Doctor Practices that Dump Patients

[FireStarterRN, BSN, RN]

There is a doctor practice in town that has been finding reasons to get rid of patients they don't want. It all came out in the paper. They don't like patients who are too complicated or timeconsuming, they get rid of anyone who changes insurance, they don't take Medicaid. I had one patient who told me that she was fired from this practice, the reason given was that she was rude to the receptionist. This patient was a very nice woman, I was really surprised about that. Other reasons being given is when patients live too far away, yet we live far away and I was encouraged to sign our family up there.

Meanwhile, the practice is recruiting new patients. In fact, I had approached the head of the practice about switching our family there because I was dissatisfied with the clinic where we were going which was bought by the hospital where I work and I didn't like the way they were doing things.

Ironically, this practice in known as an all Christian practice, that was one thing I liked about them since they pray for their patients. We haven't gone there yet, but we were accepted as patients. Now I'm worried that if any one of us ends up with chronic problems, we'll get fired as well.

Is this common?

[Tweety, BSN, RN]

I guess in America in the current health care situtation it's an MD's right to treat whom they choose.

Kudos to them for "firing" a rude patient. I wish I could fire some of my rude patients. LOL

[Noryn]

I dont think what you are describing is that common to where patients are getting fired often. From my experience it is relatively rare although I have seen a few people who were fired from their doctor but they were difficult and non compliant.

As far as Medicaid, it is horrible to say but I cant say that I blame them. The headaches Medicare and Medicaid cause honestly arent worth the compensation. Often with Medicaid the doctors even end up losing money.

The clinic seems to have a bad reputation, I would probably stay away.

[VivaLasViejas, ASN, RN]

I'm seeing this happen with disturbing frequency in my neck of the woods.

Frankly, I don't blame doctors for "firing" rude patients. Like Tweety, I should be so lucky---I can think of a couple of residents plus their families that I'd "fire" in a heartbeat if I could!

But what I'm seeing is closer to actual dumping: there is a corporate monopoly in our area that oversees 99% of the MDs and all but one of the local clinics, and NOBODY is taking Medicaid patients now. Many of the older doctors are retiring, so their former patients are having to travel to one of the bigger cities for their health care---definitely a hardship for the elderly and poor. One of my residents just got "fired" by her primary care MD, and the nearest doctor who will accept her is in Eugene.........how is she supposed to get there when she doesn't drive, her family can't take her, and the local senior bus doesn't go anywhere out of the county??

Stinks on ice, I tell you.:hdvwl:

[kstec, LPN]

In the family practice clinic I work in which is affiliated with a hospital will not except any new Medicaid patients. They also discharge patients for being rude, being repeated no-shows and possibility of being a drug seeker.

[Ms Kylee]

I fired a former PCP. Loved him, but his receptionist was consistently snotty and rude to me whenever I went in. I even told him I'm leaving you because your receptionist is horrible. He didn't seem to care, so I guess I made the right decision.

[oramar]

Hasn't there been articles in magazines and newspapers about areas of the country where a medicare patient is just out of luck. No doctor will take them period.

[steelcityrn, RN]

Its the same old reason for why this is happening as any other business decision....MONEY....These physicians know who is a better payer, who is worth their time. There are homecare companies that only take good paying insurances, why not the doctors also. Its sad to say, but I have had many medicaid patients who want want want want and want, if they had to only pay 5 bucks for their meds or visits, that would stop immediatly. I have seen physicians fire patients by giving them 30 days notice to find another one. Years ago you would not have believed this would happen, but it is and you will see more of this unless physician reimbursments improve.

[FireStarterRN, BSN, RN]

Just a clarification, the patient told me that she hadn't been rude but had had several questions to ask the receptionist, who claimed she (the patient) was rude. Of course, I wasn't there so I don't know the truth of the matter, but the patient was very pleasant in my interactions with her.

Anyways, the general opinion of most of the nurses where I work seems to be that this doctor is dumping patients. I'm not sure if that's the whole story, apparently he was very upset by the way the article portrayed him. His story is that some insurance companies, as well as Medicare, are difficult to deal with so he chooses not to. I totally sympathise with that!

[scribblerpnp]

The practice where I work doesn't make a habit of dumping patients, but we have refused to continue care (with a 30 day notice) for numerous reasons:

1. Not paying bills (if they owe us more than 100.00 and refuse to even pay 5.00 on it, we send them to collections. We have some pts who we know are working poor, and will let them slide. Again, if they would just send 5.00/month, the office manager would keep the account in good standing. This is the number 1 reason we dismiss pts.

2. Being rude to staff (which does happen)

3. "Milking the system." Mainly this is our Medicaid population who aren't sick enough to be seen and who come in for every little thing because they don't have to pay for the visit.

4. Not following recommendations made by the provider (after MULTIPLE attempts to get through to them).

Medicaid does stink, and there are times when we have enough pts that we refuse to accept new pts who have Medicaid. It is business. Medicaid takes extra time to work with (calling them to get permission to do referals, specfic treatments, medications). It takes one additional office staff to be dedicated to making these phone calls.

As an NP I can only get reimbursed 80% for treating the same illness (same coding, everything) as the doctor. So every medicaid pt I see, I lose money. They won't pay for a lot of simple office tests like rapid strep or flu, even though in the long run it costs more to get a culture (for which they will pay).

Our peds pts need care, but the system stinks.

[FireStarterRN, BSN, RN]

Thanks for the info, scribbler. Now, I was talking to a nurse friend about this and she told me that there might be legislation in the works that would mandate that every doctor take a minimum percentage of Medicaid patients. Has anyone heard about that? What do you think, is that fair?

[James Huffman]

To make a technical point ... a doctor can't "fire" a patient because the doctor doesn't employ the patient: the patient employs the doctor.

A patient who leaves a doctor's care for whatever reason has technically fired the doctor.

On the other hand, a doctor who discharges a patient from the doctor's care has "resigned" from the patient's care.