Looking Into the Future for a Child With Autism As my son’s limitations became clearer, I found it harder every year to write a vision statement for his I.E.P. Then he showed us how.

Reprinted from the NYTimes – written by 

How do you write about the happy life you hope for your child to have when you have a hard time picturing it yourself?

For 18 years, I’ve dreaded the yearly ritual of writing a “vision statement” for an Individualized Education Plan, or I.E.P., for our son, Ethan. He has autism and, as any parent of a child with significant special needs knows, the yearly team meeting to develop the I.E.P. can be emotional and fraught. For us it has felt, at times, like an annual adjustment of expectations downward. In theory, the vision statement is a lovely idea — an opportunity for parents to articulate the optimistic future they envision for their child five years down the road. In reality, as Ethan grew up and his limitations — cognitive and behavioral — became clearer, I found it harder every year to write the short paragraph. We came to see he couldn’t live independently, get married, work in a job without support — but if those are the givens, what does a hopeful future look like?

This year, as Ethan turned 21 and completed his final year in the school system, he shocked us by writing his own vision statement. Reading his words made me realize how wrong I’d been for years, trying to articulate what my son’s future should look like.

While Ethan was still in elementary school, our vision statements included the same wish list I imagine every parent of a child with autism probably has: better communication, fewer meltdowns, more independence. When he was 12, I got more pragmatic, “We wonder if Ethan’s love of farm machinery might one day become an employment opportunity.” At 13, after a successful stint in the middle school chorus, I wrote, “Ethan would like a future in music, perhaps as a professional singer?” At that point Ethan was still working on using a Kleenex to blow his nose. A future as a singer was far-fetched, I knew, but I wrote it as a way of saying: Ethan does have abilities. We’re serious about developing them.

This is the great challenge parents face in these yearly meetings: You’re fighting for teachers to help your child work toward a future that, with every year, feels as if it’s growing narrower and bleaker. When it’s clear he’ll never understand money well enough to make change, you cross off the possibility of working in any retail job. When he can’t stop rubbing his nose or touching his mouth at work, all food service opportunities dissolve as well. When his self-talk disturbs the nursing home residents where he genuinely likes volunteering, another door closes.

After six months, we got a jolly report. “He’s fun! And a pretty good worker for about one to two hours a day.” After a year, we were told he’d made it onto a landscaping crew. “What do you do on the crew?” we asked.

“Stuff,” Ethan said and listed a few machines we assumed he was watching other people operate. He could mow a lawn, we knew, but he couldn’t use a leaf blower. Or a weed whacker. We’ve lived with Ethan for 21 years. We know his limitations.

At our last I.E.P. meeting a representative from the farm came and read a report from Ethan’s “Crew Captain.” We heard that, indeed, Ethan was operating those machines, safely and effectively, along with this final line: “Ethan makes us laugh every day.”

I could hardly believe it. I stole a look at his dad and smiled.

This meeting fell at a particularly demanding time in my life and I’d arrived without writing a vision statement ahead of time. When I started to apologize, the vocational coordinator — a young woman who’d struggled for four years to find a job placement for Ethan — held up her hand. “It’s fine. Ethan wrote his own this year.” Apparently he’d dictated it to her on a recent visit to the farm. A few minutes later, he read it aloud:

“After I graduate from high school I plan to work at Prospect Meadow Farm until I retire and live at home with my family as long as I can. I’d like to keep taking classes at Berkshire Hills Music Academy. For fun, I want to play Special Olympics basketball, go to our cabin in Vermont and the shore in New Jersey, mow lawns, and collect business cards. My goals for the future are to take the PVTA bus into town to make purchases, and someday learn how to drive a zero-turn lawn mower.”

For a full five seconds after he finished, no one said anything. I looked across the table at his speech therapist who had known him since he was 14 years old. She had tears in her eyes. I did, too.

Not simply because Ethan had articulated his own entirely reasonable vision statement, but because it incorporated every aspect of his present life that brings him joy. After years of fabricating visions for a future we never honestly thought possible, Ethan was offering one that was both optimistic and breathtakingly simple: I want my life to keep looking the way it does now.

