DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Medicare & Medicaid Services

Official CMS Information forMedicare Fee-For-Service Providers

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COMMUNICATING WITH YOUR MEDICARE PATIENTS

ICN 908063 July 2012

This publication provides the following information about communicating with your Medicare patients:Ð Background;Ð Communication tips; andÐ Resources.

BACKGROUND

By 2030, the number of individuals enrolled in the Medicare Program is expected to increase to about 80 million beneficiaries – about 32 million more than are currently enrolled. The Medicare population will also be more racially, ethnically, and culturally diverse. U.S. Census Bureau data show that the total white population was 75.1 percent in 2000 and 72.4 percent in 2010. The diversity trend is expected to continue as evidenced by estimates recently released by the Census Bureau that show as of July 1, 2011, 50.4 percent of the nation’s population younger than age one are minorities.

As these changes unfold, you will more often encounter situations in which you will provide care to and communicate with the following individuals:Ð Older patients;Ð Racially, ethnically, and culturally diverse patients; andÐ Other underserved populations.

Thus, your ability to communicate effectively with your patients will be increasingly important as you help them understand and take action on health information. Effectively communicating with patients may reduce their anxiety during the encounter, and they may also more often adhere to treatment protocols, report more satisfaction when asked about encounters, engage in fewer medical malpractice lawsuits, and ultimately have better health outcomes (e.g., increased quality of care and patient safety and reduced medical errors). Some added bonuses when communication goes well – patient encounters may be more satisfying to you, and you may not need to order as many prescriptions, referrals, and tests.

1 Communicating With Your Medicare Patients

COMMUNICATION TIPS

The charts on the following pages provide communication tips that will help you understand and respond to your patients. The charts include information about communicating with all patients; older patients; and racially, ethnically, and culturally diverse patients.

ALL PATIENTS OLDER PATIENTS RACIALLY, ETHNICALLY, ANDCULTURALLY DIVERSE PATIENTS

PREPARING FOR THE PATIENT ENCOUNTER

Do:Ð Review the patient’s medical history;Ð Review the patient’s language

preference, belief systems, values, and lifestyle choices so that you can provide appropriate health care services;

Ð Recognize possible communication barriers; and

Ð Recognize that your culture, belief systems, and values may affect how you interact with patients.

Don’t: Ð Stereotype the patient.

Do:Ð Allow extra time as the patient may:Ì

Ì

Ì

Ì Ì Ì

Have complex problems and several complaints;Have memory, hearing, and/or vision loss;Require more time to take in information;Learn more slowly;Be difficult to understand; andBe less focused;

Ð Provide signage and educational materials that are printed in a large, legible font;

Ð Provide a list of agencies that can help with elder issues; and

Ð Learn about communicating with older patients.

Don’t: Ð Schedule the appointment late in

the day when the facility may be the busiest and the patient may be less alert.

Do:Ð Allow extra time as the patient’s

primary language may not be English;

Ð Provide a professional interpreter as needed;

Ð Provide signage and educational materials that are written in language(s) of commonly encountered group(s) of the service area;

Ð Provide a list of agencies that can help with multi-cultural issues; and

Ð Learn about communicating with ethnically, racially, and culturally diverse patients.

Don’t: Ð Schedule the appointment late in

the day when the facility may be the busiest.

Communicating With Your Medicare Patients 2

ALL PATIENTS OLDER PATIENTS RACIALLY, ETHNICALLY, AND CULTURALLY DIVERSE PATIENTS

THE PATIENT ENCOUNTER

Part One: Beginning the Discussion

Do:Ð Actively listen:Ì Give the patient your undivided

attention;Ì Allow the patient to speak

without interruption;Ì Your body language should

show that you are listening (e.g., maintaining eye contact and nodding);

Ì Paraphrase what the patient said and ask if you understood correctly; and

Ì Pay attention to the patient’s body language;

Ð Recognize the message you send with your facial expressions and body language;

Ð Use plain English;Ð Speak in clear, short sentences;Ð Speak in a firm tone;Ð Show respect (address the patient

as Ms., Mrs., or Mr. unless you are asked to use his or her first name);

Ð Create and maintain a partnership; andÐ Be friendly, empathetic, supportive,

and interested in the patient.

Do:Ð Recognize that you may need to

reintroduce yourself to the patient;Ð If the patient agrees, include a

family member, caretaker, or friend in the discussion. Begin the discussion with the patient and then ask for input from the companion;

Ð Sit facing the patient;Ð Speak slowly and clearly.

Recognize that if you speak too slowly, the effect may be insulting;

Ð Recognize that you may need to speak in a deeper voice and with adequate projection;

Ð Reduce background noise and distractions;

Ð Increase room lighting; andÐ Recognize that the patient may

feel significant loss (e.g., deaths of family members and friends).

Do:Ð If the patient agrees, include a family

member, caretaker, or friend in the discussion. Begin the discussion with the patient and then ask for input from the companion;

Ð Provide nonverbal methods of communicating (e.g., pictographic symbols) as needed for patients who do not speak English or whose primary language is not English;

Ð Speak slowly and clearly. Recognize that if you speak too slowly, the effect may be insulting;

Ð Learn about and respect the patient’s cultural values, spiritual beliefs, and lifestyle choices that influence care so that you are sensitive to his or her unique needs. Explain that this will help you diagnose and treat his or her illness or condition. Request information about the patient’s:Ì Beliefs, concerns, and fears;Ì Social, family, spiritual, and cultural

background; andÌ Expectations about health

and illness;Ð Determine the patient’s understanding

of his or her illness or condition;Ð Recognize that in some cultures,

the patient may believe that making direct or prolonged eye contact is disrespectful or aggressive; and

Ð Recognize that personal space requirements are not universal.

