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Does Patient Engagement Cultivate Cherries or Prevent Sour Grapes

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The question, does patient engagement cultivate cherries or prevent sour grapes, is a pertinent one in a time of healthcare reform. Especially in light of recent reports of increased cherry picking of patients by medical practices.

Cherry picking in the healthcare field is the tendency for medical practices to selectively patient engagementchoose patients to treat who have fewer health problems and for whom reimbursement is better.  It is reportedly gaining momentum due to changes in the healthcare industry linking reimbursement to outcome and quality measures. Busier practice schedules and administrative burdens on physicians are also felt to be factors contributing to the increase.

Cherry picking is not a new strategy in the healthcare industry since health insurance companies deployed it for many years until the Affordable Care Act made it unlawful for them to decline coverage for patients with preexisting illnesses.

It is difficult to know how prevalent cherry picking is among medical practices but the phenomenon is likely to gain increasing attention as more patients enter the healthcare delivery system in the wake of the Affordable Care Act. If cherry picking is truly a poison in the healthcare system, patient engagement may be the antidote. The reason is the engaged patient possesses the degree of health literacy to enable doctors to provide high quality care and achieve favorable treatment outcomes, both of which are altruistic goals which supersede financial gain.

Cherry picking is not totally unchecked. HMO healthcare plans, which are fairly prevalent, prohibit primary care physicians from rejecting patients who have selected them as their primary providers. Doctors do have the option however of terminating relationships with patients, particularly if they don’t adhere to treatment instructions.

Physicians have the freedom to not accept patients with other forms of insurance as long as the reason is not discriminatory based on ethnicity, creed or gender.  In either case, selectively rejecting a patient or terminating a doctor/patient relationship engenders the attitude on the part of the patient – “the grapes were sour anyway.”

sour grape patientsDespite the fact that patient cherry picking does occur, it is most likely tempered by the fact that many physicians derive great satisfaction from providing quality healthcare and experiencing favorable patient outcomes. That satisfaction is even greater when their efforts help very sick individuals with severe medical problems.

Patients and patient caregivers who are empowered through resources that build health literacy are patients who can become engaged in their care in ways that help physicians meet their goals of providing quality care and achieving favorable treatment outcomes. Since many doctors would prefer to treat such patients such as these, they are cherries – not sour grapes.

So, back to the original question – does patient engagement cultivate cherries or prevent sour grapes? The answer is – probably both. After all, the fox didn’t just call the grapes sour which he could not reach. He also called the grapes sour which he did reach but had taken from him.

It remains to be seen what the final score will be in the battle between patient cherry picking and patient engagement. The math will just have to play itself out.



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