The current economic recession will present challenges to risk management in physician offices and urgent care centers.
As patients modify their behavior in response to changing economic circumstances, those changes in how patients respond to medical guidance may increase risk for physicians.
It is, therefore, incumbent on physicians to take proactive steps to manage that risk.
Patients are canceling appointments, failing to show up at specialists’ offices when referred by primary care physicians, and declining diagnostic tests and elective procedures primarily to avoid having to pay deductibles and co-payments.
It is important to communicate with patients and attempt to work out a treatment plan that meets the patient’s basic needs within their financial means. And although physicians are prohibited by law from routinely waiving deductibles or co-payments, they are not prohibited from working with patients on their accounts based on economic hardship.
As patients lose their jobs and health insurance, it will be especially challenging to maintain continuity of care. Encourage patients to try to continue their health insurance with COBRA benefits. Review and inventory community resources with staff to determine what public and non-profit organizations may be available to assist the patient if the patient is unable for financial reasons to continue the treatment plan with the physician. Provide patients with the list of resources upon discharge and offer to provide information and copies of medical records to facilitate a smooth transition.
As patients become more noncompliant or stop coming to appointments or stop communicating with the office for financial reasons, there is an increased likelihood that a significant finding will be missed or not reported to the specialist or to the patient.
Identify patients at higher risk of noncompliance with lab work, medications, treatments, diagnostic services, and specialty physician services. Review the office’s protocol for follow up to ensure that patients or test results don’t fall through the cracks. Document all contact with patients. If the office is unable to reach the patient, send a written note and maintain a copy in the file.
Physicians have long provided a certain amount of uncompensated services to patients. Providing free medical services is commendable, and physicians who provide a discrete service are better able to manage their philanthropy.
But physicians should consider the scope of the obligation they are undertaking at the time they undertake it. A physician who undertakes to treat a patient may be obligated to continue treating the patient until she is discharged or the patient’s care is transferred to another physician who accepts responsibility for the patient’s care.
In these difficult economic times, the physician’s or urgent care center staff will be crucial to managing risk. As the downturn in the economy affects physicians’ offices, there may be layoffs.
If there are staffing adjustments, consider the risk management implications and patient care coordination functions. Be sure to reassign any functions essential to risk management.
With careful planning and anticipation, physicians’ offices and urgent care centers will be able to continue to assist patients compassionately with their medical needs while managing the critical elements of risk.
William Spratt, a Florida Bar board-certified healthcare attorney, is a former healthcare administrator. He has significant experience in the areas of acquisitions, sales, mergers and reorganizations of healthcare businesses.