Should Doctors Be Penalized for Patient Outcomes?

Leigh Page

Disclosures

November 03, 2016

In This Article

Ways to Help Improve Outcomes

As physician payment begins to shift to value-based payments, the measures of quality care will slowly move from processes to outcomes.

That's a relief for some doctors who have never liked reporting process measures and instead wanted to be judged by their outcomes. But outcomes also present a new burden: You'll be held accountable for patients who don't improve because they aren't following the treatment plan you recommended.

"Most doctors don't mind being judged on their quality of care," says Kevin Campbell, MD, a cardiologist at the University of North Carolina. "But if the physician has done everything right for the patient and the patient is nonadherent, should that reflect poorly on the clinician?"

The answer from some adherence experts is "yes," although that answer is disputed by many physicians. Assuring patients' adherence is as much a part of being a good doctor as drawing up a successful treatment plan, says Stephen Wilkins, MPH, a former hospital executive who runs Mind The Gap Academy, a San Jose, California, group that seeks to improve outcomes through better physician/patient engagement.

Even when patients decide not to follow the treatment plan, Wilkins thinks physicians should bear some financial responsibility for the resultant poor outcome. "Physicians should be checking prescription fill and refill rates, or taking similar measures," he says.

Many physicians have strong feelings against this type of sentiment. Their view is that patients should bear a large degree of responsibility for their own health and health-related decisions. Why should a doctor pay the price if a patient continues to drink too much, continue smoking, or gorge on french fries? Others, though, feel that with today's apps and electronic communications, it has become less burdensome for doctors to urge patients toward better outcomes.

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