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    MACRA plays blame game when patients don't adhere

     

    There is no universal solution for improving adherence. It has to be addressed on a patient-by-patient basis, Coleman adds. 

     

    In case you missed it: House Obamacare bill won't fix healthcare system, doctors say 

     

    In many cases, physicians know that patients are non-adherent and even why, but don’t have the time or resources to address it, says the ACP’s Nickel. “Doctors are being pulled in so many directions. The problem is time. Who has time to provide all this information” to patients, she asks.

    Some practices are adding care managers and other staff who can address non-adherence as part of their care coordination efforts. Others are using technology, such as secure messaging, texting and at-home medical monitoring, prompting and communication tools to improve adherence.

    For Oak Street Health, a multi-site practice with clinics in Illinois, Indiana and Michigan, having current data and patient updates are key to improving adherence, says primary care physician Laolu Fayanju, MD. The organization receives reports from the Centers for Medicare & Medicaid Services (CMS) and commercial payers that show medication adherence (from claims on filled prescriptions), clinic by clinic and patient by patient. This allows doctors to identify and address problems. 

    Oak Street Health uses registered nurses, nurse practitioners and social workers to follow up with patients following appointments to ensure adherence. Staff members who visit a patient’s home might even count pills to see if the patient is really sticking to the regimen and prepare for problems resulting from non-adherence, Fayanju says.

    “My team and I are not flying blind,” he says. “We have the relevant information on our patients.”

    Group effort

    Physicians aren’t alone in tackling patient non-adherence. CMS, commercial payers, employers, pharmaceutical companies and medical technology firms have undertaken their own initiatives to improve adherence to make medicine more effective, cut costs and, in the case of pharmaceutical companies, increase revenues.

    Some pharma companies are developing “smart pills” embedded with sensors that can send an alert when a pill is swallowed or when a dose is missed. Others are awarding gift cards to patients who refill prescriptions. And the industry has lobbied regulators for permission to pay third parties, such as pharmacists, to remind patients to take their medications. Also, manufacturers are creating medical devices, such as inhalers, that can record the time and date of their use.

     

    Further reading: Uncertainty in healthcare driving DPC growth

     

    In addition, some employers are rewarding employees for taking part in wellness programs that can reinforce their physicians’ orders to lose weight, exercise more, stop smoking etc. And commercial insurers are experimenting with giving free medications and providing financial incentives for patients who stick to their treatment plans. Private payers also give information regarding non-adherence to doctors. 