Update on Fellow Therapists Impacted by Hurricane Harvey and How to Donate to Them

Thanks to great networking efforts, especially from Nikki Goodale OT (an OT in Texas who lives north of the impact area),  we are beginning to identify therapists who have been personally and directly impacted by the hurricane.

Wendy McAnally OT is the  co-owner of the  preschool/clinic New Horizons.  Desiree Mataya PT and Tricia Weger  ST are co workers. The preschool is located in Dickinson, Texas just south of Houston, one of the most devastated areas. With 2-3 feet of water, they have no idea of the extent of the damage to the building and their equipment. Of course, none of the therapists at working at this moment, and there is no timetable for when they will be able to return to the school.

Kristen Murphy,OT
works for River Kids Texas   a pediatric home health company that serves a large area of Houston and surrounding areas. One of the company’s owners is also an OT.  Kristen  was displaced and rescued by boat from her home and is now first able to go back and see the damage.  She gets paid per home health visit and is losing wages due to being out of work, displaced and her patients being displaced with flooded homes.  Alexis Belk, PTA at RiverKids, also was  displaced from her apartment, and rescued by boat due to flooding., lost 2 cars, and does not know when viable employment in home health will again be an option due to widespread displacement of her case load.
We anticipate that there will be many other therapists who own practices or work for practices that have been impacted, have homes that have been destroyed or damaged, etc. No matter how much FEMA or other funds come to be, distribution takes time, and has often  proven not to cover all the losses these therapists have or will sustain.

A Plumfund has been set up for these therapists. We will continue to add therapists in need from  damages/ losses sustained by Hurricane  Harvey. To donate 

In addition, more than one therapist brought this longtime TEXAS group to my attention: Apparently it is all volunteer run, many therapists are involved, and they need $$$ and gently used DME for the Texas communities they serve. THEY NEED WHEELCHAIRS NOW!!! Here is their website and how you can donate to them.
If anyone hears of a therapist that should be included, please email me directly at iris@nytherapyguide.com Thanks in advance.
Iris ( Kimberg, MS PT OTR)

Here’s a great read for all pediatric therapists about selected current NDT

Whether you need a refresher or are new to NDT, here’s an informative read by Gerard J. DeMauro, PT, MSPT, C/NDT

The Conceptualization of NDT-Based Handling Techniques for Infants: Two Perspectives  

Preface   The article is intended to provide both general and more detailed information on the NDT (NeuroDevelopmental Treatment) / Bobath frame of practice applicable for infants with and/or at risk for cerebral palsy and related neuromotor disorders.  Readers, including habilitative therapists, will benefit from an update of theories and concepts applicable to this approach.  It is also intended to orient those less familiar with NDT and thus may be of interest to healthcare professionals involved in the examination, evaluation and/or referral of infants for therapeutic assessment and/or treatment.  Below, the most current and comprehensive operational definition of NDT is included.  Its review includes NDT’s role in the management of infants as well as children with CP and related disorders throughout their lifespan.  The NDT frame of reference is also applicable to adults with strokes and head injuries.
Click here to access the full article.

Gerard J. DeMauro, PT, BS/MS, C/NDT has been a physical therapist for nearly 40 years. In addition to teaching, Gerard still maintains an active private practice in NYC, and is available to present at workshops for therapists, educators and parents on topics related to physical therapy practice in pediatrics. You can email Gerald directly  at Gdemauro101@aol.com  to ask any questions, or to make arrangements for specific presentations related to the pediatric practice of physical therapy.

 


NO!!!!! The New York Freelance Law Now in Effect in NYC DOES NOT INCLUDE Therapists who are Independent Contractors

Lots of therapists sending me questions about  this new law in NYC  protecting Independent Contractors ( free lance workers)  that went into effect May 16, 2017, BUT IT DOES NOT PERTAIN to Independent Contractors who are licensed medical professionals. Here is the link to the bill. You will see that licensed medical professionals have been carved out and are not included in or protected by this new law.

http://www1.nyc.gov/assets/dca/downloads/pdf/about/Freelance-Law.pdf

Where are the Children??? A Letter to Congress and the White House from the Nation’s Children’s Hospital

Reprinted from April 23rd’s Sunday NY Times because it is just that important.

