| May 22, 2006
The effects of poor Medicare reimbursement hits home in this particular case.
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I wouldn’t put up with that kind of behavior either. Violent behavior or threats of violence are cause for dismissal without exception. Not only is it unwise for the doctor to continue with a patient like that, but it hazards office employees to have people in a practice who are inclined to violence.
I’ve fired patients for considerably less, though the bad behavior was chronic and displayed numerous times during our relationship. I think people are now first starting to understand how bad Medicare reimbursement to doctors is. Maybe enough political pressure will get something to change, but I doubt it. The elderly will just have to get used to having trouble finding people to take care of them, at least people trained in the US.
So, would you keep an abusive patient if you would be paid better ? I don’t think medicare reimbursement was the reason for firing her.
The article says as much. She was fired for her abusive and violent behavior, not because she was a Medicare beneficiary. Once fired, she was not able to easily find another doctor who was accepting new patients who were Medicare beneficiaries, because of the low reimbursement and the high work demands that Medicare-age patients place on a practice. There was no mention whether the patient in the article could find a doctor if she were paying her own way. Presumably she wasn’t able to or willing to.
“The article says as much. She was fired for her abusive and violent behavior”
The article says she had a psychiatric condition which caused her outburts. Should doctors terminate patients who are victims of conditions over which they may not have control (in this case, apparently with no grace period or referral)? That’s the question you have to answer for yourselves.
Dismissals usually give a 30-day notice with coverage for emergencies only during that period, but not routine services or appointments. They might also require that the patient be seen for those emergencies in an emergency room and not in the office. Referral can be as simple as the recommendation to seek a referral at the local hospital physicians referral service or to go to the county medical society list of member physicians. They are not required to refer you to a specific doctor or to wait past a reasonable period to allow you to find a physician, and they are not required to extend coverage until you find one willing to see you on financial terms you think are satisfactory.
Violent threatening and abusive patients can be banned from your office forthwith, and required to seek interim coverage through an emergency room only. Psychiatric “conditions” are still not entitlements to be abusive or a license to violence or a free pass to remain in the care of a doctor who finds that behavior unacceptable. Those patients can be terminated for their behavior. If their conduct is a breach of public order or their threats a criminal act, they can of course be arrested.
I had to fire once a psychiatric patient, he was very violent in the office and we were two women in the office, I just had no choice. I mean, physical safety comes first. Some people should be in long term mental institutions. I know it is not their fault for the bad genes but it is not mine either and I have to make sure I get home at night in one piece.
Her husband divorced her because he could not handle anymore. That tells me enough. A medical office is not a police station, some cases you just can’t handle.
The take home is that squandering established relationships with physicians may no longer be the cost-free activity it may once have been, where patients could feel free to hop from one doctor to the next with office doors open to all. Low Medicare reimbursement isn’t making the care of high-demand–never mind difficult or threatening–patients all that desirable, and many practices are limiting the numbers of new Medicare patients they are willing to take on. Some will find that once they leave a practice that the door might not be open to their return.
With a patient roster in the low thousands and new patients calling practically daily, the “trouble patient” needs their PCP a hell of a lot more than their PCP needs them. Especially when they start discovering in the near future that doctors are less and less willing to accept their crappy insurances.
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