Accepting All Patients
Another obvious source of data on patients is the medical history questionnaire they fill out on the first visit—or better yet, before they come in. Almost a decade ago, many Canadian doctors were using the questionnaire to screen for patients who would be more difficult to treat, and at least two provincial regulators introduced rules to stop this tactic. The Ontario regulator ruled that doctors should accept patients on a "first-come, first-served" basis, and the Nova Scotia regulator stated that the introductory interview "may not be used to select 'easy patients' and/or screen out those with more difficult health concerns, such as chronic or terminal disease."
Licensing authorities in the United States haven't yet moved against initial screenings, but Zetter reports that few US doctors bother because it's time-consuming and labor-intensive. "It's hard to pinpoint particular patients who are noncompliant before they become your patients," he says.
Instead, Zetter says, it's easier to dismiss existing patients later on. "Discharging patients isn't that hard. You just have to follow the rules." This mainly involves giving the patient notice in writing at least 30 days beforehand and offering to forward copies of their records to their new physician.
A Gathering Force?
Even though widespread cherry-picking hasn't become a reality yet, some doctors are beginning to see the effects incrementally.
"I have already observed referral patterns of patients with poorer-paying insurances or more difficult patients who get referred to us," a physiatrist said in the Medscape survey.
Physicians are concerned about being inundated with nonadherent or high-acuity patients. "I wouldn't take other people's castoffs," a general surgeon told the survey.
Even if there is no economic incentive yet, the simple fact that some physicians are cherry-picking could force others to do it, too. "I can't be the only person who takes care of the complicated patients," a cardiologist said.
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Cite this: Leigh Page. Are More Doctors Cherry-Picking and Lemon-Dropping Patients? - Medscape - Feb 15, 2017.