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Am I missing something here about transfer of care?


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Elderly parent in LT care facility (one of four residences w/ avg. max capacity of 7 residents per home) who has had a physician on contract/staff over the years that the parent has been a resident who has served as her PCP.  Email sent out by the physician the first of this month stating that they were going to be leaving to work FT at UTSW, thus no physician oversight.  Today, email sent out by housing management stating that they were aware that "the physician had sent an email" detailing the exit and that a list of alternate providers had been given.  No provider list has been provided, at least that I've received.  Fortunately (so to speak), my mom is now in hospice and has an acting PCP effective ~2 weeks ago (online ratings aren't great but there isn't much to do for her other than AF/hypothyroidism and pressure sores which the nursing team is addressing.  For the other folks the email today offers a local hospital network NP house call service, or they recommend consideration of a concierge service.  Translation:  you come to us because we're not coming to you?

The company does have an employee RN who provides face to face interaction at the residences but what are they going to do other than contact one of several different PCPs who may not be available to see the patient (or have even seen the patient)?  I know, call an ambulance and take to the ED.

My concern for the other residents is that this is an AWFULLY short time window for families to contract for care through other providers, and allow those other providers access so as to be able to begin care effective 3/1 (think prescriptions).  My other concern is that while record access was made mention of by the exiting physician, their leaving without providing a listing of other providers and the short time interval stated makes me question whether this could be construed as patient abandonment.  Thoughts?

Edited by GetMeOuttaThisMess
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Is the physician an employee, or owner?  If an employee in an at-will state, on what basis would terminating an employment agreement ever constitute patient abandonment?  Serious question here, because I truly don't understand how a medical professional can be expected to render ongoing care outside an employment agreement.

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Contractual, best I can tell.  The primary concern was no reference for referral to receive ongoing care.  I've had two docs retire on me and in each instance there was a several month notification, specific information regarding availability of records (covered in this instance), and referral sources to maintain care.  If I hadn't been happy with these other providers I still have the mental/physical capability of finding other providers on my own.  The latter issue is the one that leaves a bad taste.  As previously noted, the institution waiting until the last week to notify responsible parties for the patients of their intentions leaves a bad taste.

In my personal case, others in the practice assumed care, which I was fine with.  In this instance you have a "captive audience" with one sole provider.  With the two recommended referral sources, neither would provide direct physician interaction best I can tell.  One is a NP based organization that consults with the physician(s) and the other is a private concierge practice which would require the patient leaving the facility best I can tell. 

I'm not saying that the physician doesn't have a right to change jobs.  I'm saying that the manner in which it has been handled is not ideal, and certainly not how I would handle a patient population that I was responsible for.  It is my understanding that there are three parameters which need to be met by a provider with regard to their patient population:  1)  notification of intent to discontinue care (30 days minimum notification in Tx I believe), 2)  access to medical records, and 3)  information regarding continuity of care, whether it be a practice partner or other physicians/providers who are accepting of new patients.

Edited by GetMeOuttaThisMess
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Final comment.  There must’ve been more to the story because during a phone call with one of the company admins yesterday he alluded that others had expressed a failure of the physician to follow up and provide a list of other providers as promised.  My problem actually got worse before it got better.  My mom’s hospice decided that they couldn’t act as her PCP even though I had them confirm twice during initial sign up that they would in fact fill that role.  Strike one against that group.  The overseeing physician doesn’t have a good rating with her health scores I found.  Potential strike two.

I ended up selecting a recommended IM concierge service and they recommended a monthly payment of $166.67 as opposed to the annual flat rate of $2000 since my mom’s condition is up in the air.  I’m meeting the doc at her residence on Monday afternoon to “present her” to him.  The nurse that works for her residential company has interacted with this physician in the past and states they interact well together.  Let’s face it.  How hard can it be to manage hypothyroidism and paroxysmal AF with occasional RVR when you’re already on dig and a beta-blocker?

As an aside, I decided to go the concierge route because frankly, I might become interested in taking advantage of same in the next couple of years and just go with a hospitalization plan if I can find one.  At present time, one visit to PCP and one visit to neuro for levetiracetam annually doesn’t cost a lot OOP.

Edited by GetMeOuttaThisMess
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Interestingly enough, I saw a Medicaid new patient in my pain practice yesterday. The NP who had been prescribing for her (~20-30 MED, nothing remotely bad on the pucker factor) had left the practice.  They'd referred her to us, who do take medicaid, but told her she was on her own to find a new PCP.  That is, the existing practice, that's still seeing other primary care patients, jettisoned patients just because a provider had left the practice.  Now, knowing what I do about medicaid reimbursement, I can't say I blame them from a financial perspective, but that's the kind of thing that goes on all the time.  I got her the contact info for an NP I used to work with who is taking Medicaid patients as a PCP, but fundamentally, that's not really my job, is it?

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legally all you have to do is provide a list of new PCP's and ideally not bail overnight,  That and providing access to records is the bare min.  

 

I had a house call practice that took me about 3 months to shut down after I made the decision.  It was exceptionally hard as no one else was doing house calls so every single patient had to go back to a traditional office based clinician.  This was poorly received by the patients, and I felt bad.  But it was needed.  

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On 2/27/2021 at 1:10 PM, ventana said:

legally all you have to do is provide a list of new PCP's and ideally not bail overnight,  That and providing access to records is the bare min.  

 

I had a house call practice that took me about 3 months to shut down after I made the decision.  It was exceptionally hard as no one else was doing house calls so every single patient had to go back to a traditional office based clinician.  This was poorly received by the patients, and I felt bad.  But it was needed.  

This varies by state. Texas mandates written notification and the time frame (90 days I think but I'm not sure). I recently got such a letter in the mail from a physician I saw one time for a simple med refill when my PCP was on vacation. I couldn't have told you her name if you asked.

Its an expensive process in a large practice when there may be hundreds or thousands of people you have seen who require notification.

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