Opinion: Using Health IT To “Cherry Pick” Patients is Unethical Practice

“The spread of pay-for-performance payment” and adoption of health IT tools raise “concern that physicians might” engage in “cherry-picking” and “lemon-dropping behaviors,” Carson Strong and Jim Bailey — professors in the Department of Medicine at the University of Tennessee Health Science Center — write in an American Medical News opinion piece.

Cherry-picking refers to the practice of selecting healthier individuals to accept as patients in an effort to meet performance criteria and keep medical practice costs down. Lemon-dropping or “patient dumping” refers to terminating care for patients who could be more costly or difficult to treat.

Strong and Bailey write, “The widespread adoption of [electronic health records] will provide physicians with powerful new tools for data mining that could assist in selection of profitable patients.” They write, “Lemon-dropping can be conducted easily with a highly functioning [EHR] system that includes registries for patients with chronic diseases,” adding that federal privacy rules “do not specifically prohibit these activities.”

However, Strong and Bailey write that “[p]atient selection of this sort is unethical on many levels.”

Reasons Behind Argument

According to Strong and Bailey:

• Medical organizations “that employ these practices can be expected to increase both taxpayer and employer-funded health care costs”;
• These practices “disrup[t] continuity of care and can result in adverse health outcomes”;
• Health care providers who do not engage in these practices “will care for a disproportionate number of sicker, more costly patients, which makes cherry-picking an unfair competitive practice”; and
• Such practices could “undermin[e] public trust in the profession.”

Recommendations

Strong and Bailey provide three recommendations for dissuading cherry-picking and lemon-dropping behaviors:

• “[P]ayment approaches … need to be designed carefully to avoid creating incentives for patient selection”;
• Health care providers should call for accountable care organization rules “that encourage population-based care for everyone”; and
• “American medical organizations should develop position statements on cherry-picking” (Strong/Bailey, American Medical News, 4/18).

Source: iHealthBeat