The health care debates for the past decade have focused on adults – their coverage, their benefits and how to pay for it. Medicaid, providing health care for over 70 million Americans, has been front and center of the Affordable Care Act and American Health Care Act debates. The fact that 30 million children receive their health care through Medicaid is almost never discussed. We are dismayed and alarmed national policy debates over Medicaid continue without the needs of nearly half of our country’s children considered first and foremost.
Children represent the future of the United States.

Where are kids in these discussions? Do Congress and the White House see safeguarding children’s health care as a national priority?  The reality is although children are 25 percent of the population, we spend less than 10 percent of the federal budget on them. And, kids can’t vote.

As the debate about health care for adults continues, the risk of collateral damage to children through inadvertent budget cuts is high and unrecognized. Our nation’s leaders should be protecting children, and the decisions you make now will impact their lifetime health. A child today has on average 60 or more years of productive life ahead if we choose wisely.

A stronger future for the United States depends on the health and well-being of today’s children. On behalf of the millions of children and families we serve, we call on Congress and the White House to make children the strong bipartisan priority they must become for our nation to have a brighter future.

Sincerely,
The Presidents, CEOs and Executive Directors of the nation’s children’s hospitals

Craig T. Albanese, M.D. NewYork-Presbyterian
Steve Allen, M.D. Nationwide Children’s Hospital
Michael R. Anderson, M.D. UCSF Benioff Children’s Hospitals
Meri B. Armour Le Bonheur Children’s Hospital
Michael D. Aubin Wolfson Children’s Hospital  of Jacksonville
Richard G. Azizkhan, M.D. Children’s Hospital &  Medical Center
David J. Bailey, M.D. Nemours Children’s Health System
Madeline Bell The Children’s Hospital  of Philadelphia
John Bishop Earl and Lorraine Miller Children’s Hospital
Robert I. Bonar, Dr. H.A. Children’s Minnesota
Patrick J. Cawley, M.D. Medical University of South Carolina Health and Children’s Hospital
Bob Connors, M.D. Helen DeVos Children’s Hospital
William H. Considine Akron Children’s Hospital
Kimberly Chavalas Cripe CHOC Children’s
James D. Dahling Children’s Hospital  of The King’s Daughters
Christopher G. Dawes Lucile Packard Children’s Hospital and Stanford Children’s Health
Susan Distefano Children’s Memorial  Hermann Hospital
Marcy Doderer Arkansas Children’s Hospital
Jonathan M. Ellen, M.D. Johns Hopkins  All Children’s Hospital
Luanne M. Thomas Ewald Children’s Hospital of Michigan
Mike Farrell Advocate Children’s Hospital
Deborah Feldman Dayton Children’s Hospital
Sandra L. Fenwick Boston Children’s Hospital
Michael Fisher Cincinnati Children’s Hospital  Medical Center
Christopher A. Gessner Children’s Hospital of Pittsburgh  of UPMC
Guy Giesecke Children’s of Mississippi University of Mississippi  Medical Center
Keith D. Goodwin East Tennessee Children’s Hospital
Luke Gregory Monroe Carell Jr. Children’s Hospital at Vanderbilt
Kimberly Guy St. Joseph’s Children’s Hospital
Jena Hausmann Children’s Hospital Colorado
Donna Hyland Children’s Healthcare of Atlanta
Barbara Walczyk Joers Gillette Children’s Specialty Healthcare Minnesota
Paul A. King University of Michigan C.S. Mott Children’s Hospital
Narendra Kini, M.D. Miami Children’s Health System
Thomas D. Kmetz Norton Children’s Hospital
Larry Levine Blythedale Children’s Hospital
Patrick M. Magoon Ann & Robert H. Lurie Children’s Hospital of Chicago
Joan Magruder St. Louis Children’s Hospital
Rick W. Merrill Cook Children’s Health Care System
Robert L. Meyer Phoenix Children’s Hospital
Donald Mueller Children’s Hospital at Erlanger
John D. Nash Franciscan Children’s
Elias J. Neujahr The Children’s Hospital of San Antonio
Kurt Newman, M.D. Children’s National Health System
Randall L. O’Donnell, Ph.D. Children’s Mercy Hospital  and Clinics Kansas City
Giovanni Piedimonte, M.D. Cleveland Clinic Children’s Cleveland Clinic Children’s Hospital for Rehabilitation
Jeff Poltawsky UW Health American Family Children’s Hospital
David L. Reich, M.D. The Mount Sinai Hospital/Kravis Children’s Hospital
Charles L. Schleien, M.D. Cohen Children’s Medical Center
Mark Shen, M.D. Dell Children’s Health
James E. Shmerling, DHA Connecticut Children’s  Medical Center
Edwin Simpser, M.D. St. Mary’s Healthcare System  for Children
Martha B. Smith Kapi’olani Medical Center  for Women and Children
Cynthia N. Sparer Yale New Haven Children’s Hospital
Jeff Sperring, M.D. Seattle Children’s
Johnese Spisso UCLA Health UCLA Mattel Children’s Hospital
Sheldon Stein Mt. Washington Pediatric Hospital
Todd A. Suntrapak Valley Children’s Healthcare
Peggy Troy, RN Children’s Hospital of Wisconsin
Paul S. Viviano Children’s Hospital Los Angeles
Mike Wagner, M.D. Floating Hospital for Children  at Tufts Medical Center
Mark A. Wallace Texas Children’s Hospital
William Michael Warren, Jr. Children’s of Alabama
Steve Woerner Driscoll Children’s Hospital
Brenda J. Wolf La Rabida Children’s Hospital
Mark Wietecha Children’s Hospital Association

