By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    What Are the Benefits of CBD?
    November 27, 2021
    How to Measure Adult Diapers- The Ultimate Guide to Picking the Right Size
    March 8, 2022
    medicine cabinet
    The Effect Of Finished Dosage Form Manufacturing In New Drugs
    July 5, 2022
    Latest News
    Beyond Nutrition: Everyday Foods That Support Whole-Body Health
    June 15, 2025
    The Wide-Ranging Benefits of Magnesium Supplements
    June 11, 2025
    The Best Home Remedies for Migraines
    June 5, 2025
    The Hidden Impact Of Stress On Your Body’s Alignment And Balance
    May 22, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Medical Negligence
    The Impact of Medical Negligence: How Claims Can Help You Move Forward
    January 6, 2025
    Advancing Your Healthcare Career through Education and Specialization
    April 16, 2025
    PPACA: “It’s in there!”
    September 9, 2017
    Latest News
    Let Your Lawyer Handle the Work Before You Pay Medical Costs
    July 6, 2025
    Top HIPAA-Compliant Messaging Apps for Healthcare Teams
    June 25, 2025
    When Healthcare Ends, the Legal Process Begins: What Families Should Know About Probate and Medical Estates
    June 20, 2025
    Preventing Contamination In Healthcare Facilities Starts With Hygiene
    June 15, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Pay Me or Charge Me: How Best to Engage Me
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Business > Finance > Pay Me or Charge Me: How Best to Engage Me
FinanceHospital Administration

Pay Me or Charge Me: How Best to Engage Me

JosephKvedar
JosephKvedar
Share
7 Min Read
SHARE

A couple of years ago, my clinical practice (Dermatology Associates at Massachusetts General Hospital) began sending patients a bill when they did not show up for an appointment. Dentists do this with some frequency, but it’s unusual for a physician practice to do it.

A couple of years ago, my clinical practice (Dermatology Associates at Massachusetts General Hospital) began sending patients a bill when they did not show up for an appointment. Dentists do this with some frequency, but it’s unusual for a physician practice to do it.

Our reasoning was that we have many folks who insist they need to be seen right away and, despite a large, busy practice (we see more than 1,000 patients each week), we still have a long wait time for appointments. Our practice used to overbook slightly (like the airlines) and count on a few no-shows. Every now and then, everyone would show up for their scheduled appointments and we’d have to deal with understandable patient frustration at the long wait times in the office.

Since implementing the ‘bill for no-show’ policy, our no-show rate has decreased.  This is an illustration of the well-studied psychological concept that if you give something away it has no value.  People, it seems, were routinely making appointments with dermatologists all over town and taking the one where they got in quickest, not bothering to cancel the rest. Since we began informing patients of the consequence of not showing up, we’ve had more engagement around keeping appointments versus canceling.

More Read

AstraZeneca Doubles Down on Personalized Medicine
Trend Watch: Obamacare Challenging Community Hospitals
Healthcare Software Testing for Seamless Stakeholders Experience
Is Your HealthCare Web Site Mobile Friendly?
3 Big Healthcare Trends To Watch in 2015

In contrast, there is a famous project from the city of Ashville, NC, where a large, self-insured employer made history by implementing a system that waived co-pays for medications for certain chronic diseases. The poster child for success was type II diabetes.  So, it seems we have a case here of giving something for free and improving engagement.

Finally there are a few studies (among them research done at Partners Connected Health) showing that compensating patients with a small financial incentive can improve adherence.

All this makes my head spin.  The conventional wisdom seems to vary from asking people to pay to keep them engaged (‘skin in the game’), to giving something away to remove a barrier, to paying people for achieving a behavioral goal…. Is one of these based on better evidence than the rest?

Calendar: Medical Exam Reminder/ Doctor Appointment

Maybe there are other variables.  In the first example, the patient was motivated enough to call an office to make an appointment.  Presumably there was some anxiety or physical symptom of concern.  In this case, the patient already has skin in the game in that she wants to get a question answered or a problem solved.  This is important, especially as we deal with chronic illness. So much of early stage chronic illness is asymptomatic. In fact, the habits that lead to chronic illness (smoking, excess calorie intake, etc.) all have reward systems of their own.   When you are already motivated to achieve an outcome, we can probably expect that you would be willing to make a financial commitment as well (copay, missed appointment fee, etc.).

The Asheville project was multifaceted and the biggest part of that intervention featured high-touch pharmacist involvement with patients. Maybe we could say that, in the case where you have a recurring, engaging interaction with a provider, the idea of waiving co-pays makes sense.  Our research shows that interaction with a care provider is a powerful stimulus to improve adherence. In that context, it may make sense to give medication away because the pharmacist is ever-present to remind the patient to take it.   In this case, the waived co-pay may indeed be perceived as a gift and a motivator rather than a communication that the medication has no value.

cHealth Blog_Kvedar_reward

The last example is most vexing to me.  I believe the preponderance of behavioral research shows that financial incentives are weak long-term motivators.  They get your attention early on, but over time they become expected and if taken away can have a significant negative ‘boomerang’ effect.

All of these are important to think through.  As health care providers take on risk for population health, we’re actively considering these matters.

One of the earliest forms of physician payments for achieving desired financial or clinical outcomes is ‘pay for performance.’  In this setting, the physician receives a bonus payment if you reach certain quality or efficiency targets.  Some of my more savvy colleagues have asked, wryly, over the years, “Why don’t we have pay for performance for our patients?”  What they are pointing out, of course, is the irony of being held accountable for health outcomes — many lifestyle related — for a population of individuals where you have no control over their lifestyle.

As we move in the direction of taking more risk, we are seriously considering how to incentivize patients to adhere to their care plans. This is a topic area where I have some instincts, but confess to not having the evidence to make a case for any of these tactics:

Charge patients to insure skin in the game?

Give them medicine and services for free?

Pay them to be adherent?

I’ll bet many of you know the obvious answer. Let us know.

Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

car accident lawsuit
Let Your Lawyer Handle the Work Before You Pay Medical Costs
Policy & Law
July 6, 2025
women dental care
What Is a Smile Makeover and How Much Does It Cost?
Dental health
June 30, 2025
HIPAA-Compliant Messaging Apps
Top HIPAA-Compliant Messaging Apps for Healthcare Teams
Global Healthcare Policy & Law Technology
June 25, 2025
recovering from injury
Rebuilding After Injury: Path to Physical and Emotional Recovery
News
June 22, 2025

You Might also Like

Price Transparency in Healthcare Still Lacking

January 23, 2015
Preparing for an Accountable Care Organization conversion
BusinesseHealthFinanceHospital AdministrationMedical Records

ACO Is Not One Size Fits All

August 6, 2014
HemoLife IMPACT System
FinanceGlobal HealthcarePublic Health

The One Way All Hospitals Can Save Lives And Money

November 2, 2014
CARF accreditation
BusinessHospital Administration

The Benefits and Value of CARF Accreditation

May 24, 2014
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?