The Truven Health Blog

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By Truven Staff

How Strong is the Physician-Patient Bond?

Michael R. Udwin imageThe Wall Street Journal article “Comparison Shopping for Knee Surgery” chronicles a successful California Public Employees' Retirement System (CalPERS) pilot, which established a ,000 “reference price” for hip and knee replacement procedures. Under this scenario, patients were free to pursue surgery at a hospital with pricing above this threshold but would be responsible for the excess cost. As anticipated, patients preferentially selected facilities with pricing at or below ,000, while many hospitals with pricing above ,000 reduced fees to mitigate declines in patient volume. Interestingly, this behavior contradicts the axiom: “patients choose the doctor not the hospital.”

This is not the first time we have witnessed fraying in the physician-patient bond. Routinely, outpatient respiratory complaints are encouraged to visit an urgent care center rather than the family practitioner. And the days where the office internist also managed inpatient pneumonia care are long gone, as hospitalists now attend to a large portion of admissions.

CalPERS benefited from an innovative pricing structure designed to selectively encourage high-quality, lower-cost surgical settings. Such an outcome is certainly no surprise to anyone navigating a world of increasing co-payments and deductibles. Beside monetary considerations, are there other factors contributing to physician selection and retention? Of course, word of mouth, referrals, and accessibility are relevant. With enhanced transparency, perhaps quality and patient satisfaction scores will emerge as strong motivators.

The question still remains: “how strong is the physician-patient bond?” Sentimentally, I would like to believe that personal connectedness and longevity determine the strength of cohesion. Yet realistically, perhaps I should be content with the knowledge that if not now, then soon, patients will choose their doctor based on adherence to best practice, outstanding clinical outcomes and appropriate use of resources…and a great personality!

Michael R. Udwin, MD, FACOG
National Medical Director