By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    stress management for healthcare workers
    3 Tips For Healthcare Professionals: How To Stay Beautiful, Healthy, and Happy
    November 2, 2021
    importance of relaxing on the weekend for your health
    Importance of Relaxing During the Weekend for Optimal Health
    March 25, 2022
    LASIK Eye Surgery
    What Is LASIK Eye Surgery?
    May 16, 2022
    Latest News
    6 Easy Healthcare Ways to Sit Less and Move More Every Day
    September 10, 2025
    7 Most Common Healthcare Accreditation Programs: Which Should You Use?
    August 20, 2025
    Hospital Pest Control and the Fight Against Superbugs
    August 20, 2025
    Hygiene Beyond The Clinic: Attention To Overlooked Non-Clinical Spaces
    August 13, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Heroism in Harm’s Way
    February 21, 2015
    5 Things Every Trainee GP Should Know
    August 27, 2019
    Top 5 Facts About CPPA Accreditation
    April 9, 2015
    Latest News
    Healthcare at a Crossroads: Why Leadership Matters More Than Ever
    September 9, 2025
    How Social Security Disability Shapes Access to Care and Everyday Health
    August 22, 2025
    How a DUI Lawyer Can Help When Your Future Health Feels Uncertain
    August 22, 2025
    How One Fall Can Lead to a Long Road of Medical Complications
    August 22, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Fragmentation: The Enemy of Patient Outcomes
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Policy & Law > Health Reform > Fragmentation: The Enemy of Patient Outcomes
Health Reform

Fragmentation: The Enemy of Patient Outcomes

tkilpatrick
tkilpatrick
Share
7 Min Read
SHARE

My friend’s dad was advised by his cardiologist that he needed a coronary angioplasty procedure. My friend and his family pushed back with their dad, telling him it was too much of a risk with his advanced stage coronary artery disease.  The cardiologist comforted my friend’s dad by describing it as a common procedure, citing his quality scores and reminding him that he has never lost a patient. Against the advice of his family, he had the procedure. Two weeks later, my friend lost his dad. The cardiologist, according to the quality measures, has still never lost a patient.

My friend’s dad was advised by his cardiologist that he needed a coronary angioplasty procedure. My friend and his family pushed back with their dad, telling him it was too much of a risk with his advanced stage coronary artery disease.  The cardiologist comforted my friend’s dad by describing it as a common procedure, citing his quality scores and reminding him that he has never lost a patient. Against the advice of his family, he had the procedure. Two weeks later, my friend lost his dad. The cardiologist, according to the quality measures, has still never lost a patient. The procedure may have been a success by the quality measures. Our fragmented healthcare system doesn’t track patient outcomes two weeks later.

Health and Human Services Secretary Sylvia M. Burwell announced in January that Medicare will change the way it pays hospitals and doctors by rewarding quality over volume. We all want quality, yet Medicare tying more payments to promoting fragmented quality measures continues to ignore the most important quality measure, the patients’ quality of life.

I heard Dr. Atul Gawande speak at a conference say that “if you purchased parts from BMW, Mercedes and Ferrari and assembled it yourself, you would own a very expensive car with poor performance.” His analogy to our fragmented healthcare systems will still apply if we tie payment to quality measures and value while ignoring patient recovery and well-being outcomes.

More Read

Debate Over Doctor Shortages
Dual Eligibles in the U.S.: Statistics and Facts
5 Key Elements of the Peer Review Process
Healthcare Insurance Marketplaces: What You Need to Know
Medicare Cuts: Hospitals Don’t Make It Up on Volume

Dr. Gwande’s, the author of the new book Being Mortal, stresses the need to begin focusing on the patient’s well-being. Dr. Gwande writes that members of the medical profession, himself included, have been wrong about what their job is. Rather than ensuring health and survival, it is “to enable well-being.”