The Independent Physical Therapists of CA Files Unfair Competition Lawsuit Against Unlicensed Workers’ Compensation Network Brokers, One Call Medical and Align Networks

A lawsuit filed with a California state court accuses One Call Medical Inc. of running an illegal patient referral scheme driven by improper financial inducements, interfering with the right of injured workers to choose a treating physician within an employer’s medical provider network and acting as a claims administrator without being certified to do so.

The Independent Physical Therapists of California (iPTCA), a non-profit association of California physical therapists dedicated to advocating for physical therapists and their patients, announced today that it has filed suit against One Call Medical, Inc, D/B/A One Call Care Management, and Align Networks in the Superior Court of the state of California, County of San Diego- North County, Case No. 37-2017-00008817-CU-BT-NC. Click here to view the formal complaint. (To Review the Complaint, Please Click Here).

The Complaint in this unfair competition lawsuit alleges that iPTCA and its non-contracted members have suffered injury and lost money or property as the result of numerous unlawful, unfair, and deceptive or fraudulent business acts and practices engaged in by the defendants, which operate as unlicensed ‘middlemen’ between Workers’ Compensation payers and injured workers and their rehabilitation providers.

Dr. Paul Gaspar, DPT, President of iPTCA summarized the Complaint. “The Complaint details numerous allegedly unlawful activities by the defendants, particularly a referral scheme where defendants demand that physical therapists accede to significant discounts or potentially lose the ability to provide physical therapy services to large numbers of injured workers.” The Complaint explains how such conduct potentially violates numerous state laws, including, but not limited to unauthorized claims administration and violation of laws that tighten restrictions on injured worker referrals by prohibiting companies from offering discounts or other forms of compensation as an inducement for increasing business referrals.

According to Doctor Gaspar, “California’s Legislature approved an appropriate medical fee schedule for the care of injured workers in 2012 by passing Senate Bill 863 (DeLeon). It is unlikely, in my opinion, that they intended a significant percentage of these payments might be diverted away from direct patient care services toward an out-of-state middleman. Injured workers deserve the benefit of the resources the Legislature directed toward their care.”

