And since he wasn’t accepting new patients, she had to find a new primary care physician.
“I think that’s unconscionable,” Siegel said, noting that many patients may have avoided the doctor’s office in recent years because of the pandemic. “There was no notification to patients that they were about to lose their doctor.”
At the start of the open enrollment period – when people can get health insurance – people should check to see if they are still patients with their doctor, experts say.
It’s shocking to hear that you’ve been kicked out of a doctor’s practice because a few years have passed since your last visit, but the approach isn’t uncommon. How widespread the experiment is, no one can say. But specialists do it too.
The argument for abandoning the occasional patient makes sense. Since many primary care physicians have a waiting list of potential patients, removing those they rarely see opens up windows for patients and improves access for others.
“Most primary care practices are incredibly busy, in part due to pent-up demand due to covid,” said Russell Phillips, director of the Center for Primary Care at Harvard Medical School and general internist at Beth Israel Deaconess Medical Center. .
“Even though continuity of care is important, if the patient hasn’t come and we don’t know if he’s coming, it’s hard to give him space,” he said.
A difficult transition to a new doctor
Patients often move or find another doctor when their insurance changes, without telling the practice, experts say. Additionally, doctors may seek to classify people they haven’t seen in a long time as new patients, as their medical, family, and social histories may require tedious updating after a long break. Patient status is one element that determines how much doctors are paid.
Yet the transition can be stressful for patients.
“I can fully understand the patient’s perspective,” said Courtney Jones, senior director of case management at the Patient Advocate Foundation. “You think you have a medical team that you trusted before to help you make decisions, and now you have to find another trusted team.”
Siegel said she rarely went to the doctor, adhering to her doctor father’s advice that people shouldn’t go unless they were sick. She hadn’t been to her doctor’s office in person recently, but Siegel said she corresponded with office staff, including updating them on her coronavirus vaccination status.
After receiving the referral online through the Jefferson Health System patient portal, Siegel called the family practice patient line directly. They told him that three years was the protocol and that they had to follow it.
“I asked, ‘And the patient?’ said Siegel. “They didn’t have an answer to that.”
That was a month before Siegel, who is covered by Medicare’s traditional fee-for-service program, could see a doctor who was accepting new patients. By then, her stomach virus symptoms were gone.
Jefferson Health does not have a policy that patients lose their doctor if they are not seen regularly, according to a statement from spokesperson Damien Woods.
He said, however, “Patients who have not been seen by their provider for three years or more are classified in electronic medical records as new patients (rather than established patients), per Center for Medicare and Medicaid Services guidelines. (CMS). Whenever possible, Jefferson works with these patients to keep them with their primary care provider and offers options for new providers in certain circumstances.
The American Medical Association’s ethical guidelines recommend that doctors notify patients in advance when they are withdrawing from their records so that patients have time to find other doctors.
But the organization, which represents doctors, has no guidance on maintaining a patient panel, AMA spokesman Robert Mills said.
The American Academy of Family Physicians, which represents and advocates for family physicians, declined to comment for this story.
The demand for services is expected to increase
A primary care physician’s patient panel typically includes those who have been seen within the past two years, said Phillips, of Harvard. Doctors may have 2,000 or more patients, studies show. Maintaining an acceptable number of patients is crucial, both for effective patient care and for physicians.
Demand for medical services is expected to continue to outstrip supply over the coming decades as people age and need more care, while the number of doctors retiring increases. According to projections by the Association of American Medical Colleges, by 2034 there will be a shortage of up to 48,000 primary care physicians.
Maintaining a regular relationship with a primary care provider can help people manage chronic conditions and identify new problems early. Regular check-in also helps ensure people receive important routine services such as vaccinations and blood pressure checks, said David Blumenthal, a former primary care doctor who is chairman of the Commonwealth Fund, a research and policy organization.
Healthcare organizations are increasingly working to require physicians to meet certain quality measures, such as managing patients’ high blood pressure or providing comprehensive diabetes care. In this environment, “it could be problematic for physicians to be responsible for the health of patients who don’t see them,” Blumenthal said.
Money is there too. Regular visits are good for a firm’s bottom line.
In general, doctors are not obligated to continue seeing certain patients. A physician may dismiss patients for not following clinical recommendations or for regularly canceling or missing appointments. Belligerent or abusive behavior is also grounds for abandonment of a patient.
In some cases, physicians may be legally liable for “patient abandonment,” a form of medical malpractice. State rules vary, but there are common elements. These rules generally apply when a doctor harms a patient by dropping him suddenly at a critical stage of treatment. It would generally not apply if a patient has not seen the doctor for several years.
Even if the quiet abandonment of a rarely seen patient has no immediate medical consequences, patients should be informed, experts said.
“That’s really good customer service to explain the situation,” said Rick Gundling, senior vice president of the Healthcare Financial Management Association, an organization for finance professionals. As for Siegel, he said: “This woman should not be left hanging. If you are the patient, the doctor must be proactive.
This article was produced by Kaiser Health News, a program of the Kaiser Family Foundation, an endowed nonprofit organization that provides information on health issues to the nation.