FM practice declining a patient

[GoodmanBrown]

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Are there any laws or rules on declining a patient in a PCP practice? I have a friend who's on private insurance (through his wife), but is on disability. His wife emailed me and said that during an initial visit, when the doc/office found out he was on disability, they said they will not accept him as a patient. She was pretty upset and emailed me to ask if there were any discrimination laws being broken.

My hunch is that there are not. I don't believe there are laws requiring physicians to see any particular patients. I understand if the person is already part of the practice, you cannot (or should not) discharge them without documentation that their medical care is being continued elsewhere. But, seeing as this was his first visit to the practice, that would not apply.

Finally, does this mean a physician could not see black people or Catholics? Thanks!

 

[ghost dog]

Are there any laws or rules on declining a patient in a PCP practice? I have a friend who's on private insurance (through his wife), but is on disability. His wife emailed me and said that during an initial visit, when the doc/office found out he was on disability, they said they will not accept him as a patient. She was pretty upset and emailed me to ask if there were any discrimination laws being broken.

My hunch is that there are not. I don't believe there are laws requiring physicians to see any particular patients. I understand if the person is already part of the practice, you cannot (or should not) discharge them without documentation that their medical care is being continued elsewhere. But, seeing as this was his first visit to the practice, that would not apply.

Finally, does this mean a physician could not see black people or Catholics? Thanks!

Do you honestly believe that this is the entire story?

What year of medical school are you in ?

When you get a bit more experience under your belt, you start to realize that some people may have ulterior motives for attending a doctor's office. Some examples include :

1. Rubber stamping a disability application, or continuing to endorse said application.
2. Prescribing controlled substances, where they are not indicated.

Even if this is not the case, some people don't get along. If a person rubs the admin the wrong way, this may cause the doc to indicate they aren't going to see the patient on an ongoing basis.

The above and racial / religious discrimination are a pretty big difference.

 

[deleted87716]

Are there any laws or rules on declining a patient in a PCP practice? I have a friend who's on private insurance (through his wife), but is on disability. His wife emailed me and said that during an initial visit, when the doc/office found out he was on disability, they said they will not accept him as a patient. She was pretty upset and emailed me to ask if there were any discrimination laws being broken.

Technically, by seeing him, they've already accepted him as a patient. If they don't wish to continue seeing him, they can simply tell him that they can't help him with whatever he is requesting (e.g., fill out my disability paperwork without any supporting documentation or old records, refill my prescription for 500 Vicodin per month, etc.) and hope that he voluntarily goes elsewhere, or they can formally dismiss him from the practice. In most cases, this involves simply sending a registered letter informing the patient that they have been dismissed, and providing 30 days of emergency care to allow them to become established with another physician. It is not (repeat NOT) necessary for the patient to actually become established with another physician in order for them to be dismissed. That's their responsibility.

We have declined to accept patients based on prior knowledge or experience (e.g., bad debt with other physicians in our practice, prior dismissal from another practice, etc.) The key, however, is not to schedule that first appointment. Once you do, they're yours until you dismiss them or they leave voluntarily.

It could simply be an insurance-related matter. We've had patients who called to schedule an appointment claiming to have one type of insurance, only to have them present a different insurance card (one we didn't accept) when they showed up for their appointment. In most of these cases, we would not be able to accept them as a patient based on the fact that we cannot file their insurance claims (which they would expect us to do).

This is not the same as discrimination. I don't participate with any Worker's Compensation plans, but that doesn't mean that I discriminate against injured workers. It's simply not part of my practice.

 

[Shinken]

I agree that there's part of the OPs story that's probably missing.

I have been in practice since July 2011, a mere 6 months, and I've already dismissed about 4 patients from my practice. Also, I routinely decline patients as well - my practice is close to the residency clinic where I trained, so many of the residency clinic patients want to come see me. I accept some of them, and some of them I decline, because I already know the type of patients they are (manipulative, rude, drug-seeking, etc.). Although I'm of the mindset that everyone needs a primary care physician, they're already established at the residency clinic so it's not like they don't already have a PCP.

In the 3 years of residency and 6 months of practice, the "reason for visit" that raises a big red flag in my mind are:

- chronic low back pain (especially on someone who's unemployed or applying for disability). Chronic LBP on someone with insurance and employed full-time is a totally different story (they don't want narcotics, they want physical therapy and other modalities...they can't afford to be all doped up at work).

- chronic anxiety (otherwise known as "I can't live without my xanies")

- "need help with filling out disability paperwork"

I have also had people set up an appointment at my office for a "physical", drive to my office, sit in the waiting room reading a magazine, enter my exam room walking normally, transfer from the chair up to the exam table and back, and then present me with paperwork to have all their federal student loans discharged because they're "disabled".

