Patient Accountability and Responsibility

I think you can add this post to my series of posts on the Physician Revolt that I talked about earlier. The following message is from a doctor who emailed me. Obviously, they didn’t realize it would be published, so ignore some of the grammar errors, but the message is a good one that we should be discussing.

The doctors are going to be graded on the health outcomes but yet patients are going to do whatever. Nowhere in the law it states that patient is responsible for anything.

So while the ACOs are going to offer coverage…… there is going to be no immediate access due to shortage of MDs and the current MDs whose slots are overfilled are going to be dinged with penalties for not taking care of their patients completely (ie. all time coverage for all patients all the time). which means the MD has to refund the already reduced reimbursements back to the government because patients will complain about this.

Of course, the patients themselves will not tighten their belt and become personally responsible for their health so that they take up less appointment slots……..

So the significant question is Where are the patients held accountable in all these free health care reforms?

This is an important question as we shift to an ACO model. I think the above narrative places a little too much blame on the patient for the higher healthcare costs. Certainly there are things that doctors and our health system can do to lower costs that are outside of the patient. A simple example is 2 doctors ordering duplicate tests. If they just transferred the data, they’d provide the same care for a much lower cost. Plus, I think there are ways that a doctor together with a clinical care team can improve the overall quality of care of a patient population regardless of the patient’s choices. Another example of this is the hospital to PCP hand off. Doing this right can lower healthcare costs by reducing hospital readmissions.

While much can be done by doctors and the healthcare system as a whole, the doctor does raise a good question about patient responsibility. In what ways could we incentivize patients to take some accountability and responsibility for their healthcare as well?

The first thing that popped in my head was the way car insurance companies are doing it. One of the insurance companies is tapping into your car’s computer to monitor safe driving and then they provide discounts to you for being a safe driver. Are we going to have the same models in healthcare? In some ways we do, since if you’re a non-smoker your health insurance costs a lot less. Will health insurance companies start lowering a patient’s health insurance costs based on data from a wearable device that monitors your activity?

I’m honestly not sure how it’s all going to play out, but I am sure that healthcare IT is going to play a role in the process. We’ll never totally solve the issue of patient responsibility and accountability. That’s a feature of life, but I think that technology can help to hold us all more accountable for our health choices. What technologies do you see helping this?

About the author

John Lynn

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

6 Comments

  • This is a worthy topic–the patient who just goes to the doctor when experiences pain, and doesn’t bother to examine his lifestyle and behavior when he’s no longer in pain–but clinicians have to act like adults and face up to their responsibility to help patients. Coordinated care organizations are doing amazing things with recalcitrant patients. One key strategy is hire other staff with less training and lower costs than physicians–dietitians, etc. who will form emotional bonds with patients and guide them intensively through behavior change.

  • Sure Andy; I have seen that personally in one of our client locations where extensive diabetic counselling is given to those select group of patients who are ‘recalcitrant’. While this practice was using the paper charts, they used to deploy Counsellors to all the diabetic patients – since they did not have the data about the patients. Now they focus on the 10% of the patients who need the counselling and through this focussed approach they have been able to better deal with the ‘recal’ patients.

    John, as you are aware, there are many things that are happening including the promotion and campaign to adopt PHR by the Physician Community as well as the Consumers. This may be an eye opener for many of the patients who do not follow through with preventive diagnostics and health maintenance. Many states are doing this as well and NYeC is planning to deploy a PHR for the 20 million residents.

    As you have commented, at some point in the future, the health insurance can follow the Auto Insurance model. Auto Insurance has come a long way including their ability to track the driver behavior over a period of time through remote devices and then set the discounts accordingly. That’s possible since the data is made available to compute. I am sure such data will be available on health as well and may be used in the commercial space to encourage wellness living and enable incentives for better care. I believe its a matter of time.

    Nice post John. I do agree that a lot can be done by all the participants/stakeholders in the healthcare system.

  • It’s worth pointing out that the doctor’s email was not about “higher healthcare costs,” but on doctors being held responsible and punished for their patients’ actions or the lack thereof.

    How often are duplicate tests ordered, and more importantly, how often is a duplicate test more expensive and more of a hassle than trying to do things the “interoperable” way? If a doctor has a choice between waiting and scheduling another appointment, or simply conducting another test, it’s probably more efficient to simply do another test. I had this experience at a dentist recently where it was easier to just do another set of X-rays, and he did it at no charge to me. That’s a lot easier than “just transferring the data.”

    Hospitals don’t want do do the “PCP hand off.” They are buying up physicians and working to get patients into the hospital, not out.

    The discussion of “patient responsibility” in terms of “incentivizing,” I respectfully submit, misses the point. The question is not “How do we get patients to do X,” but why are we basing our treatment of doctors on the actions of their pateints? Patients already have all the incentive they need: they are sick and they want to get well.

    Patients are not cars. If you think there is EHR backlash now, watch what happens when you start monitoring their every move. People should not accept surveillance with their driving or their health.

    Tim
    13,047 days

  • Tim – I agree that the Providers are not responsible for the actions or lack thereof of patients.

    But that’s not to say that the Provider cannot use a tool (it could be any computational tool and in this case it can happen to be EHR) to identify the recalcitrant patients with diabetes and use the resources/counselors to help them understand risks and manage the diabetes better.

    I am sure, everyone agrees that there has to be a simple system to do this and the PCP cannot go through hundreds of paper charts to identify his patients with diabetes.

    There is certainly wasteage in the system that can be overcome through interoperability.

    And interoperability is not too far away; for those of us who are working in the trenches, we do see that the interoperability can be achieved over the next couple of years with the cooperation and participation of Providers, HC Organizations and Patients/Consumers.

    Lastly about the monitoring of the driving – this exists today and the participating drivers do get a discount based on their driving habits. Those of us who do not participate do not get access to the discount. I sure the same can be applied to health insurance as well so that the premums can be based on the efforts as opposed to being the same for all. This happens even today with the employers; and the employers who provide various benefits including gym membership, dietician access, etc., do get to pay a lower premium.

    With EHR and PHR, we find the consumers comforts have been addressed; even the simple benefits to add up. Pediatricians are able to share the Immunization data over the PHR and parents are saved a trip to the practice to get the copy of immunization cert for the school. Consumers are able to schedule their appointments online; are able to do the telemedicine through the patient portal.

    THere are challenges to overcome and it will be done in due course, I believe.

  • Great discussion that really captures what I think are the major challenges associated with patient accountability and responsibility and the physician viewpoint. This is going to be a very important topic over the next couple years.

    I also want to thank Andy for taking this discussion to a whole new level with his use of the word recalcitrant. Learn something new every day.

  • @Anthony, I am not at all sure “everyone agrees” we should be setting up government (or government-controlled) databases of diabetes patients and monitoring them for compliance. In fact, I’m quite sure there is no such consensus.
    http://junkfoodscience.blogspot.com/2008/04/government-health-surveillance-medical.html
    http://blogs.wsj.com/health/2008/04/28/are-mandatory-registries-for-diabetes-patients-worthwhile/

    @John, @Andy, I would not consider the use of the word recalcitrant to be a “whole new level” in this discussion, unless we’re talking about a whole new low. To be “recalcitrant” is “Having an obstinately uncooperative attitude toward authority.”
    https://www.google.com/search?q=recalcitrant

    The key word there is authority. Citizens and patients are the authority for their health care, not the doctor and not the government. EMRs and EHRs (the IT, not the blog) seem to be singularly focused on reversing this, and that will generate a whole new level of “patient engagement” singularly focused on putting this technology back in its place or refusing it altogether.

    Tim
    13,050 days

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