Editor's note: This popular story from the Daily Briefing's archives was republished on June 27, 2019.

Nine out of 10 practices have "fired" a patient, but not because doctors are trying to cherry-pick patients—it's because of poor patient behavior, according to a new study in JAMA Internal Medicine.

Methods

For the study, researchers surveyed 794 practices, including 443 participating in the Comprehensive Primary Care (CPC) initiative and 351 practices in a comparison group. The researchers asked each practice, "In the past 2 years, has your practice ever dismissed a patient from your practice? By dismissing patients, we mean directing patients to leave your practice and seek primary care elsewhere."

The respondents that answered "yes" were then asked to specify the reasons for the dismissal, and how many patients they had dismissed over the past two years.

Results

The researchers found that "firing patients doesn't happen often," STAT News reports. While the majority of practices said they had dismissed at least one patient over the past two years, 67 percent of those said they had dismissed between 1 and 20.

As for the reasons for dismissal, the study found:

• 81 percent of practices that had fired patients said they did so because a patient was "extremely disruptive and/or behaved inappropriately toward clinicians or staff";
• 78 percent said they did so because a patient had "violated chronic pain and controlled substance policies";
• 74 percent said they did so because a patient had "repeatedly missed appointments";
• 45 percent said they did so because a patient had repeatedly "not follow[ed] medical recommendations";
• 39 percent said they did so because a patient had "violate[d] bill payment policies";
• 7 percent said they did so because a patient had repeatedly "not follow[ed] recommended lifestyle changes"; and
• 6 percent said they did so because a patient made frequent ED visits or self-referred to a specialist.

The researchers noted that a key takeaway from the study is there are no signs that providers are seeking to cherry-pick healthy patients and expunge those with difficult or complex chronic conditions—a practice that some health care experts have feared would arise as insurers shift from fee-for-service reimbursement to value-based payments.

"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," Ann O'Malley, Mathematica Policy Research senior fellow and lead author on the study, said. Rather, according to O'Malley, some of the reasons practices cited for dismissing patients were "perfectly legitimate" (O'Malley et al., JAMA Internal Medicine, 5/15; Blau, STAT News, 5/15)

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