In other words, it's crazy out there and you don't need the aggravation of an abusive patient (abusive to you or to staff).

 

[GoodmanBrown]

This is not the same as discrimination. I don't participate with any Worker's Compensation plans, but that doesn't mean that I discriminate against injured workers. It's simply not part of my practice.

Thanks, BD. I admittedly don't know all of his story, so I don't know for sure what went down. I know he's had some trouble keeping PCPs in the past, so I wonder what part(s) of the story I don't know about.

I'm still a bit hazy on physician discrimination aspects of private practice. I found a site for the Office of Civil Rights FAQ in the HHS. It gives lots of standard non-discrimination lists. However it also says this only applies to clinics receiving "federal financial assistance" with Medicare Part B specifically excluded. So, if a private practice office isn't receiving government money except for Medicare Part B payments, the implication to me is that none of the non-discrimination laws are enforceable there. Help me out here, where am I going amiss?

 

[deleted87716]

I'm still a bit hazy on physician discrimination aspects of private practice.

It would certainly be "bad P.R." to actively discriminate against a particular ethnic or religious group, race, or gender. I'm not sure about the legal ramifications, but I imagine there are pitfalls.

I know of one doctor locally who has fired patients for being liberal democrats. I am not kidding.

I also know of some who refuse to take on new patients who are smokers.

Another is a born-again Christian, has religious trappings throughout his office, and incorporates prayer into his treatment plans. Obviously, this would not appeal to everyone. His patients wind up being somewhat self-selected.

 

[JustPlainBill]

Technically, by seeing him, they've already accepted him as a patient. If they don't wish to continue seeing him, they can simply tell him that they can't help him with whatever he is requesting (e.g., fill out my disability paperwork without any supporting documentation or old records, refill my prescription for 500 Vicodin per month, etc.) and hope that he voluntarily goes elsewhere, or they can formally dismiss him from the practice. In most cases, this involves simply sending a registered letter informing the patient that they have been dismissed, and providing 30 days of emergency care to allow them to become established with another physician. It is not (repeat NOT) necessary for the patient to actually become established with another physician in order for them to be dismissed. That's their responsibility.

We have declined to accept patients based on prior knowledge or experience (e.g., bad debt with other physicians in our practice, prior dismissal from another practice, etc.) The key, however, is not to schedule that first appointment. Once you do, they're yours until you dismiss them or they leave voluntarily.

It could simply be an insurance-related matter. We've had patients who called to schedule an appointment claiming to have one type of insurance, only to have them present a different insurance card (one we didn't accept) when they showed up for their appointment. In most of these cases, we would not be able to accept them as a patient based on the fact that we cannot file their insurance claims (which they would expect us to do).

This is not the same as discrimination. I don't participate with any Worker's Compensation plans, but that doesn't mean that I discriminate against injured workers. It's simply not part of my practice.

Question about the bolded comment --

I happened to be in a discussion with one of my program attendings who portrays himself as the expert on all things -- he speaks with great confidence and has some rather interesting opinions, some of which are probably ok ---

Anyway, I asked about the classic - new patient calls to be seen for URI and due to some fluke, you realize you don't want them in your practice...what do you do? His comment was that you have to see them for the URI but just because you have, doesn't make them your patient. You should treat them for the URI and then make it clear that you are not accepting them as a patient and they should seek another physician and you're ok, no letter required. Sounded rather squirrelly to me, in my mind, once you've sat in my office and I've taken your money, you're my patient...

Now, if you come into my office to establish care and chemistry just ain't right or I get a twitch on the BS meter, if I don't take your money, no relationship established....

You come in for a URI, I treat you and take your money, guess what Charlie Brown....

How does that really work?

 

[Shinken]

Now, if you come into my office to establish care and chemistry just ain't right or I get a twitch on the BS meter, if I don't take your money, no relationship established....

You come in for a URI, I treat you and take your money, guess what Charlie Brown....

How does that really work?

This is a difficult topic with many grey areas. The best thing to do is do the extra work and "fire" the patient through the proper channels. The fact that the patient was not charged for the visit does not eliminate the physician-patient relationship at all.

 

[deleted87716]

You should treat them for the URI and then make it clear that you are not accepting them as a patient and they should seek another physician and you're ok, no letter required....Sounded rather squirrelly to me, in my mind, once you've sat in my office and I've taken your money, you're my patient.

You're correct. It's always better to formalize a dismissal with a letter. If you later refuse to treat the patient, you could be guilty of abandonment if the dismissal wasn't done properly.

if I don't take your money, no relationship established.

It's not necessary for money to change hands for a doctor-patient relationship to be established. When I've seen somebody once and told them I couldn't help them and didn't want to continue seeing them, I no-charged the visit and sent a formal dismissal letter. The no-charge visit technically isn't necessary, but I would do it as a matter of goodwill.