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Will Patient Engagement Produce Cherries or Prevent Sour Grapes?
A real fox calls sour not only those grapes that he cannot reach but also those that he did reach but
had and taken away.
The question, does patient engagement cultivate cherries or prevent sour grapes, is a pertinent one in a milieu of
healthcare reform, given recent reports of increased cherry picking of patients. Cherry picking in the healthcare
field, which is the tendency for medical practices to selectively choose patients to treat who have fewer health
problems and for whom reimbursement is better, is said to be gaining momentum as a result of changes linking
reimbursement to outcome and quality measures, and because of busier practice schedules and administrative burdens
Although cherry picking is not a new strategy which health insurance companies deployed for many years up until the
Affordable Care Act made it unlawful for them to decline coverage for patients with pre-existing illnesses, it is
likely to gain increasing attention as more patients enter the healthcare delivery system and patient-empowerment
responsibilities are defined. If cherry picking is truly a poison in the healthcare system, patient engagement may
be the antidote, inasmuch as it makes it more possible for doctors to provide high quality care and achieve
favorable patient outcomes, which supersedes financial gain.
Cherry picking is not totally unchecked inasmuch as HMO healthcare plans, which are fairly prevalent, prohibit
primary care physicians from rejecting patients who have selected them as their primary providers. Doctors however,
have the option of terminating relationships with patients, particularly if they are not adherent or compliant
with the treatment provided them. Moreover, physicians have the freedom to not accept patients with other forms of
insurance as long as the reason is not discriminatory based on ethnicity, creed or gender. In either case,
selectively rejecting or terminating a patient engenders the attitude on the part of the patient, “the grapes were
It is difficult to know at this time how prevalent patient cherry picking is or will become over time, but most
likely can be tempered by the fact that many physicians derive great satisfaction from providing quality healthcare
and experiencing good patient outcomes, particularly in patients that are very sick with severe medical problems.
By empowering patients or their caregivers with health-literacy enhancement resources that enable them to become
engaged in their healthcare in ways that are mutually beneficial with respect to achieving quality improvement in
health care, many will be the types of patients doctors selectively prefer to treat, or essentially cherries
instead of sour grapes.
So, back to the original question, does patient engagement cultivate cherries or prevent sour
grapes The answer is, both. The math just has to play itself
Victor E Battles, M.D. is a board-certified internist with more than 30 years of patient
contact. He has served on hospital quality assurance committees and in October 1986 was certified by the American
board of quality assurance and utilization review.
Victor E. Battles, M.D.
January 2, 2014
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