From the Journals

Value-based care didn’t trigger spikes in patient dismissals


Fears that the transition to value-based care could lead to doctors dismissing patients from their practice who could adversely affect their reimbursement didn’t come to fruition in a recent federal value-based initiative.

“Patient dismissal could be an unintended consequence of this shift as clinicians face (or perceive they face) pressure to limit their panel to patients for whom they can readily demonstrate value in order to maximize revenue,” Ann S. O’Malley, MD, senior fellow at Mathematica Policy Research, and her colleagues wrote in a research letter published online May 15 in JAMA Internal Medicine (doi: 10.1001/jamainternmed.2017.1309).

Researchers looked at patient dismissals from all 443 practices participating in the Medicare Comprehensive Primary Care (CPC) initiative, an early value-based care model tested through the CMS Centers for Medicare & Medicaid Innovation and a comparison group of 351 practices, based on survey responses from the practices. Surveys were sent in 2016, the final year of the 4-year CPC program. Practices were asked if there was ever a patient dismissed. If the practice answered, “yes,” they were then directed to select a category explaining why.

“A similar portion and distribution of CPC and comparison practices reported ever dismissing patients in the past 2 years,” 89% and 92%, respectively, the researchers reported.

CPC and comparison practices “dismissed patients for similar reasons,” Dr. O’Malley and colleagues added, noting the exception that more comparison practices reported dismissing patients for violating bill payment policies than CPC practices did – 43% vs. 35%, respectively.

Other reasons for dismissing patients included patients being extremely disruptive and/or behaving inappropriately toward clinicians or staff, patients violating chronic pain/controlled substances policies, patients repeatedly missing appointments, patients not following recommended lifestyle changes, and patients making frequent emergency department visits and/or frequent self-referrals to specialists.

Practices participating in the CPC initiative were also asked if participation in the value-based payment model would make them more or less likely to dismiss patients.

“According to most CPC practices, the initiative had no effect or made them less likely to dismiss patients,” the researchers found.

The CMS Centers for Medicare & Medicaid Innovation funded the study. The study authors reported no conflicts of interest.

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