With health plans increasingly holding physicians accountable for quality measures, it may be tempting for practices to dismiss patients who don't appear to comply with doctor's orders. Although there are circumstances in which a doctor and patient can't maintain a therapeutic relationship, according to experts who spoke with Medical Economics, it is most often possible to make it work.
If your practice is finding itself on the brink of terminating one or more patients who don't keep appointments, take their medications or otherwise follow advice about their health, consider the following tactics:
Look for root causes. Short office visits make it difficult for physicians to understand the full scope of a patient's home life. But a team member, such as a nurse, office manager or social worker, may be able to uncover contextual issues that are impeding care, such as difficulty affording prescriptions or lack of transportation to get to doctors and pharmacies.
Historically the practice's role would then be to help patients work around limitations, such as scheduling appointments when busses were running, but that may be changing. The U.S. Department of Health and Human Services (HHS) announced earlier this month it will provide up to $147 million to fund a new Accountable Health Communities model that will screen Medicare and Medicaid recipients for health-related social needs and refer them to clinical and community services.
Consider a contract. While some physicians have had success having pain patients sign contracts in which they agree to handle opioid medications responsibly, doctors in other fields are increasingly applying the technique to spell out expectations for patients in managing various chronic conditions. Such a document may not be legally binding in court, but it can help patients take greater ownership of their health, said Sidney S. Welch, an attorney in the Atlanta office of Polsinelli PC and co-chair of the law firm's healthcare innovation practice.
Check your gut. It is considered unethical to dismiss a patient during periods of serious illness, the article noted. Some might argue that those struggling to control a chronic disease also fit into that category.
Family physician Justin Reno, M.D., discussed in a recent post on the KevinMD blog, for example, the unfair pressure on physicians to take responsibility for the health problems of society. But in spite of the inevitable "bad grades" taking care of patients with poor health habits may elicit, he argued that physicians should not cherry pick for patients who take better care of themselves.
"The smokers, the alcoholics, the fast food addicts, the drug addicts--those are going to be the ones that suffer--the ones that require the most but yield the least results," he wrote. "The ones that honestly need physicians. And the physicians that truly care about them are going to have the lowest grades."
To learn more:
- read the article
- here's Reno's post