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If You’re Not Patient-Centered, Walmart Will Be

Published May 24, 2013 11:14 AM by Adrianne OBrien

Editor’s note: This blog was written by Anthony Cirillo, FACHE, a healthcare consultant and aging expert who helps CEOs connect the dots that start healthcare movements. Contact him at and learn more at


Two JAMA articles last month caused me to pause.

In the first, published online by JAMA Internal Medicine, a survey of almost 22,000 admitted patients at the University of Chicago Medical Center found patient preference to participate in decision making concerning their care was associated with a longer length of stay and higher total hospitalization costs. 

Hyo Jung Tak, PhD, and colleagues examined the relationship between patient preferences for participation in medical decision-making and healthcare utilization.

"Preference to participate in medical decision-making increased with educational level and with private health insurance," the authors noted. "…Patients who preferred to participate in decision-making concerning their care had a 0.26-day longer length of stay and $865 higher total hospitalization costs." 

"That patient preference for participation is associated with increased resource use contrasts with some perspectives on shared decision making that emphasize reductions of inappropriate use."

Hold that thought. 

The second study in the same publication examined a national survey sample of adults who had discussions with their physicians in the preceding two years about common medical tests, medications and procedures. The conclusion: the discussions often did not reflect a high level of shared decision-making. 

Floyd J. Fowler, Jr., PhD, from the Informed Medical Decisions Foundation and the University of Massachusetts, Boston, conducted a 2011 survey of a cross-section of U.S. adults 40 years or older and asked them to indicate whether they reported making one of 10 medical decisions and to describe their interactions with their physicians concerning those decisions. The decisions included: medication for hypertension, elevated cholesterol, or depression; screening for breast, prostate or colon cancer; knee or hip replacement for osteoarthritis, or surgery for cataract or low back pain. 

"…We saw great variation in the extent to which patients reported efforts to inform them about and involve them in 10 common decisions," the authors wrote. "If shared decision-making is to be one defining characteristic of primary care as delivered in medical homes, primary care physicians and other healthcare providers will need to balance their discussions of pros and cons to a greater degree and ask patients for their input more consistently."

Wow. How do you balance those two studies?

It seems that while the industry talks a lot about being more person-centered, the second study would conclude that we clearly are not. (Don’t wave HCAHPS scores in my face.) And the first study would seem to indicate the industry might have even more incentive to not be person-centered because it costs too much.

Will the HCAHP reward/penalty be less important than readmission and length of stay costs? Will leaders do the knee-jerk reaction and cave to the finances? How much will things get worse when this influx of patients everyone is anticipating actually happens? It scares me as a potential patient and a healthcare professional.

If we cannot become more person-centered, other industries are waiting in the wings. In one of my recent Hospital Impact blogs, I lamented, "hospitals have missed the boat again. I wrote in March of 2006 about a hospital's place in the wellness movement. I wrote in July of 2007 about the retail clinic revolution….The fact is the wellness industry is now owned by the Whole Foods, the Targets …. and the Walmarts of the world."

Just a month later, The Advisory Board Company backed me up. In a video entitled "Are You Ready to Compete With Walmart?", Lisa Bielamowicz, MD, their chief medical officer, said that Walmart could become your most formidable competitor. They are entering primary care with a vengeance, aiming for a full primary care presence in rural markets in 5 years. And after all, a third of your patients shop there.

The "what if’s" she outlines are fabulous. View the video. She concludes that "health systems need to fundamentally shift their growth strategy because the basis for competition is about to radically change." She says that the industry must promise and deliver better value. (How’s that working so far in light of the JAMA studies?) As she says at the end, if you can’t offer your consumers a high-value experience, someone else will.


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