Eighty-give percent of physicians say that unmet social needs lead to worse health outcomes, according to a new survey sponsored by the Robert Wood Johnson Foundation. But only 20 percent are confident in their ability to help patients and their families meet those needs. Talk about good news and bad news!
The survey asked about a wide range of social services from employment assistance for younger, low-income patients to transportation and food assistance, the kind of help that is often critical to the frail elderly living at home. But whatever the assistance, it seems beyond the abilities of doctors to even to tell their patients and their families where they can get it.
This is not a surprise to seniors or their family caregivers. Too often, even primary care physicians are on an island when it comes to patient care. Too often, they see their job only as providing a medical solution to a specific complaint. But when it comes to helping a patient cope when she goes home, too many doctors are clueless.
This is a particular problem with the frail elderly who often suffer from multiple chronic diseases and may need personal assistance as much as medical treatment. Doctors often have no idea whether a patient with severe arthritis must climb stairs when she returns home. Similarly, physicians rarely know whether a patient with diabetes has access to proper foods or whether someone recovering from a stroke has transportation to her physical therapy appointments. And most often, docs have no idea whether their patients can manage complex medications.
It is easy to criticize physicians for their lack of knowledge and attention. But rarely are they trained to address these issues. And neither Medicare nor most insurance plans pay them to even ask about these critical needs, much less connect patients to people who can help.
Three of four docs surveyed said the health system should reimburse the expense of making those links. But it does not.
A few practices, some using the patient-centered medical home model, do address this gaping hole in the system of care. Nurse practitioners or physician assistants sometimes do help patients with making lifestyle choices and meeting social care needs. As medical homes catch on, we may see more doctors able to help where, as this survey shows, they recognize a real need.
For many patients, it wouldn’t take much. A few words of advice and a simple flyer that identifies local resources (with phone numbers and Web addresses) would do wonders. Letting patients know what caregiver support groups are out there, what information and referral services are available, or providing a list of local care managers would be immensely helpful. And they’d cost the doctor next-to-nothing.
Going a step further, providing coaching or direct care management services would make all the difference for frail elderly patients. The American College of Physicians has long recognized the importance of primary care practices providing case management to chronically ill patients.
Provisions of the 2010 health reform law such as Accountable Care Organizations and various integrated care models may encourage docs to take on this role. New rules that will penalize hospitals for excessive readmissions may provide financial incentives for medical systems to support better care management.
The good news from this survey is that most doctors recognize the need. Now, they need the right incentives and some training to make it happen.