Providers must take action to get patient compliance

Elizabeth E. Hogue, Esq., Burtonsville, MD

Home health, private duty, hospice, home medical (HME), and case managers encounter frequent instances of non-compliance. Diabetic patients do not stick to their diets. Wound care patients or their caregivers do not follow instructions for dressing wounds. Bed-bound patients do not regularly change position in bed as instructed. Patients smoke while on oxygen.

Providers may be reluctant to confront instances of non-compliance and to attempt to assist patients to achieve compliance. On the contrary, it is imperative to take action to bring patients and/or their primary caregivers into compliance or, if they cannot achieve compliance, to discontinue services to them for the following reasons:

Risk Management

When providers continue to render services to non-compliant patients, their risk of legal liability is greatly enhanced. The "bottom line" is that it is extremely difficult to separate substandard care from non-compliance by patients and caregivers. Sooner or later, patients' attorneys are likely to get to the heart of the matter which is: If practitioners knew that patients or their primary caregivers were non-compliant, why did they continue providing services to them?

Reimbursement Based on Quality of Care

Payors, such as the Medicare Program, are determined to implement payment systems based on the quality of care provided as evidenced by outcomes such as the pay-for-performance (P4P) program. Private insurers and managed care organizations (MCO's) such as Aetna are also implementing payment programs that are tied to outcomes achieved. Non-compliance may produce poor outcomes. Regardless of the cause, providers are likely to experience reductions in reimbursement as a result of poor outcomes. Many providers simply cannot afford such reductions in reimbursement.


Caring for non-compliant patients and/or primary caregivers is likely to be more expensive than caring for patients and caregivers who adhere to their plans of care. Wound care patients, for example, may not achieve healing of their wounds, or they may require more lengthy or expensive treatments as a result of non-compliance. These factors may increase the cost of care substantially.

Ethical Considerations

There is an important ethical principle called "distributive justice" that says all patients being cared for by a provider, for example, are entitled to appropriate care. Non-compliant patients and caregivers tend to require a great many resources, including expenditures of huge amounts of energy by staff. In some instances, the resources expended on non-compliant patients and caregivers may mean that other patients do not receive appropriate care. This result is unacceptable from an ethical point of view.

With enhanced risks of legal liability and unethical conduct and emphasis on outcomes and quality of care, providers cannot afford to care for patients whose non-compliance hampers the results of their treatment. Now is the time to confront non-compliant patients and their caregivers and to take action.