As Charlie Baker recovers from his foot injury, he talks about the difficulties of following medical orders to the letter.

Pay for performance will become widespread in the near future. How to deal with patients who are unwilling, or unable, to listen to physician orders will be a more relevant issue.

For instance, there is a subset of diabetic patients who are unwilling to take lipid-lowering therapy to treat their elevated cholesterol numbers. Should the doctor be penalized?

I can see physicians simply firing patients who do not comply with treatment recommendations, which will be one of the unintended consequences of the pay for performance movement.


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