QUALITY
Team effort Addressing patient noncompliance
BY AMY LYNN SORREL Last year, when Almas Mecklai, MD, no- ticed an influx of patients streaming in with wellness forms to get their physicals, she was delighted to discover their employ- ers offered a financial bonus to get healthy. The Houston family physician’s enthusiasm waned, how-
ever, when most of those patients declined to return to follow up after she discovered ailments from high blood pressure and cholesterol to diabetes. Some cited their high-deductible health plans and medica- tion costs as barriers to getting the care they needed. Others worried about missing work; some had no reason at all. But Dr. Mecklai also found pa- tients’ noncompliance presented a barrier to her efforts to improve their health.
“My priority is to get patients in to follow up in the office so they can have more cost-effective care and better quality of life, instead of landing in the emergency room with strokes and heart attacks. But there is a limit to what doctors can do,” she said. Yet an increased emphasis on
care quality and physician perfor- mance has Sugar Land internist and Harris County Medical So- ciety President Elizabeth Torres, MD, concerned about the impact patient noncompliance could have
to be penalized for something we really have no control over,” Dr. Torres said.
Because private health plans typically follow Medicare’s
path, Dr. Torres suspects commercial pay-for-performance pro- grams aren’t far behind. Drs. Mecklai’s and Torres’ concerns prompted an informal
“One of our worst fears is
that we are going to be penalized for something we really have no control over.”
on how payers purport to grade and ultimately pay physicians based on their patients’ health. For example, Dr. Torres uses a patient registry to report cer- tain quality measures under Medicare’s Physician Quality Re- porting System. She wonders about the future financial impact on her practice if, for example, half of her patients don’t take their medications or get their lab tests done, as recommended, and she is unable to hit the quality targets. “I will receive a decrease in payment because I didn’t fulfill the requirements. One of our worst fears is that we are going
survey by the Texas Medical Association Council on Health Care Quality. It shows private health plan policies vary in how they address patient noncompliance and whether they factor it into emerging pay-for-performance programs. TMA continues to advo- cate for protections for physicians from quality-of-care measures in Medicare and commercial pro- grams that don’t account for vari- ances in patient populations, in- cluding chronically ill or noncom- pliant patients.
Health plans, meanwhile, point to an industry-wide shift to tackle a problem they, too, agree has a di- rect impact on health care quality and costs. “This really is the first global at- tempt to raise the level of health care by population,” said Rene Vega, MD, chief executive officer of Aetna’s Medicaid managed care organization, Aetna Better Health of Texas. When it comes to non- compliance, “we [health plans] know physicians can’t do this by
themselves, and patients have some responsibility. And our responsibility is getting providers as much information as we can to get gaps in care closed,” he said.
Arming physicians with data For example, Aetna Better Health has case management pro- grams to identify patients with high-risk conditions and help set up follow-up primary care appointments or arrange trans- portation or medical supplies. Using claims data, the health plan notifies physicians of patients who frequently visit the
April 2014 TEXAS MEDICINE 59
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