Red Line for Patient Dismissal, What's Yours?

[jmj11]

Because my demand exceeds my ability to see patients, I've wanted to take a fairly aggressive dismissal program.  I dismiss patients who are argumentative and who break their narcotic contract.  The touchy one is no-shows. I wrote a letter of dismissal for a patient yesterday who has no-showed the last two appointments and come late for two before that. But then I read a lawyers page about dismissals.  He (and lawyers live in a much different world than we do where they have time to go to the bathroom whenever they want) said that you should never dismiss a patient for no-shows, but if a patient has record of no showing to have a family meeting with them and try to learn why they are missing appointments and come up with a plan to accommodate them better, and document the meeting (eyes roll here).

 

So what is your red line for dismissing a patient?  How many no shows? 

[bradtPA]

My practice owner won't even charge for no shows, much less dismiss for them....

[jdenning]

Depends if a new or established patient. For new patients, first NS they get a call and one opportunity to re-schedule. If they NS again, a letter is sent to referring physician. For established patients, things are a little more gray. First NS our patients get a call and get an opportunity to reschedule. 2nd NS they get a warning call, and again an opportunity to re-schedule. 3rd NS they get a warning letter, then dismissal after that. The problem seems to be keeping track of the time frame - how many NS within what time frame. It's not really fair to penalize a patient for a 3rd NS if their 2nd one was 2 years ago (just to use that as an example) and they've attended consistently since then.

 

The narcotic contract is an easy one. With NS there is a lot more wiggle room

[LT_Oneal_PAC]

Pediatrician office in my town has a 3 no show = dismissed policy. I think 20 minutes late is a no show equivalent.

[EMEDPA]

Pediatrician office in my town has a 3 no show = dismissed policy. I think 20 minutes late is a no show equivalent.

I think outside smoking when called is a no show equivalent....:)

[JFarnsworth]

Pediatrician office in my town has a 3 no show = dismissed policy. I think 20 minutes late is a no show equivalent.

Same here.

[rev ronin]

Why dismiss them?  Simply have an escalating no-show fee, and require fees be paid in advance before records are transferred or patients are scheduled again.

[arosswoods]

Not an expert. But wouldn't holding records hostage violate HIPAA portability? At the very least pt would still have the right to obtain their own records and take them to new provider w/o paying fees.

[ventana]

I have a house call practice (I drive to them)

 

first no show - stern warning  

Second now show - no longer my patient

 

Established patients

 

first no show - stern warning

second no show $50

(never had a third but I would likely do $100 no show fee or discharge)

fourth no show - never had one....

[rev ronin]

Not an expert. But wouldn't holding records hostage violate HIPAA portability? At the very least pt would still have the right to obtain their own records and take them to new provider w/o paying fees.

Just view it as a mechanic's lien on their self. :-)

 

If that's the case, then make each patient pay a $50 deposit (or whatever) up front, and don't let them see you without replenishing that deposit in full.