Question: At our hospital, we seemed to be getting more and more behaviorally difficult and noncompliant patients (and sometimes family members, too).  Patients like this can make providing treatment difficult at best, and they really wear down our staff.  But if we take determined action against them, we’re afraid that this could negatively impact our HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores.  What should we do?

Answer: This is a complicated one.  At Horty Springer, we seem to be writing more and more “we can no longer be your hospital/physician” letters and “how to deal with noncompliant patients” policies.  At the same time, we know that Medicare’s value-based purchasing (“VBP”) payments to come will use HCAHPS scores as a surprisingly high percentage of the VBP payment determination.  What is to be done?

Even with “patients with issues,” some of this can sometimes be addressed by good communication by the health care providers involved.  That not only includes being good “active listeners” and having the ability to put yourself in their shoes, it can also include working with patients to make better health choices.  As one of its Professional Issues pieces, the American Medical News recently ran an article entitled “Motivating Patients To Make Wise Choices.”  With the ongoing changes to reduce fee for service payments, expect to see more and more of these kinds of articles.

Can “health coaches” help?  If done right and well, a health coach can help patients make better health decisions.  So, if a health coach has established a relationship with a patient outside the hospital, could that health coach get through to a patient who is being noncompliant in the hospital?

One worry tied to the original question is that some health care providers might decide they will not take certain kinds of patients whom they believe will drive down their HCAHPS scores.  This is comparable to the concern that some health care providers might not accept “sicker patients” because this will affect their quality scores.

None of this is meant to disparage any health care provider in any manner.  These situations and the questions and concerns they raise are complicated and difficult.