Engaging The Patient

Dr. James Merlino, Cleveland Clinic Chief Experience Officer

When I first heard the “Patients First” creed years ago as a fellow training at Cleveland Clinic, I thought to myself, “We’re doctors; when do we ever not put patients first?”

As I moved beyond my training and into practice, I encountered patients who were facing more than just a disease or a condition. They and their families were facing uncertainty, anxiety and fear.

I have learned that just trying to fix a patient’s medical problem—especially a chronic disease or a difficult diagnosis that could not be treated —and only focusing on the patient’s medical care was not enough. To be a successful clinician, I had to support the person, to support their family. I had to provide great caring.  That’s what it means to put patients first.

The realization was visceral, and to a large extent, it has animated my career.

But gut-level feelings alone do not drive premiere evidence-based institutions like Cleveland Clinic. As Chief Experience Officer, I must demonstrate an impact and measure value. And as we talk with other healthcare organizations nationwide, I must answer a simple question.

Why should top hospitals care about the patient experience?

Cleveland Clinic is a good example.

You can use the US News & World Report as a marker of quality if you want. You may argue about specific rankings, but if you accept that Cleveland Clinic is in the top 5 (Editor’s note: Cleveland Clinic is ranked #4 overall), then we can clearly be relied upon to provide excellent care. But realistically, if you live in the Midwest and are considering treatment at the Mayo Clinic, UCLA, Johns Hopkins or Cleveland Clinic, the quality of your care would likely be excellent at each of these options.

But will each hospital provide excellent caring? Will they show you empathy? Will they ensure that you won’t be treated as a number? Will they communicate with your family? Will they give you confidence about the care you are receiving?  When clinical outcomes are similar, patients may choose their healthcare facility based on its ability to deliver excellent, compassionate service.

Now let’s scale this up.

This level of caring especially makes a difference when dealing with insurers and private payers. We can go to Lowes, the retail giant with which Cleveland Clinic has a publicly reported contract, and assure them that we will do more than just provide high-quality health care to their employees. We can ensure that their employees are going to be cared for better. Additionally, our focus on the patient experience creates a return in new and more patients.

Patient experience is an important competitive differentiation in our business model. Striving to provide  an excellent patient experience is not only the right thing to do, it’s essential to the future of our organization.

But there’s more too.

Hospitals now must focus on improving patient satisfaction as part of reimbursement from the Centers for Medicare & Medicaid Services (CMS). HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems), the inpatient survey from CMS, is currently linked to ‘pay-for-reporting.’ That means the government processes Medicare claims from a hospital, and holds back 2% of your payment. When the hospital provides all the required HCAHPS process data, then it earns that 2% back at year-end.

That’s where we are now. However, in 2012, CMS will implement ‘pay-for- performance.’ This means providers will be financially rewarded or penalized based on performance in specific, evidence-based quality measures. The first pay-for-performance targets include core measures and HCAHPS. In other words, if you don’t meet a particular benchmark that’s measured against the top performing hospitals in the country, you will not receive that reimbursement back.

Currently, the bottom line financial return on improving the patient experience is a combination of market differentiation and ‘pay for reporting’ incentives. But right around the corner, financial reimbursement will be tied to benchmarked performance.

Ultimately, the story about patient experience is compellingly simple.

Think about patient experience as the right thing to do, and how you would like to be treated if you were the patient. Also understand that in today’s healthcare environment, HCAHPS performance is a government mandate and is a priority, because your institution’s financial performance will be affected by it.

That is the bottom line.

About James I. Merlino, MD, FACS, FASCRS

James Merlino, MD, is the Chief Experience Officer for the Office of Patient Experience, the Vice-Chairman of the Digestive Disease Institute and a staff colorectal surgeon at Cleveland Clinic. Committed to patient-centered care, Dr. Merlino has been working on several initiatives to improve access and communication since his July 2009 appointment as Chief Experience Officer to ensure that all aspects of the patient experience meet the highest standards.

He believes that Patients First is more than just providing great quality  medical care … it’s about caring with empathy and compassion, and paying attention to the physical and emotional component of health care as well.

Ultimately, he believes it is about treating your patients the way you would want your family members to be treated. Additionally, he is leading efforts to positively impact the employee experience to ensure that employees are engaged and satisfied, which will thereby impact the patient experience.

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