Health IT and the Forbidden Fruit

Electronic health records will make it easier for physicians to dump their sickest patients, an unethical practice known as "lemon-dropping," two medical professors wrote this week in an industry ethics forum.

Performance-based payment systems already tempt medical practices to "cherry-pick" healthier patients to meet performance criteria and reduce practice costs, Carson Strong and Jim Bailey, professors at the University of Tennessee Health Science Center, wrote in American Medical News.

They argue that EHRs and the vast array of patient data they hold, including chronic-disease registries, can entice some physicians to employ the companion practice of lemon-dropping -- especially with the growing prevalence of pay-for-performance payment models.

"The widespread adoption of electronic medical records will provide physicians with powerful new tools for data mining that could assist in selection of profitable patients," Strong and Bailey wrote. "Poorly designed pay-for-performance incentives could motivate physicians to end their relationships with 'difficult' patients or not accept elderly patients, those with multiple chronic medical problems or those with low health literacy."

Cherry-picking and lemon-dropping ultimately drives health-care costs up across the board and deny care to "our most vulnerable citizens," they maintain. They say the practices can be minimized by:

• Ensuring payment approaches do not create incentives for patient selection.
• Reforming insurance rules to allow accountable care organizations -- consortia of doctors, hospitals, nursing homes and others that coordinate care.
• Strong advocacy efforts by American medical organizations.
• Designing payment plans appropriately.

American Medical News is published by the American Medical Association.