Nav: Home

Penn researchers call for better laws covering patient incentives to improve care

March 22, 2017

PHILADELPHIA - Current federal anti-kickback laws prohibit pharmaceutical companies and providers from bribing patients to seek their goods and services. Unfortunately, the laws also prevent hospitals from offering services that could potentially benefit patients, such as free rides to elderly or disabled patients to help them get to their appointments. In an essay published today in the New England Journal of Medicine, researchers from the Perelman School of Medicine at the University of Pennsylvania call for a recrafting of these laws to permit more sensible health-promoting initiatives.

"The current sweeping prohibitions against patient inducements are well intentioned but no longer make sense - sometimes it's good to get patients to seek care," said lead author Krisda H. Chaiyachati, MD, MPH, a fellow in the VA Robert Wood Johnson Clinical Scholars Program at Penn Medicine.

The authors propose that laws restricting patient inducements should put more emphasis on the value of the services that patients are being nudged to seek.

"We believe that if inducements encourage patients to seek high-value services, they shouldn't be viewed negatively," Chaiyachati said.

Anti-kickback laws are considered necessary in the American healthcare system because Americans seldom face the actual costs of their prescription drugs or healthcare services - typically government or private insurers share the costs. Thus, even a small inducement may be enough to persuade a patient to seek an expensive drug or healthcare service, even when the actual value is low, because others are footing the bill. One important law, the federal Anti-Kickback Statute, is designed to block such practices, at least among providers receiving federal dollars, by outlawing financial inducements (beyond a nominal value of $15) that may increase referrals for publicly or privately insured patients.

The problem is that laws with such broad prohibitions may end up throwing the baby out with the bathwater. As the authors of the essay note, recent changes in health insurer practices in America, such as the penalizing of providers for care failures resulting in hospital re-admission, ought to shift our thinking. "Encouraging patients to get low value and expensive care is a problem," says David A. Asch, MD, MBA, a professor of Medicine at the Perelman School and of Healthcare Management at the Wharton School at the University of Pennsylvania, and a co-author on the report. "But encouraging patients to get care means something entirely different when that care aims to prevent something bad and even more expensive."

"Services that would never have been considered under traditional payment models, such as providing low-salt food parcels for patients with heart failure, are now seen as potential ways to avert re-admissions and associated penalties," Chaiyachati said.

As an example, the researchers suggest a rideshare program in collaboration with Uber or Lyft could help get Penn Medicine patients to their primary care appointments, but some of the higher end services could be viewed as prohibited inducements under the Anti-Kickback Statute.

The team suggests that such laws be altered to better distinguish inducements for high-value services that provide medical benefits at reasonable prices from inducements for low-value services that mostly benefit providers' profit margins. "We are judging these inducements based on what they cost, not on what they deliver," says David Grande, MD, MPA, an assistant professor of Medicine at the Perelman School of Medicine, director of Policy at Penn's Leonard Davis Institute of Health Economics, and the third of the essay's authors.

Specifically the laws could, for example, treat inducements according to who pays for them. "Graft is less likely when inducements come from parties with greater risk sharing," Chaiyachati said. The laws also could treat inducements according to the type of care they promote, such as standard forms of preventive care. "Probably any of these approaches would be better than what we have now," he added. "In general, we should start thinking of some of the inducements that are currently prohibited as positive tools for driving high-value care."
Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $5.3 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 18 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $373 million awarded in the 2015 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center -- which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report -- Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2015, Penn Medicine provided $253.3 million to benefit our community.

University of Pennsylvania School of Medicine

Related Health Articles:

Mental health of health care workers in china in hospitals with patients with COVID-19
This survey study of almost 1,300 health care workers in China at 34 hospitals equipped with fever clinics or wards for patients with COVID-19 reports on their mental health outcomes, including symptoms of depression, anxiety, insomnia and distress.
Health records pin broad set of health risks on genetic premutation
Researchers from the University of Wisconsin-Madison and Marshfield Clinic have found that there may be a much broader health risk to carriers of the FMR1 premutation, with potentially dozens of clinical conditions that can be ascribed directly to carrying it.
Attitudes about health affect how older adults engage with negative health news
To get older adults to pay attention to important health information, preface it with the good news about their health.
Geographic and health system correlates of interprofessional oral health practice
In the current issue of Family Medicine and Community Health (Volume 6, Number 2, 2018, pp.
Bloomberg era's emphasis on 'health in all policies' improved New Yorkers' heart health
From 2002 to 2013, New York City implemented a series of policies prioritizing the public's health in areas beyond traditional healthcare policies and illustrated the potential to reduce cardiovascular disease risk.
Youth consider mobile health units a safe place for sexual health services
Mobile health units bring important medical services to communities across the country.
Toddler formulas and milks -- not recommended by health experts -- mislead with health claims
Misleading labeling on formulas and milks marketed as 'toddler drinks' may confuse parents about their healthfulness or necessity, finds a new study by researchers at the NYU College of Global Public Health and the Rudd Center for Food Policy & Obesity at the University of Connecticut.
Women's health has worsened while men's health has improved, trends since 1990 show
Swedish researchers have studied health trends among women and men aged 25-34 from 1990-2014.
Health insurance changes, access to care by patients' mental health status
A research letter published by JAMA Psychiatry examined access to care before the Patient Protection and Affordable Care Act (ACA) and after the ACA for patients grouped by mental health status using a scale to assess mental illness in epidemiologic studies.
Community health workers lead to better health, lower costs for Medicaid patients
As politicians struggle to solve the nation's healthcare problems, a new study finds a way to improve health and lower costs among Medicaid and uninsured patients.
More Health News and Health Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Clint Smith
The killing of George Floyd by a police officer has sparked massive protests nationwide. This hour, writer and scholar Clint Smith reflects on this moment, through conversation, letters, and poetry.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Dispatch 6: Strange Times
Covid has disrupted the most basic routines of our days and nights. But in the middle of a conversation about how to fight the virus, we find a place impervious to the stalled plans and frenetic demands of the outside world. It's a very different kind of front line, where urgent work means moving slow, and time is marked out in tiny pre-planned steps. Then, on a walk through the woods, we consider how the tempo of our lives affects our minds and discover how the beats of biology shape our bodies. This episode was produced with help from Molly Webster and Tracie Hunte. Support Radiolab today at