“iPTCA is confident it will prevail in the lawsuit,” said Dr. Gaspar, “because as the Complaint alleges, the unlawful, unfair, and deceptive or fraudulent business acts and practices detailed in the Complaint have potentially harmed the Association and many of its members, have the potential to result in increased harms to consumers, and are contrary to state law and the California Legislature’s intent in passage of this reform legislation.”

Vote for a Longtime NYC Occupational Therapist to be a 2017 National Local Hero!

Lori Rothman, OTR, a dedicated NYC Occupational Therapist for over 38 years, has been selected as one of five finalists from hundreds of nominations from around the country to receive the 2017 Child Mind Institute Local Hero Award.

This institute is a prestigious national organization dedicated to transforming the lives of children and families struggling with mental health and learning disorders. The winner will be decided as a result of online voting at https://childmind.org/campaign/2017-change-maker-awardsVoting ends April 4th so it would be great if  you will consider voting as soon as you get this email.

If you want, you can vote daily.

Thank you in advance!!!!

OTs and PTs – Support an Academic Therapy Program in Haiti

The Department of Rehabilitation of the Episcopal University of Haiti, Léogâne  needs the help and support of OTs and PTs in the USA.  There are many ways each and every one of us can help.
An overview of the program– The Faculty of Rehabilitation Sciences in Léogâne (FSRL) is a department of the Episcopal University of Haiti (UNEPH). Planning for FSRL began in 2011, when volunteers working at St Vincent’s Center for Handicapped Children realized how helpful it would be for St. Vincent’s to have Haitian therapists. The dream became a reality in Oct. 2015 when the first small class of students enrolled. First-year students take interdisciplinary courses at the FSIL nursing school in Léogâne, which is also a department of the Episcopal University. Second, third, and fourth year students specialize in OT or PT and graduate with a bachelor’s degree in Occupational or Physical Therapy.   The curriculum for the OT program has already been approved by the World Federation of OT, and the PT curriculum is now under review by the World Confederation of PT.  The Haiti Rehab Foundation (HRF), a 501c3,  was formed in 2014 to support the work of FSRL.

HOW CAN I HELP?
DONATE ONLINE: one-time or monthly, at  www.haitirehab.org
MAKE A GIFT BY CHECK made out to Haiti Rehabilitation Foundation.   Send to
Treasurer,  HRF, P.O. Box 183, Hamilton, NY 13346 USA.
WHAT CAN MY MONEY DO?
$25-pay for learning supplies
$100-pay for 1 course for 1 student
$250-pay all fees, 1 mo., 1 student
$1000-cover cost of 1 faculty vol.
$4000-per year: fund a scholarship that will cover 1 student’s fees, tuition, room & board

THE NEED FOR REHAB IN HAITI is very high.  It is estimated that 1.1 million Haitians have disabling physical and/or mental conditions. There are only about 50 Haitian PTs.  and 1 Haitian OT, who have a bachelor’s degree from overseas, mostly from the Dominican Republic.
There are good programs in Haiti for rehab technicians.  However, rehab technicians don’t practice independently.  They often depend for supervision on the many foreign OTs and PTs who come for short-term medical missions.

TEXTBOOKS Needed:
(1) Heurtelori, M. & Vilsaint, F. English/Haitian Creole Medical Dictionary/Diksyoné Medikal Anglé Kréyol. Coconut Creek, Florida, EducaVision, Inc.

(2) Netter, F.H. (2014). Atlas d’anatomie humaine, 6e ed. Philadelphia, Saunders Elsevier.

(3) Thompson, J.C. ( 2008). Netter. Précis d’anatomie clinique d’orthopedie. Issy-les-Moulineaux cedex, France, Elsevier Masson.

There is also a need for Visiting Professors and Adjuncts.
For more information
:

Contact:  Dr. Janet O’Flynn  Acting Dean of FSRL
(509)4397-2658  OR  (315)708-5820
janetoflynn@hotmail.com

 

Here’s a Business New Year’s Resolution Everyone Can Keep

Years of consulting with therapists in private practice  has meant helping hundreds of therapists make informed decisions about key aspects of their practice.  Therapists who are optimists, pessimists, ruminators, and procrastinators. Some are analytical, others instinctive. Many have (far too many)  projects and ideas being tossed around and often float from one idea or  to the next making it challenging to decide what to work on. Inherent in helping therapists  make decisions is showing them how evaluate the opportunity cost of proceeding with one option, while eliminating another.

