A Provider's Choice.....

Our current healthcare system functions in a dichotomous relationship between two major, but independent variables. These variables encompass the gray zone most clinical healthcare practitioners find themselves in on a daily basis, and they are the balance act that all healthcare professionals must juggle. These variables of course are the relationship of management driven versus patient-centered care.

Management driven care often comes down to productivity standards – aka how many people you’ve seen per week and the revenue generated from those visit numbers. This is not necessarily a bad thing as the lights have to stay on in the clinic for healthcare practitioners to distribute any care at all. The problem comes about when this is the sole determinant of patient care. This can in part be due to greed, but more likely, reimbursement issues with insurance (denials, extension issues with plans of care, etc.).

It is no secret that management driven care can lead to the development of patient factories where substandard and cookie-cutter care is delivered to patients. A sidenote, but extreme example: Imagine treating most of your patient caseload with the same interventions and/or modalities irrespective of the acuity of the pathology, the location of the joint/soft tissue involvement itself, or even INDEPENDENTLY of the injury diagnosis and disease pathology! That’s a problem and should never happen to our patients (it should be noted that caseload and documentation requirements, for both CYA and insurance regulations, can lead to this situation. This situation doesn’t usually present itself because of healthcare professionals’ willful engagement in this behavior as it promotes a burnout culture of volume before results).

Patient-centered care is the exact reverse of the above situation, and it involves an environment of where the best and CURRENT evidence-based practice (aka taking patients goals, healthcare providers experience, and current literature into account) is executed by the healthcare practitioner for that patient’s welfare. This kind of care doesn’t consume itself with billable units to the degree that management driven care does, which can be problematic in the short-term from an institutional growth standpoint. However, valued care is delivered each and every treatment session from the health professional as if the patient was an indoctrinated family-member of their own, which can lead to more long-term growth institutional growth for a myriad of reasons and opportunities that won’t be discussed here.

This approach can be taken to the extreme, however, and result in employees costing institutions more money than they produce due to a patient first, institution second clinician mindset. This can then snowball into a host of institutional problems (anywhere from lack of funding for research, continuing education, and so on, to ultimately, employee(s) termination due to budgetary concerns within a department) which then promote a dissatisfied, resigned, and complacent employee workplace. A workplace that may even welcome the first refreshing job opportunity which comes their way.

The above scenarios illustrate the need in moderation between both of these approaches. Money doesn’t grow on trees, and patients shouldn’t be viewed as numbers or a means to an end, but rather, the unique individuals that they are. All healthcare professionals should be prompt to remind themselves of why they got into the profession, but aware of the system in which they operate under too. Recognition of these variables will assist the healthcare professional in being cognizant of the barriers to patient-centered care so that potential opportunities and solutions to circumvent the management driven philosophy that institutions will otherwise impose can be implemented. Additionally, recognition of these variables can ultimately assist those healthcare practitioners who do not participate in the institutional structure, at least to the rigid nature portrayed above (i.e. direct access physical therapists), the opportunity to identify potential pitfalls in their business model and practice while still delivering the value-based care that is needed to sustain it.