I want healthcare like my dog!!

Thursday, June 6, 2019 | Joel Sauer

Roxy is an Australian Shepherd mix that has been part of the Sauer family for 16 years now. In case you don’t know, that’s a really long time in dog years!  Our three adult children barely know life without her. She was there for most of their childhoods, nervously watched them go off to college and then form lives of their own, and now ecstatically welcomes them “home” for visits. 

At least part of the secret sauce behind Roxy’s longevity (beyond over-doting parents who went to crazy lengths to keep her healthy) has been outstanding veterinary care.  We have never missed beneficial regular checkups, vaccinations, heart worm prescriptions, rabies shots and distemper updates, not because my wife and I are such great organizers, but because Roxy’s vet never lets us forget!  We regularly and without fail receive postcards and text messages notifying us that it’s time to bring Roxy in and exactly what she needs.  How often does this happen for your human care?

It gets even better.

When we call to get an appointment, a human being answers the phone, not a complicated phone tree with more options than Roxy’s kidney pill regimen, and books us a slot within the next couple days.  If we’ve needed urgent care it’s been rare that we don’t get in the same day and with that single phone call – not “let me talk to her nurse and call you back”.  On arrival to the office we are greeted warmly by people who genuinely seem to love being there, with no lines or the ubiquitous plethora of signs stating “Do Not” or “Effective Immediately” or “No” or “Payment in Full”. 

Maybe twice in 16 years have we been seen more than 15 minutes past our appointment time, even in the urgent situations.  The process is slick and efficient, the doctor thorough and empathetic.  There is no sense of haste or pressure to get somewhere else – questions are welcomed and answered in detail.  When we leave, we have everything we need and fully understand what needs to be done for Roxy until next time.  There’s no need to set reminders in our calendars for follow-ups or test results because we have learned to trust their systems will take care of it, which is a very reassuring feeling.  If she’s needed specialty care beyond our vet, like surgery, it’s all been arranged and coordinated on Roxy’s behalf to the point where we feel it was provided by the same company.

Now I can already feel the collective eye rolls and indignant exasperation on what an unfair comparison this is.  Like you, I can quickly come up with scores of reasons human care is more complicated, higher stakes, and with dizzying economics.  But is it?  Why can’t I as a human being have care delivery like Roxy?   Is it really impossible to provide high quality, accessible, compassionate, well-coordinated and high-touch care to human beings?  As a country that spends more than any other nation on the earth for its healthcare, shouldn’t this be what we expect?

For sure THE major obstacle in people care is the way we get paid.  A system that rewards units of “things” – and pretty much only “things” – should expect to receive things, a lot of things. Human beings respond to their incentives, which isn’t evil, it just is.  Heck I’ve made a very good living throughout my career leading or teaching organizations to respond to and maximize incentives.  As a consumer in our current healthcare system, I want for no things (meaning I get plenty of things).  Fundamentally this country needs to change the incentives in human healthcare to reward more than things. As consumers we want peace of mind, easy payment structures, welcoming environments, happy providers, regular and easy communication, care coordination and the like.  This is happening, but as we’ve all witnessed it’s coming very slowly – too slowly for us to wait on it. 

Roxy responding to incentives and posing to receive a treat. 

Despite this, we can start to make changes immediately.  Here are just a couple things that will continue to nudge us down the path of patient centered care. 

First, let’s govern our care through the lens of the patient.  No really, not just lip service or billboards, but really re-orienting our governing structure to consider the patient first.  Every meeting should open with a review of the agenda from the perspective of the patient; what matters, how they will be impacted and can we deliver in a high-quality, comprehensive and high satisfaction fashion.  Let’s include patients in our planning meetings, particularly when considering new services or programs, getting their input at the beginning not after the infrastructure is up and running, which is much more difficult to change. 

A recent article in the NEJM Catalyst provides very simple examples of what care with the patient at the center really means.  Another by the Picker Institute & Harvard Medical School describes eight principles of patient centered care.  What’s striking to me is how large a role simple communication plays in each – and is what I would identify as the magic ingredient in Roxy’s veterinary care.  Communication is all about being accessible (both in person and electronically), providing information and education, coordinating care, including family members, etc.  This is not how most of today’s provider organizations are oriented which means recalibrating our governance structures to focus in on and around the patient.  

Second, we can commit to quality – really commit, even when it’s expensive, not required or not perfect. 

A recent JACC article highlighted the costs and burden of public reporting for PCI outcomes measures.  The article reviewed a study of the cost and burden index for certain public reporting requirements in the state of Massachusetts. It found that the median cost is between $100,000 and $200,000 per institution per year.  It goes on to note that it was challenging for the researchers to tease out what portion of these costs, if any, were also part of the overall cost for registry participation.  The article’s conclusions are that public reporting requirements of PCI mortality impose “financial and administrative burden” and have “not been shown to improve care or outcomes”. 

While none of us want to waste time or money on things that don’t work, I can’t help but wonder what an appropriate investment in quality should be for a service (PCI) that costs Medicare on average around $20,000* per procedure.  For open heart surgery the average cost doubles to more than $40,000 per procedure*.  In CV services lines that measure revenue in the 10s of millions of dollars, is several hundred thousand dollars in quality collection and reporting costs “burdensome”?  Would it be appropriate to spend more on quality than on marketing?

