Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

We are all responsible for behavior change

John Corsino, DPT
Policy
October 4, 2016
Share
Tweet
Share

Helping our patients make better health decisions can be a challenge. Whether we aim to get them out of bed in the hospital or off of the couch at home, factors contributing to follow-through may be complicated, and the best strategies to facilitate the right choices are seldom clear.

As providers, we would hope that a long and healthy life would serve as the most powerful incentive for behavior change, but with health decisions, consequences are not often direct or immediate enough for patients to always draw the right connections. In our system right now, it’s not explicitly understood who should be most responsible for helping patients stay healthy, but it is clear that individual accountability is slim. With bundled payments per care episode on the horizon, it makes sense to ensure that each party understands their role.

Incentives are powerful tools as long as they’re focused on the right groups and the right behaviors. When a patient with congestive heart failure returns to the hospital shortly after discharge, shouldn’t they have some stake in the penalty that’s assessed by Medicare? After all, CHF exacerbation and intermediate-term management is highly dependent upon the choices of the individual: dietary indiscretion, daily weight, medication adherence. We don’t want to pressure them to avoid the hospital; instead, insurers should implement financial incentives (like reduced premiums) for patients who can demonstrate vigilance managing their chronic conditions. Penalizing hospital systems may help stimulate the creation of more urgent care clinics or expansion of home and outpatient services, but the incentive is still aimed at the wrong party, and that makes it less effective than it could be.

In contrast, if one hospital is discharging their 80-year-old pneumonia and UTI patients to skilled nursing facilities at a rate much higher than their geographic peers, it might make perfect sense to penalize that hospital for overutilization. In this case, the risk of losing reimbursement for admissions would stimulate better practices during those visits: more attention to nutrition, better physical activity for inpatients, improved focus on minimizing delirium. These factors are directly within the hospital’s control, and so financial incentives should affect them directly.

Behavior change is a high-value focus: We can derive substantial improvement in patient outcomes at very little cost. On the part of providers, the barrier has been that our administrators don’t fully understand how much help we can do here because it’s difficult to capture in terms of billable services and productivity, which leaves us with few opportunities to impart meaningful education in an actionable manner. Instead, we give informational print-outs and hurry on to the next service.

If we instead had the time to learn from our patients what separates them from the behavior changes they need, we could better help them. A gap of knowledge is rarely the only obstacle: Many patients underestimate the likelihood of some diseases or how significantly they can actually affect their risk through lifestyle modification. We won’t ever achieve perfect adherence, but we can do better, and the coming changes to payment structure make this the right time to revisit our approaches.

John Corsino is a physical therapist.

Image credit: Shutterstock.com

Prev

A physician experiences a medical error. Here's her story.

October 4, 2016 Kevin 11
…
Next

Be frugal: The key to physician financial fitness

October 4, 2016 Kevin 1
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
A physician experiences a medical error. Here's her story.
Next Post >
Be frugal: The key to physician financial fitness

ADVERTISEMENT

More by John Corsino, DPT

  • Navigating organizational dysfunction: lessons from Boeing

    John Corsino, DPT
  • Lifelong learning: a game-changer in diagnosing dizziness

    John Corsino, DPT
  • This light is theirs alone

    John Corsino, DPT

Related Posts

  • We need to change the way we talk about climate change

    Jacob A. Fox
  • For change to happen, humbly look at ourselves

    Gabriella Gonzales, MD and Alexander Rakowsky, MD
  • It is our job to change the rhetoric on who physicians are

    Simran Kripalani
  • Crazy is how you feel when working within a system you feel you cannot change

    Nina Mirabadi
  • We must be brave enough to seek change

    Fred N. Pelzman, MD
  • Has your doctor asked you about climate change?

    Martha Bebinger

More in Policy

  • Health equity in Inland Southern California requires urgent action

    Vishruth Nagam
  • How American medicine profits from despair

    Jenny Shields, PhD
  • What I learned about health care by watching who gets left behind

    Maanyata Mantri
  • How the One Big Beautiful Bill could reshape your medical career

    Kara Pepper, MD
  • Why the U.S. Preventive Services Task Force is essential to saving lives

    J. Leonard Lichtenfeld, MD
  • Brooklyn hepatitis C cluster reveals hidden dangers in outpatient clinics

    Don Weiss, MD, MPH
  • Most Popular

  • Past Week

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Could antibiotics beat heart disease where statins failed?

      Larry Kaskel, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why palliative care is more than just end-of-life support

      Dr. Vishal Parackal | Conditions
    • When life makes you depend on Depends

      Francisco M. Torres, MD | Physician
    • Guilty until proven innocent? My experience with a state medical board.

      Jeffrey Hatef, Jr., MD | Physician
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • The many faces of physician grief

      Annia Raja, PhD | Conditions
    • Why the doctor-patient relationship needs a redesign

      Alexandra Novitsky, MD | Physician
    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Imposter syndrome is not a personal failing

      Jessie Mahoney, MD | Physician
    • Why sleep must become a central pillar in modern health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • How early care saved my life from silent kidney disease

      Charlie Cloninger | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Could antibiotics beat heart disease where statins failed?

      Larry Kaskel, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why palliative care is more than just end-of-life support

      Dr. Vishal Parackal | Conditions
    • When life makes you depend on Depends

      Francisco M. Torres, MD | Physician
    • Guilty until proven innocent? My experience with a state medical board.

      Jeffrey Hatef, Jr., MD | Physician
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • The many faces of physician grief

      Annia Raja, PhD | Conditions
    • Why the doctor-patient relationship needs a redesign

      Alexandra Novitsky, MD | Physician
    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Imposter syndrome is not a personal failing

      Jessie Mahoney, MD | Physician
    • Why sleep must become a central pillar in modern health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • How early care saved my life from silent kidney disease

      Charlie Cloninger | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

We are all responsible for behavior change
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...