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There have been some recent articles stating that 20% of hospital admissions and physician care are the result of patient noncompliance and/or poor adherence to medications and treatment regimes. The health care spending related to this is estimated at 100 billion per year. This reality has to be an incredible disincentive for hospitals to actually do more to improve patient compliance and adherence. Why would they invest in activities that can potentially reduce their revenues by 20%?

Hospitals collect tons of clinical information about patient conditions, but absolutely nothing about patient psychological or behavioral predispositions that could predict how well he or she is likely to comply and adhere. With this added dimension of assessment, hospital clinical staff could know better how to engage and persuade patients to be more compliant, and discharge staff would know better who to follow-up with. As I said, there is a huge disincentive for this to happen. Because “hospital care” ends at discharge and hospitals are not “to blame” for what the patient does after he or she leaves, there is no incentive for them to improve compliance. There is much more incentive for them to make it worse.

I agree that hospitals have generally “abandoned” their patients at discharge, rather than doing anything about their compliance with post-discharge care recommendations, taking of prescribed medications, etc. — and that it is not in their best financial interests to change. The surprising thing is that there are quite a few hospitals that are exceptions to this rule, some because they do not want to see patients come back when they would be financial losers under Medicare DRG, Medicaid stinginess, or because they are uninsured. But some actually do it because it is part of their health mission, and some because they can make money at it under special pay-for-performance schemes. Only when it becomes financially sounder for hospitals to engage in full disease management, health promotion and risk reduction does it seem likely that these will become widespread investments on their part, and continuous health management rather than episodic sickness treatment become the rule rather than the exception. But there are some signs that payers are making this more possible in the future than in the past.

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