Here’s a resolution – how  about instituting a  new decision-making process in 2017?  In every decision there’s a cost, but there’s also a hidden cost – the opportunity cost. That’s the lost opportunities of all the other options you could have taken instead. The concept of opportunity cost is a powerful one and can help you instill reason and pragmatism behind multifaceted decisions. Weigh not only the benefits, but the costs of every decision you make.

For example –
If you are considering offering a new service and do all the preparations to get it up and running, realize that the “cost” or trade off may be that you don’t have the funds, skills, the time or the “real estate” in your office to offer another service. This comes up frequently when therapists consider running a group versus offering individual services.

If you fail to keep abreast of  a current trend or a new modality  in delivering your service, the “cost” may be your inability to serve your target market as  these new technologies make inroads in improving the delivery of that service – and you may lose clients to the competition who may be embracing the trend.

If you decide to keep employing a staff member with “issues” from chronic absenteeism to poor people skills  the “cost” may be  the time spent doing damage control, which may drain resources, and  could cause others to quit in frustration.

If you spend your time doing the books and handling collections yourself, the “cost” may be the opportunity (and time) to get before prospective clients by networking, or building deeper relationships with your referral sources.

And examine the cost of doing nothing – Don’t fool yourself if you think doing nothing is  neither good nor bad but neutral.  There is indeed an opportunity cost of doing nothing, that is, the failure to reap the benefits of an effective intervention or the cost of inaction. Despite the fact that doing nothing can feel safe and comfortable, especially if you operate from a position of risk adversity or suffer from what some call organizational fatigue, for each new potential project in 2017, make a rule that the cost of doing nothing be quantified and considered. Once the cost of doing nothing  is established as a factor, therapists  often become more comfortable at approximating and considering it.

Every decision has a “cost” and each of these costs impacts either positively or negatively the processes and profitability of your practice.
When making decisions, you can control the quality of the decision, though not the ultimate outcome that occurs. But by understanding and examining the opportunity costs associated with important decisions, we can improve our odds of making good decisions.

Speaking of decisions, 2017 is looking like a year when we will all be challenged to learn  to make decisions together as a crucial element of getting along and getting things done with others. All the best to you, your families and your patients in the new year.  I am filled with gratitude for the opportunity to work and connect with so many of you.

Wondering about Whether to Seek out Yelp Reviews on Your Practice????

Many therapists and other medical professionals remain conflicted  when it comes to Yelp – should they encourage patients to review them on Yelp or stay with more controlled ( and possible  less credible) testimonials planted on their website. Clinicians and other professionals certainly have a right to be concerned about protecting their reputation as social media penetration continues at a rapid rate. As the shift in what people consider private and what they are willing to share on social media continues, it is more important than ever to keep up with what patients will find problematic and what they won’t. Having an open, amicable relationship with your patients is always the way to go while remaining, HIPAA compliant and maintaining professional boundaries. Check out a September 12th NY Times article on the topic by Aaron Carroll:

How Yelp Reviews Can Help Improve Patient Care

Hospitals and many insurance carriers care about patient satisfaction. It especially matters to hospitals because insurance payments can be influenced by how patients rate the care they receive, as well as by the health of the patient, which hospitals usually report. Many people in the health care profession are put off by this. They argue that patient satisfaction scores aren’t necessarily aligned with outcomes. Moreover, they say that trying to improve satisfaction is a waste of time.

It’s possible, however, that patient satisfaction is being rewarded already, and that the efforts we are making to highlight it aren’t helping as much as we think. Almost every study on patient satisfaction uses the Hospital Consumer Assessment of Healthcare Providers and Systems (H.C.A.H.P.S.) survey. Studies show it is correlated with clinical measures of quality, although some other studies dispute this.

