Nine of ten practices surveyed have dismissed patients

(HealthDay)—The majority of medical practices have dismissed patients, according to a research letter published online May 15 in JAMA Internal Medicine.

Ann S. O'Malley, M.D., M.P.H., from Mathematica Policy Research in Washington, D.C., and colleagues examined the prevalence of and reasons for patient dismissal among primary care practices participating in a Comprehensive Primary Care (CPC) initiative and a matched sample of comparison practices. Practices' responses to a survey from the last year of the four-year CPC initiative were analyzed, with data included for all 443 CPC practices and 351 comparison practices.

The researchers found that 89 and 92 percent of CPC and comparison practices, respectively, reported ever dismissing patients in the past two years. Most practices reported dismissing only a few patients in the previous two years: about 10 percent did not dismiss any patients and 67 percent dismissed one to 20 patients. The reasons for dismissing patients were similar for CPC and comparison practices, except that comparison practices more often reported dismissing patients for violating bill payment policies (43 versus 35 percent). Reasons for dismissing patients included extremely disruptive or inappropriate behavior toward clinicians or staff, violation of chronic pain and controlled substance policies, or repeatedly missed appointments (81, 78, and 74 percent, respectively).

"Our study contributes new insight into an issue that will be increasingly important as insurers move to reimbursing for value rather than volume," the authors write.