Non-adherence has been a problem for as long as physicians have been treating patients. But now it is an even greater concern because it can affect their Medicare Part B reimbursements under the new Medicare Access and CHIP Reauthorization Act (MACRA).
MACRA brings with it a new set of initiatives, benchmarks and reporting requirements, accompanied by escalating financial incentives and penalties. The program is meant to strengthen the role of primary care and improve patient outcomes, but navigating the new reporting and reimbursement landscape can be problematic for physicians, particularly when patients don’t, or can’t, cooperate.
Patient engagement is a factor in three of the four reporting categories under what is expected to be MACRA’s most common track, the Merit-based Incentive Payment System (MIPS). Policymakers hope the increased coordination between providers and patients will lead to improved adherence. But some think it could be unfair to doctors.
“The performance measures are archaic and they hold physicians responsible for things that are systemic,” says Wendy Nickel, MPH, director of the American College of Physicians (ACP) Center for Patient Partnership in Healthcare, which promotes patient-centered care. “If you tie non-adherence to the physician alone, you’re losing the responsibility that everyone else in the healthcare system has.”
There has been a long and vigorous debate in primary care about non-adherence and how much responsibility physicians should bear for patients’ failure (or inability) to follow medical advice, often to their own detriment.
Some physicians argue that adherence is not their responsibility. All they can do, they say, is prescribe the appropriate treatment; it’s up to the patient to follow through. However, the opposing point of view, which holds that physicians are obligated to do whatever they can to increase adherence, was gaining the upper hand even before MACRA tied reimbursement to results.
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One of the reasons for this is that physicians who might once have attributed non-adherence to patient indifference or laziness have become more aware of the reasons why patients might not follow advice or fill prescriptions, such as financial difficulties, depression, and language and education barriers.
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.”