Why Should Your Noncompliance Harm My Income?
As payers begin to shift to outcomes-based reimbursements, physicians with high percentages of nonadherent patients stand to potentially see payments fall. Patients who don't take their medications or don't adhere to treatment recommendations are at risk of getting sicker and requiring more services, and this added cost could come out of physicians' reimbursement.
A recent Medscape article explored the fairness of this situation, where physicians are penalized for poor outcomes which they are usually helpless to control, but patients aren't penalized for poor adherence or nonadherence, as if doctors were to blame.
"This is one of the foolish liberal policies espoused by our increasingly liberal government," an internist wrote. "We see it in schools, where teachers are being punished for the laziness of failing students, and the students are increasingly being shielded from the consequences of their actions (or inactions). Same applies here, and it is only going to get worse as this once-great country speeds towards being a nanny state."
"If you want to change behavior, the penalty must be for the one behaving badly," a general surgeon reasoned." I don't put my son in timeout when his sister hits him. But patients will cow their legislators if penalized for their noncompliance."
"I am more than willing to go out of my way to treat patients and obtain the best outcomes," noted an orthopedic surgeon, "but when patients knowingly neglect their part of the treatment plan, then why does it become our responsibility and financial burden?"
"My approach is simple," a family physician wrote. "Just fire the patient who is noncompliant. He is not only costing you money, he is also wasting your time."
An emergency physician was not alone in pointing out the absurdity of the situation. "I can imagine patients being 'fired' in droves for their poor health," he commented, "leaving the 'best' doctors with a practice consisting of only healthy people who do not need a doctor."
"There really is no way one can be sure a patient is truly compliant," a cardiologist opined. "So you prescribe a treatment appropriate for their condition, and they do not do well. Now what? Did you prescribe the wrong treatment? Or was the patient noncompliant? Or is the patient illness just nonresponsive to your prescription?"
"Too often physicians seem to think that noncompliance is equal to defiance," a family doctor observed. "My brother was a cop. His noncompliant subjects were 'tased.' Should we do the same?"
"I find it ridiculously funny that insurance companies send all that extra paperwork about noncompliant patients," another family doctor wrote, "yet they deny payment/coverage for their medication and services and then wonder why the patient is noncompliant."
"This explains some of my particular challenges as a fee-for-service, cash-only doctor," an internist said. "All the noncompliant types you all fire from your clinics are showing up on my doorstep! My wise RN tells them that when they don't take their meds, it just results in more appointments (and more revenue!) for us, which does seem to help a bit with the compliance issue."
Medscape Family Medicine © 2014 WebMD, LLC
Cite this: Neil Chesanow. Physicians Are Talking: Why Punish Docs for Patient Actions? - Medscape - Dec 15, 2014.
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