Collecting such information is costly, but there may be other sources for quality assessments that don’t require investment from the health care system. In 2012, researchers in the Journal of General Internal Medicine examined online reviews from RateMDs.com and Yelp. They found that a majority of reviews were positive. They noted, however, that patients reported on aspects of care that extended beyond the patient-physician encounter. They were concerned about staff, access to the hospital and convenience. They also cared greatly about the bedside manner of the doctors they encountered.

 Dr. Naomi Bardach, associate professor of pediatrics and health policy at U.C.S.F. Benioff Children’s Hospital San Francisco, and her colleagues looked at Yelp to determine how consumer ratings compared with those of the hospital consumer assessment survey. Of the almost 3,800 hospitals with survey and other data, about 25 percent also had ratings on Yelp. The correlation between Yelp and the survey was quite strong. Moreover, high ratings at Yelp were correlated with lower mortality for myocardial infarctions and pneumonia — and fewer readmissions for those problems as well as heart failure.

A recent study in Health Affairs expanded on this work. Researchers compared the content of Yelp narrative reviews with the factors considered important in the hospital consumer assessment survey. They found that Yelp reviews did cover most things the survey tallied. But they also covered an additional 12 criteria not in the survey.

These included the cost of a visit; insurance and billing; scheduling; compassion of staff; family member care; and the quality of many staff members. All of these things were important to patients, and all might be correlated with outcomes. More important, nine of the 15 most prevalent criteria in reviews were not included in the survey. The use of metrics like the hospital consumer assessment survey assumes that those in the health care system have figured out how best to measure patient satisfaction. They also assume that all the information we need should come from patients or from the medical record.

That’s not how the real world works. In a more recent study, Dr. Bardach found that the perceptions of other family members matter and can also be powerful because they focus on safety in a way that patients may not be able to do. The same is true of those who help care for patients at home and help make medical decisions for them. Their opinions are ignored by the survey. Those publicly available data may even be more comprehensive than that gathered at the behest of payers. The next question is whether the health care system needs to measure satisfaction — maybe the publicly available data, like at Yelp, is sufficient. Could those data be used alone to incentivize providers?

A couple of weeks ago, my colleague Austin Frakt wrote a column on hospital quality and market share. He argued that people could improve their health by choosing a hospital that has a higher quality rating. He also underscored that patient satisfaction scores are often aligned with quality and with better outcomes.

He highlighted a paper published in The American Economic Review that looked at how performance of hospitals was related to market share. Conventional wisdom holds that patients lack information on quality and that they cannot tell, or favor, providers who seem better. But researchers found that hospitals that performed better, on both outcomes and process-based measures, tended to have greater market share, and experienced greater market growth.

Further, they found that as patients shifted to hospitals with higher performance, that change alone drove a significant amount in the improvements seen in overall survival rates for a number of conditions. Overall survival improved, in part, just because patients shifted from hospitals with lower quality to higher quality. If patients had the ability to choose between hospitals, they tended to gravitate to those with higher performance.

In other words, this may be an area of health care where the free market is working. When allowed to choose, patients seem able to discern quality — as they define it — and gravitate toward it. It’s not clear that we need to be forcing the issue with measurement and reimbursement. It’s important to recognize, though, that this was a study of Medicare patients, all of whom arguably have more flexibility in terms of hospitals and doctors than those with private insurance. Those with private insurance often are restricted by “narrow networks” and directed to a few facilities and offices.

Americans cry out for more choice in their health care. This sometimes gets translated to mean a choice of insurance companies. But Americans with government-provided Medicare, who have the least choice of insurers, have the most choices when it comes to providers. And they seem to use that freedom to choose providers who perform better. I asked Dr. Bardach about this. “It’s still unclear how people are getting the information to choose the hospitals, but the power of stories is likely an important part of why Yelp and other online reviews are compelling,” she said. “Stories add nuance and context to the otherwise somewhat sterile numbers that the H.C.A.H.P.S. produces.” Research shows that patients reward quality on their own — when they can. We might just need to make it easier for more of them to do so.