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Patient compliance, test results are problematic
The struggling economy makes William J. Spratt, JD, a health care attorney with K&L Gates in Miami, worry about the effect on health care providers. Spratt is a former health care administrator, so he has seen the health care industry from all angles and says risk managers will face more trouble in the near future. Some of the problems will not have an obvious connection to the recession, but the causal link is there if you look, he notes.
"Patient compliance will be a major issue, especially among some demographics, such as the low income, the elderly, those on Medicare and Medicaid. Physicians are reporting that patients are canceling appointments, not filling prescriptions, not having diagnostic work done, and not returning for follow-up appointments, because they can no longer incur the expense of copayments," Spratt explains. "This will require physicians to be especially attentive to follow up with patients, especially on critical diagnostics and referrals to specialists, and will require thorough documentation of patient compliance/noncompliance with treatment orders and referrals."
Physicians should consider staffing a critical case management function to identify, track, and follow up with those patients who are most at risk, Spratt suggests. In anticipation of an increasing number of patients canceling appointments or not showing up, encourage physicians to develop a mechanism for referring the charts of those patients to a clinician to ensure that appropriate follow-up occurs.
Risk managers should be especially wary about test results not being communicated and important follow-up care falling through the cracks, he says. Tighter budgets and smaller staffs may mean that there are fewer resources for following up on a breast cancer diagnosis, for instance, and failure to do so can create major liability.
"When we start cutting staff and budgets and telling everyone to tighten up, there is the real possibility that those follow-up calls won't be made, that no one does anything when the patient doesn't respond to an important test result, or maybe that test result isn't even communicated to the patient," he says. "You can't let the standards slip for that kind of work, no matter how bad the economy gets."
For more information on the how the recession will affect health care providers, contact:
William J. Spratt, JD, K&L Gates, Miami. Telephone: (305) 539-3320. E-mail: firstname.lastname@example.org.