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Better Care at Lower Cost: If Patients Comply

February 14, 2014 | No Comments
Posted by admin

New legislation is being introduced in the Senate by Democratic Senator Ron Wyden and Republican Senator Johnny Isakson and in the House by Democrat Peter Welch and Republican Erik Paulsen.  It is known as the Better Care Lower Cost Act of 2014.  The focus of the proposed legislation is the elimination of fee for service reimbursement and switching to a concept of pay for performance.

What providers, and their various group representatives, such as the AMA or the AHA, need to be aware of, is the shifting of the risk of the noncompliant patient from the payor (be it the Medicare program or any other payor) to the provider.

Currently, the costs involved with the provision of health care for noncompliant patients generally is being borne by the Medicare program or other third party payors.  No effective mechanism has been implemented by the Medicare program that would require the patient to comply with the medical protocol designed by the providers.  Terms such as “navigator” or “health coach” are being used to describe individuals in the health care systems who will assist the patient in accessing the appropriate care needed.  However, we have not seen any proposals which would impose upon the patient in those circumstances in which the patient is noncompliant.

As a provider, each of you can look at your own patient base to determine whether or not patient noncompliance with treatment protocols is an issue that you need to be concerned about.  My discussions with many doctors indicates that a significant percentage of patients regrettably are noncompliant.

The issue of the noncompliant patient and the cost associated with the noncompliant patient needs to be resolved in any pay for performance reimbursement system going forward.  Such a system will only be effective if there is an effective patient compliance program developed.

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