Discussion 2: Implications of Healthcare Reform: 'No†Will Be Heard

“Implications of Healthcare Reform: ‘No’ Will Be Heard” is led by Cliff Goodman, PhD, in a panel discussion featuring A. Mark Fendrick, MD, co-editor in chief of The American Journal of Managed Care, John L. Fox, MD, MHA, and Ira M. Klein, MD, MBA, FACP. The panelists determine what it means when a patient says “no.”

Dr Fox says that payers don’t want to be in a position that interposes them between patients and providers. “We can’t expect that patients are always going to make rational decisions, but we can certainly expect that patients be afforded the opportunity to make their choices known, and to have their choices respected.” Dr Fox adds that the challenge is that all too often, patients don’t have the opportunity to make their decisions known until it is too late.

Dr Ira Klein agrees with Dr Fox, saying that the “no” conversation between providers and payers is sometimes necessary. “The patients are often, and this is not their fault, not fully informed as to what it is that is requested, and what the repercussions and ramifications are,” says Dr Klein. “How people feel about care affects utilization, and for them to feel anything about care, they have to understand care and there has to be a little bit more transparency. So it doesn’t mean we’re going to take all our patients and turn them into amateur oncologists, it just means that they should have access to a little bit more understanding about what it is going to happen to them from the beginning, the middle, and the end.” He adds that how and when you say no is related to the stakeholders at hand.

Dr Fendrick then asks, “When does no really mean no?” He suggests that having the “no” discussion, which is actually pretty rare, to shift from “easier to get, to less to get.” He says that it is important for all stakeholders to ration harmful care, or care that is known to be harmful.

The panelists continue discussions on issues including the impact of healthcare reform and payment delivery on patient engagement, and how “no” might lead to problems such as underuse.