Medicare Cost-Saving Study Revisited

Background

Yesterday I had an entry about a study Medicare carried out in an effort to save money. I was more or less merciless in my criticism of the study- both the design and the validity of the conclusions. In short, it would be surprising to find a short-term cost-saving in patients with chronic medical conditions such as diabetes and heart disease by simply having nurses call the patients to encourage them to receive appropriate medical care. In fact, I would have predicted the initial costs would go up if the telephone calls worked since patients would likely use the health care system more.

I stand by that statement, but I should have added something about the health care benefits of telephone calls, e-mails, etc., to patients with chronic medical disorders.

Does patient care reinforcement help?

There is no question that frequent patient contact by health care providers who know the patients well can enhance medical care. Sometimes it’s just a quick call to see how a patient is doing with their new treatment plan. Sometimes it’s a call to find out if the patient is doing better with their care. Many physicians and other health care providers now use e-mail communication with patients to serve the same basic purpose as telephone calls. I have been quite surprised that quite a number of my patients who already use e-mail (about 90% of my patients have e-mail access and about 60% use e-mails quite regularly- it’s a whole new world out there), communicate regularly with me about this or that- sometimes it’s about their diabetes and sometimes it’s something exciting in their lives such as getting a new car, running a marathon, etc.).  I am particularly impressed by how many of my teenage patients send me e-mails regularly and I am convinced (not a  scientific study) some of my greatest “problem” patients have improved their care simply by the back and forth communication.  It’s rarely anything prophetic I tell them to do, it’s just knowing that I care.  Anyway, I just wanted to set the record straight- in general, I am a strong proponent of patient care reinforcement (positive reinforcement almost always works better than the negative type) which can be a powerful treatment tool, whether it’s done with a telephone call, an e-mail,a letter, or a brief follow-up clinic visit just to see how things are going

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