Cookbook Medicine Update

Will physicians fire noncompliant patients to meet quality measurements? It may come to that:

According to participants at AHRQ’s National Advisory Council forum, as more payers are instituting pay-for-performance programs, patients are becoming increasingly engaged in medical decision making and at times challenging official recommendations.

As a result, physicians ultimately may “fire” noncompliant patients from their practices, push back against quality-improvement initiatives, and minimize patient empowerment efforts, CQ HealthBeat reports. Some physicians already are “firing” unvaccinated patients, noting that they pose a risk to others and reflect a lack of trust for physicians’ medical advice.

Comments (9)

Trackback URL | Comments RSS Feed

  1. Linda Gorman says:

    Already happening.

    There have been new reports of pediatric practices refusing to treat unimmunized children ever since immunization was adopted as a metric of practice efficiency.

  2. Brian R says:

    One suggestion by the Council was “adjusting down performance measures that aim for 100% compliance.”

    This seems intuitive, but difficult to implement. Are vaccinations a limited instance where patients ignore their doctor’s advice or are there other major areas of disagreement? Would existing areas of disagreement and other exceptions become more commonly utilized if compliance standards were reduced? If these hurdles could be overcome then a slight reduction in compliance seems reasonable.

  3. Brian says:

    This is almost fascist. People have a right to not allow their children to receive every vaccination that Congress, state governments, school systems, or some medical association demands they get. I understand that some vaccinations are probably necessary, but others are potentially harmful for some people.

    People need to fight this. I’m not sure how as of right now, but they need to fight this.

  4. Linda Gorman says:

    Some people have religious objections to childhood vaccines. Others believe that they do more harm than good or are simply chemophobic. Others choose to vaccinate against some childhood diseases but not others for which they think that the risk profile is unreasonable. The Gardasil controversy is a good example of that.

    The real question that is raised by the ObamaCare pay-for-performance metrics is whether the government should have the right to set conditions that, in practice, require you to accept an injection or lose your right to medical care.

    If one thinks it should, then I think that it is important to be able to articulate bright line stopping points. Otherwise the endgame is the Soviet Union case where dissenters were sent to mental institutions and had “treatment” forced upon them because they were obviously crazy by virtue of their dissent.

  5. Buster says:

    I’m not convinced it’s necessarily unethical to fire non-compliant patients. What’s the point of providing expert opinion just to have the patient ask for a pill to make everything all better when there is no such thing as a pill that can undo all the harm patients seem to be able to do to themselves.

  6. Linda Gorman says:

    Obviously a physician should have the right to refuse to treat any particular patient.

    The sticking point here is government or other third party metrics (and under ObamaCare it is all government metrics) that make patients who don’t behave as the third party would like a money losing proposition. In the limit, this would make it impossible for dissenters to get medical care.

  7. Carolyn Needham says:

    Wow — talk about playing games with incentives.

  8. Valentina says:

    I find this nugegt still too complicated.Things must be simplified further if the bulk of practising GP’s will devote a greater mental commitment to this in an already overloaded day sorry.I think that periodic, updated Road Testing should be mandatory for ALL DRIVERS, based both on age and medical condition. We as doctors have to provide evidence of ongoing competency, as do pilots and others with such privileged responsibility in our society. Costs of such a road test should be paid in full, or at least part, by the driver, to save costs to the OSMV. Predictive statistics, as alluded to by the author above, already exist to help with determining who needs to be regularly tested. This may seem like an infringement on driver’s confidential information, but driving is a privilege, not a right. Costs incurred by such a road test could be reasonable.GP’s need to be able to identify patients whose health issues may impact negatively on driving ability this alludes to MEDICAL FITNESS TO DRIVE. However, I think it folly that GP’s should have to take on the responsibility of determining ABILITY TO DRIVE, or a supposed likelihood of this. What are we doing here- taking on more legal liability in an area for which we are not trained as experts ? Count me out.I welcome others’ thoughts on this.Jeff Dresselhuis

  9. Batool says:

    Hi, thanks for raideng. Because the Heart Health Checklist was a team effort, I will talk to my colleagues here and ask them if I may post the checklist online. I anticipate that they will be excited to share our work with others.The art vs science notion is something I’ve only begun to think about lately. In medical training we largely leave learning about doctor-patient communication to chance. When taught, it is largely by example. I wonder though if there is a role for a complementary scientific approach, specifically the use of formalized tools for educating patients, soliciting preferences, decision-making. The Heart Heart Checklist, if proven to be effective, would be a science approach to patient education. For breast cancer screening, I’ve been thinking about using standardized templates to convey the risks and benefits of screening, which would be most relevant for women 40-50 under the new USPSTF guidelines, for example. These are all rough ideas. Eager to hear your input.