The Patient Customer


Lyndon Johnson signing Social Security Act to create Medicare program in 1965

The Patient Customer

Disruption, the phrase we hear so much in today’s business world has clearly sets its sights on the healthcare industry. No matter what side of the fence you stand regarding the Affordable Care Act (ACA) there is no doubt it has placed the proverbial wrench in the gears of a machine that shepherds the health of our citizens and is responsible for nearly 18 percent of our gross domestic product. It was in 1965 when president Lyndon B. Johnson signed the Title XVIII Amendment to the 1933 Social Security Act, creating Medicare program that over the years has manifested into what we have today. Medicare’s major impact on the American healthcare system is based not only on provider payments but also due to the effect the program’s policies have on other healthcare delivery systems. The Medicare fee schedule has become the basis for national health-care reimbursements for all physician services. History has shown the recent ACA legislation affecting Medicare will affect private reimbursement policies as well.

Due to the ACA, we are in the midst of a major philosophical shift pertaining to how the healthcare industry is compensated for their services. Value-based care has emerged as an alternative and potential replacement for fee-for-service reimbursement based on quality rather than quantity. Exactly what “quality of care” is can be debated but how it is calculated has been made clear by the Centers for Medicare & Medicaid Services (CMS) with value-based care being the conglomeration between Core Measures (national standards of care and treatment processes for common conditions) and HCAHPS (Patient Experience) performance. While Core Measures are based on scientific evidence HCAHPS are based on the patients perspective. The combination of these two assessments have financial and branding consequence as transparent reports and survey results become payment modifiers and published star rankings.

In the burgeoning world of pay for performance healthcare the patient’s experience has clearly taken a central role beyond their clinical outcome. This new wrinkle has many hospitals struggling to define the newly empowered individual at the center of care. Are they a patient, customer, partner or client? Although this debate has gone on for years it has recently been accelerated by the arrival of value-based care and moved from an ideological discourse to an issue with bottom line ramifications. The varied questions in the Patient Experience Survey (HCAHPS) go well beyond the scope of doctor patient interaction and now all employees become ambassadors of the hospitals brand and subsequently directly connected to reimbursements. This challenge may be new to the healthcare industry but has been a constant focus for private sector businesses throughout history. Please continue to follow this blog as we explore the challenges and solutions in the rapidly changing world of the patient experience.


Patrick M Quan/ CEO Artisan Marketing Group