Recently CMS stopped requiring registry participation for facilities to perform ICD implantations.  Shortly thereafter, the ACC noted a significant drop in ICD registry participation.  Is that the right response?  Granted, it may be that the registry missed the mark for truly helping organizations improve quality, but when that’s the case is dropping participation the correct answer?  Does that send the right message about our commitment to quality?  Are we as healthcare organizations able to prove our quality, or just presuming it?  The answer to me matters. 

In my travels as a consultant, I have the privilege of seeing up close and personal anywhere from 30 – 50 CV programs each year.  What I find all too often in those travels are organizations that participate in myriad cardiovascular registries, but the data are tightly held in quality departments and rarely get in front of the people on the front lines who really need it.  At least a part of the answer to making quality less burdensome is to leverage the power and data of our investments.  In her latest blog, my colleague, Ginger Biesbrock, highlights just how to do this.

Last, let’s not make perfect the enemy of good enough.  When data – particularly financial and operational – aren’t spot on or even just plain off the mark, as healthcare providers let’s commit to reworking them or finding effective alternatives, not just abandoning them.  We certainly have resources both within our organizations and without (such as the ACC, STS) to help.  Let’s stop just rejecting without an alternative.  No this isn’t easy, but that’s what commitment will do.  It’s what our patients need too. 

When thinking of imperfect data, patient satisfaction surveys immediately come to mind, particularly HCAHPS.  My guess is if they weren’t mandatory most facilities would drop participation like a hot potato.  Here again if we want to be patient focused I believe we must get organized and seek valid feedback from our constituents.  Our cultures should embrace this communication and guidance, not consider it a burden or chore. 


Roxy has received excellent vet care throughout her long life, with providers who have been easy to access, provide regular communication and coordinate her care when she’s needed advanced treatments.  Her providers have been friendly with a genuine sense that they love their jobs, took the time she and we needed to understand her care, and did so with both empathy and compassion.  This has brought her family lots of peace of mind and satisfaction. 

While it won’t be easy to achieve the same within our human health system, it’s certainly worth pursuing and we can start with reorienting our governance structures and embracing our data – both the empirical and the imperfect.  My guess is that if the provider community doesn’t make it happen, forces outside our family will.  This pressure could come from Apple, Google, Optum or Haven, or it might just come from {gasp} our patients! 

Roxy, with great health peace of mind, sleeps stress free


*Archway Health, source Q1 – Q4 2017 CMS Limited Data Set

Illustration: Lee Sauer

About the Author
Joel Sauer

Joel Sauer, MBA, is Executive Vice President of MedAxiom Consulting. Joel consults around the country in the area of value-oriented physician/hospital partnerships preparing health organizations for the value economy. His work includes vision and strategy setting, creating and implementing effective governance and leadership structures, co-management development, joint venture and other innovative partnerships, and provider compensation plan design. Beyond the above, Joel has a wealth of experience in service line development, clinical strategy development, provider workforce planning; including care team creation and physician slow-down policies, MACRA and bundled payment planning, and operational assessments.

To contact, email: jsauer@medaxiom.com


Posted by: Bonnie Bosler on June 10, 2019 @8:44:03 am

Thank you for the exceptional article which gives us a different view. As a dog "mom" I can attest to everything that you say and in reality it also applies to the insurance company that I utilize for them. It is one call and they care.

Posted by: Ed Fry, MD, FACC on June 9, 2019 @2:45:22 pm

Great blog post. Ironically your message was "humanized" by reference to your dog! The other important aspect of healthcare that vets do better than human doctors is palliative and end of life care through dignity and respect for the patient, as well as comfort and respect for the family.

Your discussion of registries and how they are used could be (and should be) the subject of 5 more blogs, at least. As we see the threat to the registries through the prism of the ACC, we see how participants are really missing the opportunity to get their ROI and to leverage the power within the data. Is that a failure of the user or a failure of the registries' sponsors? I think both, although any failure of the user to appreciate the utility of the registries ultimately falls back on the registry authors and sponsors for having failed to educate the user and failing to have made the registries a seamless part of the daily work flow.

All the registries and their sponsoring organizations need to do some serious soul searching and to take on a consumer focused approach that makes their products indispensable in the optimal delivery of care. Failure to do so will cede the registry "market" to EHR vendors, large health systems, payers, and regulators. Today, the majority of registry subscribers view them as necessary evils of compliance and reporting. As those drivers become either no longer required (such as ICD) or are viewed as of less value (ACTION), participants are more than ready to walk away, viewing doing so as an easy cost avoidance - which many of the registry users are now measured on and rewarded by their parent institutions. This clarion call has been made at the level of the ACC BOT but must be repeated often and loudly to get notice and to induce action.

The JACC article referenced and the experience of public reporting in MA is a disservice to the field of Process Improvement. Inefficient, silo'ed data collection and lack of use of the registry data in that setting (several of the institutions being academic centers), grossly underestimates the power embedded in the registries that has not been fully exploited. This (shortsighted) example must not become the rationale for others to abandon registries as a critical tool for their institutional quality improvement. MedAxiom must be the key vehicle to translate the content of clinical registries into actionable results that is the engine for better and more patient focused care (like your dog!).

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