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How to Help Gastroenterology Patients Help Themselves: Leveraging Insights From Behavioral Economics

  • Shivan J. Mehta
    Correspondence
    Reprint requests Address requests for reprints to: Shivan J. Mehta, MD, MBA, Perelman School of Medicine, University of Pennsylvania, 1133 Blockley Hall, 423 Guardian Drive, Philadelphia, Pennsylvania 19104. fax: (215) 573-8778.
    Affiliations
    Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

    Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania

    Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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  • David A. Asch
    Affiliations
    Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania

    Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania

    Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, Pennsylvania
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      In the wake of health reform, physicians will be taking on more responsibility for the outcomes and value of care their patients receive. There will be a broader pool of insured patients to care for as well as greater pressure to provide better outcomes while maintaining efficiency. We can already see the proliferation of quality metric reporting from both governmental and commercial payers, which will likely be followed by payment and accountability based on the results of these metrics. Although many of these incentives are focused on primary care providers, gastroenterologists are also subject to these changes in organization and financing of health care. In the current predominantly fee-for-service model, gastroenterologists are reimbursed on the basis of how many patients they see and procedures they perform. With new financing mechanisms, this piecework financing will likely transition to reimbursement for quality or value, so gastroenterologists will need to evolve from the current reactive, visit-based model of care to one that is more proactive and outcome-based.
      • Gellad Z.F.
      • Thompson C.P.
      • Taheri J.
      Endoscopy unit efficiency: quality redefined.

      Abbreviation used in this paper:

      PPI (proton pump inhibitor)
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      References

        • Gellad Z.F.
        • Thompson C.P.
        • Taheri J.
        Endoscopy unit efficiency: quality redefined.
        Clin Gastroenterol Hepatol. 2013; 11: 1046-1049
      1. Vital signs: colorectal cancer screening test use—United States, 2012.
        MMWR Morbidity and Mortality Weekly Report. 2013; 62: 881-888
        • Naik A.D.
        • Hinojosa-Lindsey M.
        • Arney J.
        • et al.
        Choosing Wisely and the perceived drivers of endoscopy use.
        Clin Gastroenterol Hepatol. 2013; 11: 753-755
        • Tversky A.
        • Kahneman D.
        The framing of decisions and the psychology of choice.
        Science. 1981; 211: 453-458
        • Loewenstein G.
        • Brennan T.
        • Volpp K.G.
        Asymmetric paternalism to improve health behaviors.
        JAMA. 2007; 298: 2415-2417
        • Kahrilas P.J.
        • Shaheen N.J.
        • Vaezi M.F.
        • et al.
        American Gastroenterological Association medical position statement on the management of gastroesophageal reflux disease.
        Gastroenterology. 2008; 135: 1383-1391
        • Gawron A.J.
        • Pandolfino J.E.
        • Miskevics S.
        • et al.
        Proton pump inhibitor prescriptions and subsequent use in US veterans diagnosed with gastroesophageal reflux disease.
        J Gen Intern Med. 2013; 28: 930-937
        • Doshi J.A.
        • Zhu J.
        • Lee B.Y.
        • et al.
        Impact of a prescription copayment increase on lipid-lowering medication adherence in veterans.
        Circulation. 2009; 119: 390-397
        • Trivedi A.N.
        • Rakowski W.
        • Ayanian J.Z.
        Effect of cost sharing on screening mammography in Medicare health plans.
        N Engl J Med. 2008; 358: 375-383
      2. FAQs about Affordable Care Act Implementation Part XII, Feb 2013. Available at: http://www.dol.gov/ebsa/faqs/faq-aca12.html. Accessed January 15, 2014.

        • El-Serag H.B.
        • Naik A.D.
        Surveillance in Barrett's esophagus: lessons from behavioral economics.
        Gastroenterology. 2009; 137: 763-765
        • Bennett C.
        • Vakil N.
        • Bergman J.
        • et al.
        Consensus statements for management of Barrett's dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process.
        Gastroenterology. 2012; 143: 336-346