Why 'Cherry-Picking' Patients Is Gaining Ground

Leigh Page

Disclosures

December 19, 2013

In This Article

Tougher to Dismiss Existing Patients

Whereas refusing to see a new patient is relatively easy, it's much harder to remove an existing patient, a process that some doctors have called "lemon-dropping." A 2008 study[14] found that as many as 85% of primary care physicians had dismissed at least 1 patient, but only 14% had dismissed more than 10; the most common reasons were verbal abuse and drug-seeking behavior, not economic reasons.

"Firing a patient is a very rare event at my practice," said Michael Kirsch, MD, a gastroenterologist in Willoughby, Ohio. "I do not feel noncompliance is the threshold for firing a patient, and there is no economic dimension to this issue."

However, the economic issue may rise up more strongly when physicians are forced to accept more patients than they can handle. This could happen when an insurer launches an exchange plan and forces physicians in its network to sign on. Physicians' contracts with a major payer may stipulate that they accept members from all of the plan's networks, or else not accept any new members from the insurer at all, according to Sidney Welch, an Atlanta attorney who advises physicians on payer contracts.

There is a commonly accepted method to dismiss patients, based on case law. The physician sends the patient a certified letter announcing the dismissal, citing the reason and providing names of other physicians to contact, and then continues coverage for a specified period, such as 30 days.

Some physicians, however, avoid these hoops, preferring to surreptitiously force the patient to leave. When the patient asks for an appointment, the appointment clerk says the next slot is many weeks away. She may even hint that the patient would have better luck checking with another practice for a nearer appointment.

Dr. Hughes, the retired Wisconsin internist, denounced this approach, calling it unethical and possibly dangerous for patients, if they had an emergent health problem while waiting. He also argued that the tactic could just make the patient angrier. "If the patient understands what this is about, he is going to be boiling mad," he said.

Cherry-picking in some situations will continue to be part of a physician's life. Although many doctors don't like the process, it may seem to be a sort of economic necessity for some. As new patient models take hold, it's likely that the practice will gain intensity.

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