adherence and outcomes
• Upgrades quality, compliance, measurement, and reporting
• Increases patient, physician, and staff satisfaction
• Reduces risk and may lower malpractice rates
• Maximizes payment incentives
• Enhances quality of care/reduces length of stay, readmissions, and medical expenses
• Proactively manages risk
• Increases new patient referrals

Patient Impact:
• Better healthcare decisions/more effective self-care
• Healthier outcomes
• Fewer visits
• Less out-of-pocket expense
• More meaningful doctor-patient relationship

Mastering fundamentals may not be as sexy or stimulating as mastering a new technique or technology, but they win the day. Ask any athletic trainer or coach. Their success is built on executing fundamentals flawlessly.

Find out more about James Doulgeris and our other Practice Notes bloggers.