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.
“The reasons practices are dismissing patients aren’t so much related to the things people were worrying about — that if [insurers reimburse more for] quality of care, doctors might start cherry-picking patients,” said Dr. Ann O’Malley, Mathematica Policy Research senior fellow and lead author.
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
O’Malley said some of these reasons are “perfectly legitimate reasons to dismiss a patient.” 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.
The reasons behind patient dismissals can be controversial, too. For instance, many pediatricians have treated children whose parents are opposed to vaccinations. As the anti-vaccine movement has grown, the American Academy of Pediatrics last year said that doctors may dismiss such patients as a last resort so long as they provide information about finding a new doctor and provide emergency care in the short term.