You’re Fired! A Guide to Dismissing Patients

According to a new study published this May in JAMA Internal Medicine, this phrase of dismissal is more than just Donald Trump’s reality show trademark. The study found that nine out of 10 medical practices have fired a patient for reasons ranging from missed appointments to not paying bills and disregarding medical directives.

 

It is not surprising that most physicians during the course of their medical careers are tempted to dismiss problematic patients and that many have followed through and done so. Before banishing a patient from your care, however, you should heed the following considerations and avoid potential legal issues down the line.

 

Be sure to keep a written record of missed appointments, failure to follow your medical directives, payment issues and other problematic behavior for all patients. If the patient challenges your eventual decision to no longer provide their medical care, you will have a paper trail of documentation to support your decision.

 

Legal and common reasons for dismissing a patient include repeatedly missing appointments, violating bill payment policies, disregarding medical recommendations, and disruptive or inappropriate behavior towards doctors and staff.

 

A murky area that may cast you in an unethical light and raise questions among payors is “cherry picking” your patients and dismissing those with complex or chronic conditions to ensure better outcomes, especially as insurers shift from fee-for-service reimbursement to value-based payments. While this may be technically legal, it is not advisable.

 

Be aware that it is illegal to terminate a patient for discriminatory reasons, such as age, race, disability, gender, religion and sexual orientation.

Dismissing a patient in critical need of care exposes you to liability for patient abandonment, a form of medical malpractice defined as the unreasonable discontinuation of healthcare treatment.

 

As much as you would like to dismiss a problematic patient, do not cast good judgment aside. For example, dismissing an existing patient who is now in the last trimester of a high-risk pregnancy, when another doctor is unlikely to accept her as a patient, likely would be deemed unreasonable even if she has repeatedly missed appointments and is behind in paying her bills. Apply the same judgment to patients undergoing chemotherapy or post-operative care, even if you wish you could fire them now.

 

If your patient is in stable condition and transfer of care would not adversely impact their health, then you can reasonably proceed with a dismissal, but if your patient is ill or in the middle of a course of treatment, you may need to delay the termination.

Notifying your patient in writing via a certified letter is the best practice. Clearly stating your reason will help avoid the appearance of discrimination. Additionally, including a list of other providers and even taking steps to confirm that care has been transferred will help avoid issues of patient abandonment. It is also important to give patients a reasonable time frame of at least 30 days to find another provider.

 

Make sure that your staff is notified as well, lest they continue to call the patient to schedule routine follow-up care. If you are a member of a group practice, discuss the patient’s dismissal with your colleagues and decide if the patient should be dismissed from the practice altogether.

 

Finally, it is wise to review any patient dismissal policies that the patient’s insurance carrier may have in place, especially if the patient is covered by a government payor, which may have strict procedures you need to follow.

 

Firing anyone is one of the most unpleasant parts of managing any sort of business and brings with it particularly sensitive issues when the business is a medical practice. When it is necessary to do so, however, you can legally and ethically dismiss a troublesome patient from your care by following the necessary steps.