Listen to your doctor, patients have always been told and there was always an “or else’ implied. Usually it was “or else, you won’t get better.” Now, it’s “or else he or see will tell you not to come back,” according to a research letter in JAMA Internal Medicine.

Researchers found that 9 out of 10 practices have cut ties with a patient and even though that may seem like a lot, we’re talking one patient when most practices have thousands. Still, as health care moves more toward a system that reimburses physicians based on the value of the care given, practices might be tempted to close their doors to uncooperative patients. 

The research letter states: “Although understudied, the topic is important, especially as insurers begin to shift payment from volume to value. Patient dismissal could be an unintended consequence of this shift as clinicians face (or perceive that they face) pressure to limit their panel to patients for whom they can readily demonstrate value in order to maximize revenue.”

That’s a concern, but Ann O’Malley, Mathematica Policy Research senior fellow and lead author, tells STAT that the “reasons practices are dismissing patients aren’t so much related to the things people were worrying about—that if [insurers reimburse more for] quality of care, doctors might start cherry-picking patients.”

STAT reports that “among the reasons the nearly 800 practices surveyed gave for cutting ties with a patient:

  • Violent, ‘disruptive’, or inappropriate behavior toward doctors or staff
  • Violation of policies related to chronic pain and controlled substances
  • Failure to show up to scheduled appointments
  • Repeated disregard of a doctor’s medical recommendations
  • Violation of bill payment policies.”

Source: STAT

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