    Next: Playing to the measures

    16 Comments

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    • Anonymous
      I'm sorry but the author after many words really said nothing constructive or helpful to physicians, just beating the drum of CMS autocrats. I am not the mother of these patients and refuse to lower myself and my profession to that level. The solution to doctors suffering is to diversify like I am; if you are mainly government 3rd party payor dependent, change location and patients. Even in the worst of places such as LA, there are still patients who will pay cash on a reasonable fee. If you are fair in cost, they will come. Even Mexico has fee for service doctors. Wake up and just say no to MACRA metrics. Let the politicians and their autocrats in CMS cringe in fear of the monster we can become.
    • Anonymous
      Talk is cheap, and neither Wendy Nickel nor Amelia Coleman express anything worthy of our attention as physicians. I've been practicing clinical endocrinology for almost 35 years, so I have attempted to help patients with the most intrinsically self-management-requiring malady of all, diabetes mellitus. Do these two commentators actually imagine that we don't try to engage people in a proper and enduring self-care strategy again, again and again? It's risible and, frankly, insulting to even insinuate otherwise. These two intellects, not to mention the feckless sheep administrators at CMS, should direct their attention to the heart of the problem, the great American food industry, that which has bought and paid for our Congress. Or maybe they need to be brought up to speed about the causation of the major illnesses afflicting our citizenry in the first place? When I tell a patient that she/he should engage in an unprocessed, whole-food, high-fiber, plant-based diet, as I do each and every patient I encounter, I realize that I am fighting the windmill of an adversary whose advertising budget would make Midas blush. So, I am personally incensed when I see the sort of bloviation presented in these articles that is supposed to impress us with its prescience. It's enough to make a cat laugh! By my estimation these commentators aren't really fully aware the degree to which the deck is stacked! Only 29.1 million Americans with diabetes mellitus and rising. This is a problem that wasn't created by physicians not properly engaging with their patients. These people need a reality check. Wake up!
    • cfw43@------.com
      MACRA benchmarks will be easy to attain --> "Fire" all non compliant patients. I am not sure that this is "GOOD HEALTH CARE" but it will make a physician's statistics look good. I am retired for the last year but my medical practice was 95% Medicaid and I rarely "fired" patients. Lots of "no call, no show" (often patients "Fired" from other medical practices) and my statistic did not look good when compared to a 100% Insurance medical practice or a "Concierge" Practice. However, many of my patients showed improvement, perhaps not as much as could be done, but an improvement for them.
    • cfw43@------.com
      MACRA benchmarks will be easy to attain --> "Fire" all non compliant patients. I am not sure that this is "GOOD HEALTH CARE" but it will make a physician's statistics look good. I am retired for the last year but my medical practice was 95% Medicaid and I rarely "fired" patients. Lots of "no call, no show" (often patients "Fired" from other medical practices) and my statistic did not look good when compared to a 100% Insurance medical practice or a "Concierge" Practice. However, many of my patients showed improvement, perhaps not as much as could be done, but an improvement for them.
    • cfw43@------.com
      MACRA benchmarks will be easy to attain --> "Fire" all non compliant patients. I am not sure that this is "GOOD HEALTH CARE" but it will make a physician's statistics look good. I am retired for the last year but my medical practice was 95% Medicaid and I rarely "fired" patients. Lots of "no call, no show" (often patients "Fired" from other medical practices) and my statistic did not look good when compared to a 100% Insurance medical practice or a "Concierge" Practice. However, many of my patients showed improvement, perhaps not as much as could be done, but an improvement for them.
    • Anonymous
      Non adherence is a major malpractice risk. I have spoken with many plaintiff lawyers and they do not understand and make fun of doctors continuing to see non adherent patients. They compare it to "Russian Roulette". Their recommendation is clear cut: Discharge non compliant patients! You do not want to take the risk! MACRA does nothing to eliminate this. Therefore,my suggestion in future is straight forward: after appropriate discussion and help with what we can do to improve compliance patients with ongoing non adherence will be discharged. I also agree with all above comments, well said.
    • Anonymous
      The key is partnering with the patient, says Amelia Coleman, director of practice management consulting for MBA HealthGroup, a firm with offices in New York City and Burlington, Vermont. “Those doctors are going to have to find better ways to engage with patients; they’re going to have to take a more active approach’” she says. “A patient is going to be into a care plan if they believe in that care plan and can see how it benefits them.” I am family physician with 25 years of experience who still provides full spectrum care except obstetrics - including ICU/night call, ED coverage. This person if she had an education in medicine, could not walk 24 hours in my shoes. I have no idea why physicians listen to consultants like this. They have lost touch with reality. In my opinion, most important metric that cannot be manipulated is accessibility. Physicians know that an RVU at 2am is more difficult than at noon. Administrators, consultants and payers do not seem to understand that there is a severe shortage family physicians and internists. We don't have to put up with their rules under façade of quality metrics. Instead, any thinking doctor understands that it is really a mechanism to justify their existence and limit payments to physicians. If it wasn't for my commitment to care for my hospitalized patients, I would joint the direct pay movement. This movement will provide a much needed counter balance to these central planners.
    • Anonymous
      I was thinking the same thing "she's never taken care of a patient in her entire life". I once went toe to toe with an obnoxious politician, Virg Bernero, who insisted that if doctors would just take the time to educate their patients, patients would fall in lock step with our advice and outcomes would be improved. I used to get pretty po'd at docs who would just write RX's while I turned blue trying to talk and explain TLC. I finally figured out why. While I still spend much time educating--often getting nowhere-- it makes me much slower than others who have given up-- others to whom I am compared by the number crunchers.
    • kl1325@------.com
      There is a point at which the patient MUST accept some measure of responsibility for his actions. If there is an ability to reach a satisfactory agreement between the patient and the physician, it should be reasonable to note in the chart that the patient refused a particular recommendation without penalizing the doctor. As long as the patient has all of the facts and has had a chance to get all of his questions answered, it is still up to him to decide what care or treatments he is willing to accept. Bureaucrats who never see a patient, and perhaps are not even physicians fullfil the premise that "Nothing is impossible for the person who does NOT have to do it."
    • Anonymous
      So I go buy a new car. They tell me to change the oil every 3000 miles, I don't. They tell me to burn regular gas, I use diesel. The engine blows up. I am going to ask for a refund of my money, must be automakers fault! Why do we put up with this bullshit? If it wasn't so real it would be comically funny.
    • Anonymous
      Love the analogy!
    • UBM User
      So I have a diabetic with rising sugars come in today. He says he likes to eat chocolate every day. He eats Hersheys kisses. I told him that he could have one a day as a compromise and he was shocked he could only have one. They are about 26 calories each so I compromised with up to four a day. He said he could not survive like that. He stated that he eats about 20 kisses per day and is unwilling to compromise on this. Under MACRA, his uncontrolled sugars and poor dietary compliance are MY FAULT?!? I don't think so.
    • Anonymous
      Yep, sorry. I have the same patients. Made housecalls-- was a real eye-opener.Didn't change anything. Still didn't listen. This is the craziest system. Medicaid providers are getting docked for not providing Pap smears to patients who don't show up.
    • amperrymd@------.com
      I would say that we should cut the salaries of the administrators and the academics because their hare-brained ideas have not cut the cost of Medicare and is driving us deeper into debt. Come on you geniuses - how about some good results!!!
    • Anonymous
      I hope the author is taking note of our comments. In some of his other writings for Medical Exonomics, he's given me the impression he's pretty ignorant of the physicians' challenges. Look at who he quoted for this article!

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