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For a full practice, getting rid of "bad" patients may seem like an ideal way to increase the amount of time physicians have to spend with other cases and new clients. But, says Stan Zagorski, executive director of Associated Physicians of WyomingValley in Kingston, PA, "That is more a quality issue than a capacity issue."
Still, Zagorski says that noncompliant and troublesome patients always take more time than their "good" counterparts. "They are sicker; they are in the office more frequently and on the phone more often."
Zagorski’s 21 physicians have a set procedure for dealing with patients who don’t develop a positive doctor/patient relationship. "First, we try to help them comply by providing solutions to the obstacles they put up." If appropriate, the physician will suggest psychological help. "Many times, it is a psychological problem at the heart of it," he explains.
If the patient remains noncompliant after counseling, the doctor sends a letter stating that 30 days from the date of the letter, the physician will no longer be responsible for the patient’s care. In the meantime, only emergency care will be provided. (For a sample patient termination letter, see p. 82.)
The practice offers assistance in finding another provider by directing the patient to the American Medical Association or the state medical society.
The letter should cover the practice legally, says Alice Gosfield, JD, a consultant at Gosfield & Associates of Philadelphia. "But you are better off spelling out your policy when you take on a patient to begin with," she says.
Gosfield recommends that your new patient packet specify that if patients routinely break appointments or are noncompliant with physician-directed care, the practice will withdraw from care and refer the patient elsewhere.
"You have to be sure you document your willingness to refer the patient," she says, even if that referral is to the medical society or some other body that will help the person find care. "That will cover you for allegations of abandonment."
Lastly, she suggests, check with your state society, because every state has different requirements on the abandonment issue.
• Gail Holman, FACMPE, MBA, practice administrator, Dermatology Associates of Atlanta. Telephone: (404) 256-4457, Ext. 205.
• Stan Zagorski, executive director, Associated Physicians of Wyoming Valley, Kingston, PA. Telephone: (717) 288-5441.
• Alice Gosfield, JD, consultant, Gosfield & Associates, Philadelphia. Telephone: (215) 735-2384.