Financial Incentives vs. Patient Satisfaction at Windsor Dermatology: A Case Study
For specialty medical practices in densely populated areas of the United States, there are significant financial incentives to overbook staff physicians and have them see patients as quickly as possible to yield the highest possible hourly revenues for the practice (Moore & Wasson, 2007). This model for running a medical practice has significant drawbacks on patient satisfaction, since patients tend to report higher satisfaction when more time is spent face-to-face with a physician during an office visit (Lin, Albertson, & Schilling, 2001). Other patient satisfaction detractors include long wait times, poor bedside manner, and poor physician-patient communication (Peer & Mpinganjira, 2011; Anderson, Barbara, & Feldman, 2007). Strategies to improve patient satisfaction include listening to and answering patient concerns with empathy and attentiveness (Clark, 2003), the practice of patient-centered care, and compassion practices (Vogus & McClelland, 2016). There are also insurance reimbursement incentives to submit CPT codes for each patient office visit as office visits with comprehensive exams, high complexity medical decision making, and the prescription of medications during the visit, even if those criteria are not actually being met during the patient interaction (Melichar, 2009).
So why am I mentioning any of this? Because Windsor Dermatology has given me the worst patient experience of my life, to the point where I can remember how bad going there was years later (and it still bothers me).
I came here as a teenager to find a solution for my moderately bad acne, waited over an hour (at my appointed time), had my information taken down by an office assistant over the course of 5 minutes, and then the (main) practice physician came in. He did not bother to say hello or make any small talk, he did not even make eye contact coming in and looked directly to my chart, read a few things off of it, looked up at my face for a second or two, and then reached for his prescription pad to prescribe me Epiduo, which was the new acne medication pharma reps must have been incentivizing him to prescribe at the time. This took place over the course of about 30 frantic seconds. I tried to get a question in about washing my face a certain way, and he looked up from the prescription pad and started yelling "SORRY, WHO IS THE DOCTOR HERE? IS IT YOU? OR IS IT ME? IT'S ME, RIGHT? PUT THIS STUFF ON YOUR FACE TWICE A DAY, THAT'S IT!!!!"
Now that is pretty bad, certainly uncalled for. But maybe he was having a bad day, right? Maybe I can get one question answered before he leaves...?
Me: "So this is like... benzoyl peroxide and -- "
Main Practice Doctor: "I'M DONE HERE I DON'T HAVE TIME FOR THIS!"
He trudged out the door and slammed it behind him, his dumb-looking ponytail flapping in the wind. I grabbed the prescription slip, looked at it for a few seconds, then crumpled it up and threw it in the trash. As I was walking out, one of the office staff behind the desk asked what my availability was for a follow-up appointment two weeks later. I replied "Actually... I don't need a follow-up. And I would like it if you did not bill me for that visit -- I don't think I was actually seen today."
References:
Moore, G. & Wasson, J. (2007). The Ideal Medical Practice Model: Improving Efficiency, Quality and the Doctor-Patient Relationship. Family Practice Management. 14(8), 20-24.
Lin, C.T., Albertson, G., & Schilling, L. (2001). Is Patients' Perception of Time Spent with the Physician a Determinant of Ambulatory Patient Satisfaction? Archives of Internal Medicine. 161(11), 1437 - 1442.
Peer, M. & Mpinganjira, M. (2011). Understanding Service Quality and Patient Satisfaction in Private Medical Practice: A Case Study. African Journal of Business Management. 5(9). 71 - 80.
Anderson, R., Barbara, A., Feldman, S. (2007). What Patients Want: A Content Analysis of Key Qualities that Influence Patient Satisfaction. Medical Practice Management. March/April 2007. 255 - 261.
Clark, P. A. (2003). Medical Practices' Sensitivity to Patients' Needs: Opportunities and Practices for Improvement. Journal of Ambulatory Care Management. 26(2), 110 - 123.
Vogus, T. & McClelland, L. (2016). When the Customer is the Patient: Lessons from Healthcare Research on Patient Satisfaction and Service Quality Ratings. Human Resource Management Review. 26(1), 37 - 49.
Melichar, L. (2009). The Effect of Reimbursement on Medical Decision Making: Do Physicians Alter Treatment in Response to a Managed Care Incentive? Journal of Health Economics. 28(4), 902 - 907. read more