Patient Compliance - The Future Will Be Tougher

Patient compliance - or adherence, or alliance - is likely to become even more important and more all-encompassing for doctors as healthcare reform proceeds.

"A lot of what you now think is the patient's fault will become your fault," says healthcare consultant James E. Orlikoff, president of Orlikoff & Associates, Chicago, and national advisor on Governance and Leadership to the American Hospital Association and Health Forum. "Doctors need to get the phrase ‘noncompliant patient' out of their lexicon," says Orlikoff, who was named as one of the 100 most powerful people in healthcare by Modern Healthcare magazine in its inaugural list.  "You need to engage with your patients differently. You need to think about complications differently." 

Much of the change will come due to bundled payment and other new forms of payment. In bundled payments, one payment covers all care for a patient during an ‘episode of care,' typically in a hospital. For example, the bundled payment could include all services necessary for care of a diabetic patient for one year, or all services related to hip replacement surgery from pre-operative planning and prep through six months post-op.

Making Greater Efforts to Remove Stumbling Blocks

Consider the interactions that will/should be necessary when you give a patient a prescription.  Half of all patients don't even fill their prescriptions.  And, within a minute of leaving the doctor's office, fewer than 50% of patients can answer these questions: "What are your treatment recommendations? What is the prescribed drug supposed to do?" 

How many doctors' offices currently phone the patient the next day to ask if they've filled their prescription? Not many. Yet with new payment models, it will behoove doctors to do so.

Certainly, many patients--particularly older patients--need extra help and patience to be able to understand what they're being told and why it's important. It's also useful to help a patient identify factors that may keep him or her from following treatment recommendations.

Some of the new patient compliance efforts are do-able by redeploying staff. Patient-education activities can be accomplished by having staff members help patients understand what they're supposed to do; go through a checklist of questions to uncover stumbling blocks to compliance; and follow up with a phone call to see if the patient is indeed following instructions.

Leslie Kane is Editorial Director of Medscape's Business of Medicine site. She has disclosed no relevant financial relationships.

-From “Patient Compliance - The Future Will Be Tougher” The Kane Scrutiny: Money and Medicine, Oct 15, 2010, http://boards.medscape.com/forums?128@772.3dHDat9vzXL@.2a037a93!comment=1 retrieved 10/20/10.

 

10/10