Should Physicians Be Reimbursed for Conversations With Patients?

Joe Cantlupe, for HealthLeaders Media , July 22, 2010

But Levinson says more communication time should be considered by CMS for payments, particularly in relation to certain illnesses. In addition, the federal government should consider reimbursement for medical students in the last year of school and residency training for communication training, when communication skills are not developed as they should, she insists. Continuing training for physicians also should include communication programs that should be reimbursed, she says.

"It is in the third and fourth years of medical school, during clinical rotations, when students have the most patient contact and face their greatest cognitive and emotional challenges," she writes. "Unfortunately, the teaching of communication skills often receives little attention when compared to the teaching of diagnostic skills and patient management."

"Medicare and other payers have the ability to further increase the demand for patient-centered communication through reimbursement strategies," she writes. "By being procedure-oriented, they aren't well reimbursed.

Reimbursement strategies can be devised to support patient-centered care through the use of patient survey scores, payment codes for patient education and counseling, according to Levinson.

When pressed (by me), Levinson acknowledges CMS already pays a lot for doctors." But, she adds, "If it [were] tied into the whole patient-centered medical home, it can be a vehicle, a new mechanism for paying physicians. It could be linked to the patient centered care, for complicated conditions."

The C-suite also can play a role in improving patient and physician communication, she says.

"Leaders and administrators can model desired communication skills on their interactions with physicians and staff, setting high expectations for effective communication in all interactions," she writes. "Making the importance of communication between physicians and patients and among health professionals part of a medical group's culture can have a profound impact on the degree to which patient-centered care is the norm."

"Increasingly, organizations are looking at the patient experience," she tells me. "If you permeate the culture with views of the patient, this can be transformational. It can change the culture. It can take the c-suite to do that."

The importance cannot be overstated in patient-centered care, and also reveals a gap in communication between physicians and patients that needs to be closed, Levinson says. "When I tell a physician at a cocktail party that I work in healthcare communications, they go "oh" with some disinterest, she says. When she tells patients, they say, "Let me tell you a story," stressing what they consider to be the importance of what they told the physician—and how the physician reacted.

The changes needed to improve communication between patient and physician won't come immediately, and, whether more federal funds are injected or not, won't occur overnight, according to Levinson.

But neither are the possibilities for change "out of reach," she writes. "We have a moral imperative to meet this challenge, because doing so will improve the quality of care."

Joe Cantlupe is a senior editor with HealthLeaders Media Online.

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