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Greetings to all Learn & Perform subscribers,

Welcome to the Learn and Perform E-News! This is Palan, the contributing editor for this month.

In this E news, we will cover the following:
1.The Value of Doctors Talking to Patients
2.SMR News
The Value of Doctors Talking to Patients

In the latest article of Harvard Business Review, Michael Blanding reiterates the importance of doctors spending more time with the patients. There is a need for longer visit with doctors. Such a thing before the procedure can do wonders for patients. Unfortunately, sometimes, doctor visit can be like the assembly line. This could be attributed to the compensation system itself. According to the author, the fee-for-service model of American medicine doesnt put much value on long doctors visits, which arent as profitable for providers as performing costly medical procedures. This could be true for most part of the world too. And thats a problem, argues Senior Fellow Robert S. Kaplan, the Marvin Bower Professor of Leadership Development, Emeritus, at Harvard Business School.

If doctors cant charge for doing certain things, they tend not to do them even when they can make the patient better off, he says. On the other hand, sometimes doctors do things they shouldnt, just because they can charge for them. Its a very dysfunctional system.

It becomes obvious that you can make the tradeoff to spend more time earlier to prevent high-cost incidents that could occur later Excerpts from the article. Kaplan, who has been working on a multiyear project with HBS Professor Michael E. Porter on improving value in health care, has found that often the most effective medical procedure is one that costs the least: talking.

In a recent article in the New England Journal of Medicine, titled Adding Value by Talking More, Kaplan, along with HBS project director and Fellow Derek A. Haas, and former senior researcher Jonathan Warsh, demonstrates again the old adage that an ounce of prevention is worth a pound of cure. By spending more time talking patients through procedures beforehand, physicians can cut down on recovery costs and avoid costly complications later on.

Once you take this perspective, it becomes obvious that you can make the tradeoff to spend more time earlier to prevent high-cost incidents that could occur later, says Kaplan. He says incentives are misplaced emphasising the age-old HR contention that you must ensure incentives drive performance.
In one study, for example, Kaplan and Haas looked at the cost of joint-replacement surgery at 30 large orthopedic hospitals across the United States. In some hospitals, patients were discharged to high-cost skilled nursing facilities for their recovery, where they could learn how to walk, climb stairs, and get into a car with their new knee or hip. In other hospitals, however, those skills were discussed in a 30- to 60-minute conversation in the doctors office before the surgery and then practiced during the post-recovery stay in the hospital. This enabled the hospitals to discharge almost all of their patients to inexpensive home health recovery rather than to very costly skilled nursing facilities. And the outcomes were generally better with home rehabilitation.

Maybe that pre-surgical conversation costs an extra $100, in a physicians or nurses time; but if you can save $5,000 in rehab, thats a no-brainer, says Kaplan. Because the post-acute care recovery costs werent borne by the hospitals, they had not been motivated to find the low total cost alternative. After Kaplan pointed out the discrepancy, some hospitals switched to the lower-cost pre-surgical consultations.

So why arent more physicians in hospitals and clinics talking with patients as part of the therapy The incentives for doing so are missing.

Kaplan sets up the following example. Say you, the doctor, charge $100 for an office visit. The economics of the office dictate that to stay in business, you need to bring in $400 an hourthats four office visits of 15 minutes each. The length of the visit is determined not by the benefit to the patient, Kaplan says, but what they must do to stay in business, given the pricing scheme.
Adding to the difficulty is that doctors and hospitals usually do not bear the eventual downstream costs of shorter visits. Because of the fragmented way, we deliver and pay for care, no single provider internalizes the total cost of treating the patient, he says.

Some clinics and hospitals are starting to learn these lessons, experimenting with new models of care that emphasize more talking up front. We need more entrepreneurship within the health care system to set up these more holistic and longitudinal ways to treat patients, Kaplan says.
To read the full article:  
visit Newsletter 03-01-2017 (1)-March 01, 2017

SMR News
Cyberjaya University College of Medical Sciences (CUCMS) offers a holistic medical programme. The goal is to develop caring physicians. Visit
For details email

Asia Metropolitan University also offers highly engaging medical programmes. Visit
For details email

Will be in touch soon.

Best wishes,
Contributing Editor, Learn & Perform E News

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