3 Communicating With Your Medicare Patients

ALL PATIENTS OLDER PATIENTS RACIALLY, ETHNICALLY, AND CULTURALLY DIVERSE PATIENTS

THE PATIENT ENCOUNTER

Part One: Beginning the Discussion (cont.)

Don’t:Ð Use slang, medical jargon, acronyms,

or call the patient a term that may be perceived as patronizing (e.g., “honey” or “dear”);

Ð Talk too fast or too slowly; andÐ Appear rushed or distracted.

Don’t:Ð Talk down to the patient; andÐ Turn your back to the patient as he

or she may need to read your lips.

Don’t:Ð Talk down to the patient; andÐ Tell jokes or use gestures as they

may be misunderstood.

Communicating With Your Medicare Patients 4

ALL PATIENTS OLDER PATIENTS RACIALLY, ETHNICALLY, AND CULTURALLY DIVERSE PATIENTS

THE PATIENT ENCOUNTER

Part Two: Information Gathering and Sharing

Do:Ð Ask one open-ended question at a

time;Ð Be specific and organized;Ð Keep focus on the most important

topics;Ð Explain the nature of the patient’s

illness or condition; Ð Discuss the expected course

of treatment, interventions, and outcomes as well as alternative courses of action (as appropriate) in a positive manner;

Ð Acknowledge and respond to the patient’s ideas, feelings, and values; and

Ð Use visual aids (e.g., pictures or charts).

Don’t:Ð Give too much or too little information;Ð Use adverbs (e.g., “rare” and

“frequent”) as the patient may misinterpret their meaning; and

Ð Overload the patient with technical details (share this information with him or her as appropriate or upon request).

Do:Ð Simplify the discussion; andÐ Recognize that the patient may

be reluctant to discuss sensitive topics. Telling an anecdote may be helpful (e.g., “One of my patients told me that when she moved into the assisted living facility ….”).

Don’t:Ð Discuss more than one topic at a

time.

Do:Ð Simplify the discussion;Ð Recognize that in some cultures, the

patient may believe that:Ì Status is based on family or

gender;Ì Privacy, respect, trust, and dignity

are very important;Ì Events are predetermined or

caused by external forces and little or nothing can be done to change their course;

Ì Discussing bad news may result in adverse consequences or hasten death; and

Ì Information about the illness or condition and bad news should not be shared with him or her;

Ð Explain procedures and request permission to perform them before proceeding; and

Ð Ask if the patient is using alternative or complementary medicine (e.g., a Hmong patient may be working with a Shaman).

Don’t:Ð Discuss more than one topic at a

time.

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ALL PATIENTS OLDER PATIENTS RACIALLY, ETHNICALLY, AND CULTURALLY DIVERSE PATIENTS

THE PATIENT ENCOUNTER

Part Three: Summarizing, Decision Making, and Follow-Up Planning

Do:Ð Ask the patient to repeat pertinent

information and instructions to ensure that he or she understands them;

Ð If you do not think the patient understands the information or instructions, rephrase and simplify them;

Ð Ask the patient if he or she has questions or concerns;

Ð Encourage the patient to participate in decision making;

Ð Make sure that the patient agrees with the plan;

Ð Recognize that the patient may need time to absorb information;

Ð Summarize the discussion and explain follow-up plans; and

Ð Provide clear instructions and resources the patient can refer to at home.

Don’t:Ð Assume that the patient understands

what you said; andÐ Assume that the patient is willing and

able to follow the plan.

Do:Ð If a family member, caretaker, or

friend is included in the discussion, ask him or her to repeat pertinent information and instructions to ensure that he or she understands them;

Ð If you do not think the patient’s companion understands the information or instructions, rephrase and simplify them;

Ð Recognize that the patient may ask you to make decisions; and

Ð Provide clearly written step-by-step instructions and resources the patient can refer to at home.

Don’t:Ð Overload the patient with too much

detailed information.

Do:Ð If a family member, caretaker, or

friend is included in the discussion, ask him or her to repeat pertinent information and instructions to ensure that he or she understands them;

Ð If you do not think the patient’s companion understands the information or instructions, rephrase and simplify them;

Ð Recognize that in some cultures, the patient may ask you to make decisions or ask that family members are included in decision making; and

Ð Provide clearly written step-by-step instructions and resources the patient can refer to at home. The instructions and resources should be written in the patient’s preferred language.

Don’t:Ð Overload the patient with too much

detailed information.

Communicating With Your Medicare Patients 6

RESOURCES

FOR MORE INFORMATION ABOUT… RESOURCE

Current and Projected Beneficiary Enrollment in the Medicare Program

“2012 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds” located at http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2012.pdf on the Centers for Medicare & Medicaid Services (CMS) website

Census Bureau Population Data http://www.census.gov on the U.S. Census Bureau website

Improving the Health of Racial and Ethnic Minority Populations

http://minorityhealth.hhs.gov on the Office of Minority Health (OMH) website

Web-Based Training Cultural Competency Courses

https://www.thinkculturalhealth.hhs.gov on the OMH website

All Available Medicare Learning Network® (MLN) Products

“Medicare Learning Network® Catalog of Products” located at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/MLNCatalog.pdf on the CMS website or scan the Quick Response (QR) code on the right

Provider-Specific Medicare Information MLN publication titled “MLN Guided Pathways to Medicare Resources Provider Specific Curriculum for Health Care Professionals, Suppliers, and Providers” booklet located at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/Guided_Pathways_Provider_Specific_Booklet.pdf on the CMS website

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Official CMS Information forMedicare Fee-For-Service Providers

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