Responsibility for Patient Outcomes or Medical Overreach?

There has been an increasingly incentivized push to improve patient outcomes. And rightfully so. The patient should always be at the center of any healthcare program. For example, CMS's program MIPS provides monetary benefits or penalties for tracking and reporting specific quality measures. But when does holding providers accountable for outcomes cross a line between improving care and medical overreach?

The old model of healthcare was to treat patients in a more reactive manner. In the ever-evolving healthcare landscape, the new normal is becoming a more educated and preventive-based approach with a long term view. This has led to a more patient-centered ideology: How can we educate people to better care for their own health? This isn't meant to deter those who have illnesses, but rather to reduce chronic conditions that can be directly connected to patient behavior. 

So why then is there some concern amongst providers in regards to being held responsible for patient behavior? The answer isn't a definitively clear one.

A comparable way of looking at this is the controversy of tying teacher performance to student success or failure. In our case, a doctor can be a great doctor, but if the patient doesn't act on professional advice regarding ways to practice self-care, then who is at fault? This is where it gets slippery.

Provider income is increasingly reliant on quality reporting and long-term outcomes. So what happens when a provider follows proper procedures from start to finish, but a patient is stubborn and doesn't listen to medical recommendations? For one, the patient could be readmitted, leading to, in the eyes of CMS, a fault on the provider's side. When tying financial compensation to performance, there can be instances of going beyond what you'd normally do in order to ensure you earn what you worked for. 

In the eyes of the provider, financial penalties are cause for great concern. If a provider knows that a patient isn't compliant, they might opt not to see them for fear of monetary penalties. This then creates the moral dilemma of rejecting patients who might not be financially capable of following a provider-set care plan. Nothing is ever black and white, right?

So, what are some possible solutions? There are a couple of options, according to healthmanagement.org.

• Take better care of providers and other hospital staff: Hospital staffs, especially providers and nurses, need to be be mentally and emotionally supported. A healthy staff leads to healthy patient outcomes. 
• Emphasize health data and analytics: Understanding where your patient is from, where they are now, and where they are going in their health is paramount to understanding the best care to provide.
• Create a clearer continuity-of-care path following discharge: Make sure that all providers involved in patient hand-offs have up-to-date and accurate patient information so there's no disruption in the care process.
• Continue to engage and support patients after discharge: The more a patient is involved in their own health processes, the more engaged and proactive they will be. 

What are your thoughts? Is placing responsibility on providers for patient outcomes fair, or is it inviting medical overreach? Let us know!

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