Medical practice unintended consequences

The airlines, in an effort to recoup revenue, started charging passengers to check luggage a while back.  Seems like a great strategy. Not only are they recuperating revenue, they are giving passengers a reason not to bring luggage they don’t need. This of course saves money on fuel.

The result? More bags in the main cabin.

Since there is an incentive not to check a bag, more people bring their bags as carryon luggage. More bags in the main wouldn’t be a problem if airplanes were designed to stow luggage in the main cabin. But in an effort to maximize revenue (again), airplane cabins are designed to mainly carry people (revenue generating passengers). So it is no surprise there is hardly any room for your stuff.

But here’s the kicker, more bags in the main cabin means more work for the in-flight crew; which takes away time from preparing the plane for takeoff. Not to mention that more people now “gate-check” their bags and airline misses out on the revenue while inconveniencing the staff.

Which makes me wonder… in our medical practices, do we implement rules or policies that create unintended consequences?

I was talking to a doc friend of mine that also has his own practice the other day. He mentioned his staff was having a hard time getting people to book patient appointments in advance. He mentioned that most people respond by saying that they’ll call back once they know their schedule.  I suggested a few other things they could do to get people to schedule their appointments and he said, “My staff does all that, but parents are still reluctant.”

After shooting the breeze a little longer he reveals that he just instituted a $65 no-show fee because his no-shows were getting out of hand.  A bell went off in my head. “… uh… I think I know why parents are reluctant to make appointments in advance.”

His eyes opened wide. He let out an embarrassed half ass smile and said, “now that you mentioned it, people stopped scheduling appointments far in advance shortly after we started charging the no-show fee.”

I’m not saying that my friend shouldn’t charge for a no-show fee. That isn’t the point of this post. But the realization for me is that just like the airlines’ baggage charge policy changed people’s behavior to take more carryon luggage on board, the no-show fee also changed patients’ (or their parents in this case) behavior. In other words, in both cases, the new policy created unintended consequence.

So what can we do to ensure intended consequences?

I don’t think there is a right or wrong answer.  Unfortunately, that is business: a sea of unknowns. But the more we are aware, and the more critical thinking we employ, the better off we will be.  So next time you start thinking about policy change, we aware that the decision might create unintended consequences.

Have you instituted a policy change that created an unintended consequence? We’ d all love to hear it.

Brandon Betancourt manages a pediatric practice and blogs at Pediatric Inc.

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  • http://www.facebook.com/profile.php?id=1338422225 Tom Garvey

    I hope this is not too far odd-topic, but I was thinking along similar, if more global and catastrophic lines as I read a recent New England Journal perspective article, Opportunities and Challenges for Episode-Based Payment, by Robert R. Mechanic, MBA. Mechanic discussed the theoretical advantages and a few possible barriers to implementation of such a system. As a primary care doc, I nearly panicked. There willl definitely be unintended consequences, and I foresee the following:

    1. another massive bureaucracy will be necessary to keep track of yet a new way to extract dollars,
    2. our brain-space and time will be diverted from continuing medical education and patient care (especially for nontargeted patients) by yet another Byzantine coding system,
    3. and the greatest rewards will go to the best code-warriors and not necessarily the best clinicians.

    Just as we should be mindful of unforeseen consequences of our clinical and administrative decisions, we should be mindful of the untintended consequences of well-meaning refomers on clinical medicine as a whole.