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An Unintended Consequence of Payment Reforms: Providers Avoiding Nonadherent Patients

Published online by Cambridge University Press:  01 January 2021

Jessica Mantel
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Abstract

Payment reforms that link health care providers’ reimbursements to their performance on various metrics incentivize providers to improve the quality and efficiency of care they provide to patients. Unfortunately, these reforms also create strong incentives for providers to reject patients who do not adhere to medical advice. This commentary argues that providers’ avoidance of non-adherent patients flouts the medical profession's commitment to patients’ best interests, undermines patients' trust in health professionals, and aggravates disparities in health. Moreover, the economic incentives under payment reforms that encourage quality and efficiency gains are weakened when providers can escape the financial penalties for poor outcomes by simply firing their non-adherent patients.

Type
Symposium Articles
Information
Journal of Law, Medicine & Ethics , Volume 46 , Issue 4: Next Steps in Health Reform , Winter 2018 , pp. 931 - 934
Copyright
Copyright © American Society of Law, Medicine and Ethics 2018

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References

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See generally id. Anti-discrimination laws prevent providers from refusing to treat patients on the basis of the patient's race, gender, religion, national origin, age, disability, and sexual orientation. Civil Rights Act of 1964, Pub. L. No. 88-352, 78 Stat. 241, 252–53 (codified as amended at 42 U.S.C. §§ 2000d–d-4 (2012)); 20 U.S.C. § 6101 et seq. (age); 20 U.S.C. § 1681 et seq. (sex); 42 U.S.C. § 12181 (2012); Patient Protection and Affordable Care Act, Pub. L. No. 111-148, § 1557, 124 Stat. 119 (2010) (codified at 42 U.S.C. § 18116 (2012)). The Emergency Medical Treatment and Active Labor Act (EMTALA) requires physicians to screen and stabilize any individual with an emergency condition accessing a hospital's emergency department. 42 U.S.C. § 1395dd(a)–(b) (2012). Finally, the Hill-Burton Act, enacted in 1946, requires all hospitals and other facilities that received federal subsidies for construction and modernization to make their services available on a nondiscriminatory basis. See Blumstein, J.F., Court Action, “Agency Reaction: The Hill-Burton Act as a Case Study,” Iowa Law Review 69, no. 5 (1984): 1227–1261.Google Scholar
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