He tells the story of his dad, also a surgeon, during the final days of his battle with cancer. “For my dad, it was, ‘Try to take away my pain and then if it’s possible, try to make it possible so I can still Skype with my friends and my family in India, you know or have a dinner party.’ He still Skyped even the day he died.”

The Medicare goal is to have 85% of all Medicare fee-for-service payments tied to quality measures or value (total cost) by 2016, and 90% by 2018. In addition, Medicare has a target of 30% of Medicare payments tied to quality or value through alternative payment models by the end of 2016, and 50% of payments by the end of 2018. Alternative payment models include accountable care organizations (ACOs) and bundled-payment arrangements under which health care providers are accountable for the quality and cost of the care they deliver to patients over time.

These new Alternative payment models should help to begin reducing fragmentation. ACOs reward primary care physicians who effectively manage patient care over 12 months, measured by a lower overall cost (i.e., less ER visits, hospital admissions). Bundled Payments reward bundle initiators (typically hospitals) who effectively manage patient care beginning with the inpatient admission through the 90 days after they leave, also measured by a lower overall cost (i.e., less ER visits, hospital readmissions).

To improve patient outcomes (and reduce fragmentation), the Alternative payment models must go beyond quality measures and value. They need to ask patients to evaluate their overall outcome.  Did the patient recover from their acute conditions (i.e., heart procedure)? Did the patient with chronic clinical conditions achieve their level of well-being? A low cost Medicare service could simply ask 5 “Patient Well-Being” questions 4 times a year to patients via phone, web or text.  While many of us have become proficient at ignoring these “after service” customer satisfaction calls, we all have a major stake in improving patient outcomes and reducing fragmentation.

Patient Well-Being

  1. How do you feel physically? Pain, nausea, health concerns or worries
  2. How do you feel emotionally? Mood, sentiment, health outlook
  3. Are you functional? Walking, talking, working, activities of daily
  4. Are you functionally able to achieve your purpose and meaning in your life? i.e., pursue passions, be a parent, run a marathon, work, etc.
  5. How would you rate your overall health?

Patient Recovery

If the patient had a procedure or hospital stay, they would get 3 additional questions:

  1. How was the effectiveness of your procedure or treatments?
  2. How was the performance of your providers?
  3. How would you suggest improving performance?

The eight questions could easily be added to the quality measures Medicare already collects. With 80% of the determinants of healthcare outcomes not related to clinical care, people will need to realize that some patient outcomes may not be a direct result of the physician or hospital.  Patient outcomes could be sorted by treatments, clinical conditions, age, gender, physician, and hospital. Patients could understand how people feel before and after a hospital stay or procedure. They could evaluate the effectiveness of treatments and providers.

Reducing fragmentation requires measuring patient recovery after a procedure (i.e., coronary angioplasty) as well as the patient’s well-being (e.g., able to Skype with friends and my family). A single company (Acxiom) has 1,500 pieces of information on more than 200 million Americans, yet we don’t know if patients get better after procedures or hospital stays. Patients assigned to ACOs or bundled-payment arrangements are the perfect place start asking their opinion of their outcomes.

Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

a woman walking on the hallway
6 Easy Healthcare Ways to Sit Less and Move More Every Day
Health
September 9, 2025
Clinical Expertise
Healthcare at a Crossroads: Why Leadership Matters More Than Ever
Global Healthcare
September 9, 2025
travel nurse in north carolina
Balancing Speed and Scope: Choosing the Nursing Degree That Fits Your Goals
Nursing
September 1, 2025
intimacy
How to Keep Intimacy Comfortable as You Age
Relationship and Lifestyle Senior Care
September 1, 2025

You Might also Like

employer insurance
BusinessHealth ReformPolicy & LawPublic Health

One More Way ObamaCare May Lead to Single Payer

May 12, 2014

Two Visions for Health Reform

March 2, 2011

How to Curb the Cost of Cancer Care

October 15, 2012
Health Reform

Medicare by the Numbers

April 18, 2011
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?