Health care is broken. It is a great time for improvement through innovation. I see patients in a physician’s office so I am sensitive to how the offices are reimbursed. Better patient outcomes result in better reimbursement rates to your provider (similar to FICO scores and better loan rates).
My doctors have a limited amount of time with their patients. So when the patient comes in for a check on their hypertensive medications (10-15 minute visit) and has another acute issue, for example, they were in the hospital last week with seizures due to sugars over 700, OR a patient with asthma who forgot the free samples of a maintenance inhaler (lost his insurance and couldn’t afford it) and is struggling with his breathing, I come in to help manage their medications and find ways for them to obtain their needed medications.
But what about the diabetic patient whose sugars are out of control who can’t stop eating ice cream and candy bars and drinking KoolAid? This same patient who refuses physical activity, meal planning, and increasing diabetic medications. Aaaaack!
Having the physician’s office and pharmacy’s reimbursement rates dependent on their patient’s outcome seems unfair to me. Do I think they should be rated?? YES! This is so helpful when choosing who you want your healthcare provider to be. Do I think reimbursement should be based on patient outcomes? NO!
I have seen healthcare use multiple ways to reign in the unengaged patient such as:
- physicians scheduling more frequent appointments to keep a non compliant patient in check.
- pharmacies setting the patient up for automatic refills.
- our offices set patients up with adherence tools (mediset boxes, texting reminders, etc), along with education.
But, what about the patient who is the sole determinant of the outcome. Why aren’t they held accountable? In the space where I work (underprivileged), many of the patients are able to afford their medications. Some just don’t take them. Some don’t know how. We address these issues when we disvcover them. In the end, we just want to help them live the best quality of life they can with the cards they have been dealt.
What are your solutions to help the disengaged patient? How can the system also hold the patient responsible for their health?