As Reimbursement Models Shift, Doctors Rely On Patient Adherence


New trends in healthcare could cause serious issues for doctors with patients who refuse to follow the doctor’s recommendations. With insurance reimbursements shifting from fee-to-service to quality outcome-based models, “physicians with high percentages of non-adherent patients stand to potentially see payments fall,” Medscape reports.

Medicare will soon begin levying penalties on physicians who aren’t meeting their PQRS benchmarks.

For physicians working in accountable care organizations, “these patients can drive up the costs of care and deprive participating doctors of shared savings. And when sporadic adherence causes these patients to bounce in and out of the hospital, hospitals have to forfeit charges under CMS's new readmissions policy.”

Fixing the issue of non-compliance is so difficult because physicians simply don’t have time to work with each patient to address their non-compliance.

Some physicians want insurance companies to either raise premiums for patients who are noncompliant or lower co-payments for those that do follow their treatment plan as a way to incentivize patients to follow doctors’ recommendations. Currently, no insurance company does this.

There are a few things physicians can do to help raise rates of compliance. First of all, it is important for physicians to note noncompliance in their patient charts, in case the patient attempts to sue for any complications that arise in the future. If they have staff available, doctors could have their employees follow up with patients to take their medication. Some new technology also reminds patients to take their medication.

Still, the most effective way to encourage compliance is for doctors to engage with patients during their appointment and initiate a dialogue that addresses all of the patient’s concerns.

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