Julie Fritz has spent years studying chronic back pain. One of the things that the longtime physical therapist and researcher has discovered is the significant disconnects between what providers and patients value. Take, for instance, long wait times to schedule an appointment. While many clinicians might view that as a minor inconvenience, Fritz disagrees. Not seeing patients in a timely manner is more than just bad customer service—it can actually harm the patient.
“In health care systems, a lot of specialists who treat pain have long waiting lists,” says Fritz, who currently serves as Associate Dean for Research at University of Utah’s College of Health. “Patients who have an acute condition that’s allowed to linger for 6-8 weeks and become more chronic can start to feel fear and concern. They may seek to fill the void with something that’s not in their best interest. Now, the problem has become a much more complex circumstance, just because we didn’t provide that basic care. If we’re really going to take a patient-centric perspective, we need to be clearer about what patients value.”
Recent survey data reinforces that disconnect. In U of U Health’s Value Survey, providers ranked convenience low on a list of value statements — only 8% said convenience was the most accurate measure of high-value care. Patients, however, disagreed. Nearly 40% identified the ability to schedule a timely appointment as most important to them, with 36% saying the convenience of a provider’s office was paramount.
As a clinician, a distinguished professor in the Department of Physical Therapy and Athletic Training, and an adjunct professor of orthopedic surgery, Fritz views her definition of value through multiple lenses. She’s spent years tracking the various metrics that go into the value equation — Value = Quality + Service / Cost — but is well aware that the perception of value differs depending on which of those lenses you’re looking through.
A decade ago, while working with a different health care system, she initiated research on patients who reported they were satisfied with their care—but hadn’t experienced the best clinical outcomes. “A couple of my colleagues thought that was dumb,” Fritz laughs. “‘Why would you be satisfied if you aren’t getting better?’ They couldn’t wrap their minds around the fact that a lot of patients will say, ‘I really like you guys, your parking is great, the staff is nice, and I enjoy coming here—but I’m not any better.’ Patients often just don’t tie outcomes and satisfaction together.”
The Problem with Cost
For Fritz, cost is the most challenging value component to understand. “There’s been a great deal of transparency with patient-reported outcomes and patient satisfaction scores,” she says. “But quantifying cost in an objective manner is really fraught. The simple question, ‘How much does this visit cost?’ leads to all kinds of complexity. If you ask the patient, you’ll get one answer. If you ask the payer, you’ll get another answer. If you ask the health care system, you’ll get another answer… if you can even get an answer. Nobody can give you a very straight response because of our traditional lack of transparency when it comes to cost.”
And yet affordability remains one of the biggest challenges to the U.S. health care system. Fritz points to Value Survey results that show more than 80% of physicians, patients, and employers agree that we’re spending too much on health care. In fact, affordable out-of-pocket costs are what consumers point to as the best definition of high-value care for them — more than a provider’s expertise or their own health improving.
Fritz offers a sober assessment of the difficulty of making care less wasteful and more affordable. “The challenge is that one person’s waste is another person’s business model,” she says. “In the world of back pain, MRIs are a prime target. Every article you read labels them low-value care. But MRIs can be lucrative to the system, and the fundamental perspective we hear from patients is that an MRI is something they perceive as reassuring.”
Still, Fritz remains cautiously optimistic about University of Utah Health’s value journey—both because of the quality of the individuals attracted into health care professions and the institution’s commitment to transparency and improvement. “A foundational principle of value-based health is getting the right patient to the right provider at the right time,” she says, highlighting an area of synergy between patients, physicians, and health care systems. “That’s the ideal, and we’re putting a lot of work into getting that pathway correct.”
Nick McGregor is a Senior Communications Editor at University of Utah Health.