Physicians given the opportunity to read their patients’ feedback on the effectiveness of treatment don’t review them, say researchers.
Patient-reported outcome measures (PROMs) are the unfiltered responses of individuals regarding a clinical health encounter on a questionnaire. The use of PROMs is promoted by the Centers for Medicare and Medicaid Services and the U.S. Food and Drug Administration, and PROMs are being implemented by many health systems.
However, a study on the use of PROMs in a major health care system in Minnesota found that although about 60 percent of patients complete the forms, and they are available in the patient’s Electronic Health Records, only one percent of the questionnaires were accessed by clinicians.
‘Nothing to Gain’
The reason health care providers do not use the PROMs could be due to our third-party payment system, wrote Elise Amez-Droz, manager of the Open Health Project of the Mercatus Center at George Mason University, on April 7.
“Why don’t doctors care about these metrics?” wrote Amez-Droz. “Probably because they have nothing to gain from using them. Patients can’t reward or penalize doctors for performance. … The real customer is insurance companies.”
It could also be due in part to the growing shortage of primary doctors (see related article, page 7). Or perhaps doctors are already overburdened with paperwork.
‘Stick to the Script’
It is not surprising to see Minnesota doctors bypassing government-recommended patient reports that aren’t used in their employer’s performance evaluations, says Matt Dean, a senior fellow for health care policy outreach for The Heartland Institute, which publishes Health Care News.
“Doctors are under increasing pressure to see more patients and stay within the contours of best practices,” said Dean. “Minnesota, which brought HMOs (Health Maintenance Organizations) to the rest of the country, is more integrated, systematized, and compliant than nearly any other state. So, it isn’t surprising that docs stick to the script in the Gopher state.”
The Minnesota Legislature is considering a bill that would give patients a wider choice of physicians if they don’t want to entrust their care to physicians employed by a hospital system. The bill would compel hospitals to allow patients to be treated by their “trusted” physician, regardless of hospital privileges, as Health Care News reported.
The issue of patient choice moved front and center during the COVID-19 pandemic as patients and families had to go to court to allow family physicians to enter hospitals and to prescribe treatments such as Ivermectin that were not part of hospital protocols.
Doctors are well aware of the new realities of today’s health care system and the Minnesota study results reflect that says Twila Brase, president and co-founder of the Citizens’ Council for Health Freedom,
“Medicine today is dictated by corporate and government-imposed protocols, not by individualized and personalized care,” said Brase. “Corporate treatment protocols restrict treatment options and prohibit personalized care. Thus, if the patient reports good outcomes or bad outcomes, it’s likely because of the corporate protocol, not the physician who complied with it. If physicians can’t use their skills and critical thinking to treat a patient, why should physicians care about outcomes that are the result of a treatment protocol that the doctor is forced to use?”
‘An Elaborate Façade’
While the growing doctor-patient disconnect is real, Brase says she questions the value of PROMs and other mandated busy work that distracts doctors from their primary purpose of providing care to patients.
“First, looking at and evaluating PROMs data takes more time away from patient care than the government and health plans have already taken away with their myriad reporting requirements, which can amount to death by 10,000 clicks,” said Brase said. “Second, when CMS created PROMs, it was never meant to improve patient care. It was meant to make it look like the government cares about patients, but it doesn’t,” said Brase. “If government officials truly cared about patients and patient outcomes, they would get out of the way, eliminate bureaucratic processes and reporting systems … and they would let doctors be doctors that answer to patients and their own conscience, not bureaucrats and their corporate collaborators.”
Setting aside any potential merit to patients’ self-reported outcomes, Brase said doctors may feel the issue is moot.
“Given the imposition of standardized corporate treatment protocols, doctors may not be able to do anything differently if they want to get paid and stay in practice,” said Brase. “So, doctors could see the entire enterprise as an elaborate façade, which does not deserve their time or attention.”
‘Make Care Patient-centered’
Despite the challenges, patient-driven health care data can provide a path for improvement, says Dean.
“Individualized medicine offers and the technology surrounding it creates, unbelievable opportunities to truly make care patient-centered,” said Dean. “But the devil is in the data. Right now, data is the most valuable commodity on the planet. Your health data is worth more than gold. As patients track their steps, heart rate, calorie intake, locations, and purchases, this data is being captured and sold, mostly without the knowledge of the target.”
Unlike consumer data, such as purchasing history or internet searches, health data can be used against someone, says Dean.
“Insurance companies can use it to decide what, if any, care I get,” said Dean. “Machine learning applications might predict I am not going to be worth treating for medical or nonmedical reasons. Health data might be shared with third-party apps on my phone because I desperately clicked ‘accept all safety recommendations’ without reading the legal disclaimer on a picture editing app.”
Kevin Stone (firstname.lastname@example.org) writes from Arlington, Texas.