Missing appointments? Skipping doses? You might get fired by your doctor – By Max Blau @maxblau – May 15, 2017
A new survey of primary care doctors reveals an interesting statistic:
9 out of 10 practices have told a patient not to come back.
The doctors have fired their patients.
The research, published in JAMA Internal Medicine on Monday, found that firing patients doesn’t happen often, but it’s making some health experts nervous that doctors will expunge difficult patients from their rolls as insurers move toward reimbursing them more for benchmarked health outcomes than actual services provided.
The study’s authors say it could happen, but they’re not seeing that yet.
What does that even mean? Pain patients are “seeing it” all over as doctors try to get rid of patients that require opioids because of the regulatory issues that could cause them to lose their license.
As much as we pain patients feel helpless and abused when it happens to us, we must remember that all of that doctor’s patients will lose care if such treatment leads to loss of the doctor’s license.
Among the reasons the nearly 800 practices surveyed gave for cutting ties with a patient:
- Violent, “disruptive,” or inappropriate behavior toward doctors or staff
- Violation of policies related to chronic pain and controlled substances
- Failure to show up to scheduled appointments
- Repeated disregard of a doctor’s medical recommendations
- Violation of bill payment policies
“Violation of policies related to chronic pain”? The only policies are against opioids and no one cares that some severe intractable pain can only be controlled with opioids – none of the woo-woo alternative medicine treatments are effective for it.
She said that “a dearth of literature” exists on the subject of patient dismissals. But as more doctors rely on value-based reimbursements, patient dismissals could still rise.
How could this NOT happen?
Did no one think of the very obvious adverse effects these new pay-for-performance/value reimbursement plans were going to cause?
It seems ridiculously obvious that if a doctor is paid a one-time, simply-calculated flat fee for “fixing” a patient, doctors will find ways to exclude complex or difficult patients from their practices.
Chronic pain patients require so much more time and effort than complaints about a runny nose or even a sprained ankle, that a flat fee would not reimburse a doctor for all the work such patients need.
Links [given in article]