I called it! Almost three and a half years ago, to be precise.
- The date: September 24, 2009.
- The topic: Defining “Quality” of medical care
- My take:
What if [a] doctor decided that the best way to improve his P4P data was to discharge all the patients from his practice who, for whatever reason, failed to achieve acceptable control of their blood pressure and diabetes? Or who didn’t stop smoking? Or who refused to get a flu shot, or go for a mammogram, pap smear, or colonoscopy? As it happens, there’s nothing in the Hippocratic Oath against discharging patients. With enough money at stake in a P4P arrangement, this is inevitable.
For the past two years, I have been searching for a primary care physician who will not require that I undergo prostate cancer screening as a condition of accepting me as a new patient. Usually physicians don’t admit this directly when I ask them in the initial interview; sometimes, they actually agree with me that the PSA test and digital rectal examination are neither necessary nor beneficial. But something strange and frustrating happens after I leave each office: these physicians decide that they require screening after all and send me a letter, telling me in a short sentence that they won’t or can’t accept me as a new patient.
The comments reflect bafflement at what is going on here. Isn’t it obvious?
I’ll bet you dollars to doughnuts that most of these practices participate in some version of an Accountable Care Organization, or are beholden to insurance companies, which provide financial incentives too juicy to risk by accommodating patients with perfectly reasonable requests to forego needless health screenings. The real reason doctors have begun “requiring” that patients undergo all manner of screening interventions is to enhance their compliance ratios. After all, the quickest way to get to 100% is to get rid of everyone who falls short.
At first, I admit it sounded a little far-fetched. Would doctors really be so blatantly unethical as to “sneak” in unwanted screenings? Why on earth would they do it? It’s downright disgusting, but frankly, it’s the only (semi) legitimate explanation that comes to mind.
FSM help us as we continue our slide down this slippery slope. Today, it’s just reporting that we measured A1c’s and blood pressures; tomorrow, we doctors will be on the hook for the actual results. Watch as the trickle of discharge letters becomes a deluge.
Remember: you saw it here first.