The chasm between providers and non-providers in health care may be deeper and wider than anyone can imagine.  The differences in priorities, cultures and motivations are astounding.

Take for instance a recent article in the Harvard Business review titled “Making Appointments Fast and Easy Must be Health Care’s Top Priority”.  The piece was submitted by Jonathan Bush the CEO of athenahealth, a provider of health care services such as EHRs and billing.  In the article Mr Bush asserts that fast and easy appointments should be the focus, or keystone habit, of every health care system in the US.  The author begins with a subtle trashing of the “Triple Aim” which originated from the Institute for Health Care Improvement in 2008.  The Triple Aim suggested that the focus of health care systems should be to 1) Improve the patient experience, 2) Improve the health of populations and 3) Reduce the per capita cost of care.  The Harvard Business Review article even contains a seemingly sarcastic association between the Triple Aim and “motherhood, apple pie and the Stars and Stripes”.  The contrast between Mr Bush’s (a non-provider) quick access keystone habit and The Institute for Health Care Improvement’s (providers) goals are striking and revealing.  Mr Bush’s push is to get patients into a broken system as quickly as possible.  The Institute for Health Care Improvement implies that the focus should be on fixing the system first.

Can there really ever by alignment between providers and non-providers?  Probably not.  Consider the training, job description and motivations of all involved.  Providers are trained to provide health care to patients in need.  They are trained to review complex scientific literature and make decisions for patients.  Their loyalties are first to their patients.  Non-providers, such as those in the health care services industry, are business people who are trained to make money and their entire motivation is a bottom line.  Their loyalties are first to the corporate bottom line (See Self Serving Interests).  It is not surprising that a health services company would focus on quick access.  It’s what they do.  They can sell quick access via their services.  It is how they improve their bottom line.  It also provides non-providers with a metric that they can manage in an era where their cash cow wRVU metric is rumored to be obsolete.  Both metrics, quick access and wRVUs, measure and drive utilization – nothing more.  Nothing to do with quality or value.

There is no question that access is important.  There are certain conditions which require immediate access for better outcomes.  On the other hand there are a lot of medical conditions that are emotional emergencies but do not require immediate care.  And yes patients have come to expect on-demand care for even the most trivial conditions.  However, forcing non-urgent conditions into immediate care helps no one.  This expectation of immediate care is better addressed with educational initiatives.  As mentioned in a comment following the article most patients, if properly educated, are likely to understand that their care will be better, less rushed and likely more affordable with the appropriate timing.

So the Harvard Business Review article exposes the chasm between providers and non-providers with respect to how to improve the health care system.  It’s time to educate patients (i.e. the paying customer) and let them help define the future of health care.  Do they simply want the quickest access possible to a dysfunctional system?  Or are they smarter than that and willing to wait (when appropriate) for quality?

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