Friday, June 14, 2024

responses about firing a patient

Aaron Laster

I wanted to post the responses since many people were interested in what
responses I got about firing a difficult patient. Most responses were
helpful so I hope they help you all too.

Aaron Laster

give the patient a list of other providers in the state


provide 30 days notice

reimburse patients insurance and tell patient we will no longer provide care

I just read an article on this just this month, so I’m attaching below.
But we have a dismissal letter that we send certified mail, return receipt,
that explains that we are discharging the patient for the following
reasons: and then list why. We also don’t do it until they are outside of
their 90-day delivery date because Medicare mandates a 90-day warranty for
follow-up and repairs, so that’s our warranty policy for all patients. We
don’t send anything within that first 90 days, but we have had to say to
patients that we can’t make any additional changes unless they affect the
stability or functionality of the device, unless they are willing to pay
the labor and costs of such changes. I know we aren’t required to give an
amount of notice, but it’s always a good idea to let them know if there is
an emergency before they’ve found a replacement company, to contact your
office immediately, as this limits your liability if they get injured and
claim you gave them no options to be seen. Hope this helps!

According to the Medical Group Management Association, there are steps you
should follow to ensure legal compliance and avoid patient abandonment.

1. If you are part of a group, decide if you are dismissing the
patient from a particular practitioner or from the entire practice.

2. Do not discharge a patient without warning! Counsel the patient on
his or her behavior (not paying his or her balance, several no-show
appointments, harassment of providers and staff, habitual non-compliance,
etc.) and let him/her know that if the behavior continues, he or she may be
asked to leave the practice permanently. Some practices offer a three
strikes rule before dismissal, which is especially effective for
appointment no-shows.

However, there may be a situation where a patient is dismissed from the
practice after a single incident that damages the practitioner-patient
relationship, such as physical or sexual abuse, theft or other criminal
3. Develop a “Dismissal Letter” that includes

1. The reason for the dismissal.
2. A recommendation for continued care “I encourage you to contact a
new prosthetist/orthotist as soon as possible”
3. An offer to provide emergency care within 30 days to allow the
patient time to find a new provider.
4. An authorization to release the patient’s medical records.
4. Send the letter in a manner that allows you to get a proof of
delivery. If it is returned, place the evidence of the return in the
patient file and send another.
5. Reach out to your Malpractice Carrier. They can help you construct
your dismissal letter in a way that complies with your policy and any state
requirements for dismissing a patient.
6. Don’t let anger or emotion control the decision. Practitioners and
staff members are bound to have patients that “push their buttons,” but
that’s not necessarily grounds for dismissal. Ethically, dismissal should
be your last option, not your first choice.

Document! If you have a patient who starts to behave in a way that would
warrant dismissal, keep a record in the patient’s chart of all
correspondence, including phone calls, emails and letters, between your
practice and the patient.

perhaps you should stick to selling wheelchairs

If the patient has been fit and delivered with, I assuming an orthosis of
some sort, and is within a 90 day window, unfortunately they are yours
according to M. Care guide lines.
After 90 days, you may charge for your services as you wish. Always have
them sign an ABN and charge
Up front prompting insurance to reimburse patient. There is no fee schedule
for P and O labor. It is a laborious task to justify the 15 minute
Labor slots. Let the patient do it. They will most certainly not receive
much if anything at all as we have all experienced.
You most likely will not need to right that letter or see the patient again.
Trust me, it works.

We all take pride in our profession and most want to do the best Job
possible with the best patient compliance and outcomes. However few they
are, and we all get them, sometimes the only thing that makes orthosis do
it’s job correctly and feel better is to have to pay for something.
This all under the assumption that the device was anatomically fit properly.

Sorry for the later reply, you went into my spam for some reason. Did
anyone tell you that they found rules for P&O about cutting ties to a
We looked several years ago & found nothing. So we developed a policy that
new pts are made aware when we start working together that 3 missed
appointments with no call to inform us that they cannot make that appt will
result in immediate termination of our services. We tell folks that we
understand that things come up, but have the common curtesy to let us know
that you won’t be making the appt. Most healthcare facilities around here
have a 24hr notice policy. We’re happy if we get a call the morning of
their appt.

We have “fired” 3 patients in 14 yrs. One just recently for no shows/no
calls PLUS lying about appointments scheduled. Trying to say the “front
office girl never said…” this or that. Well, we are a very small
company & there is only one office person! You can’t pit her against
herself (!?). They went back to the referring Dr, who, I had already
advised of this situation (that occurred over 3month period!), he called
stating “they are begging to come to you”. We stood our ground because
some folks are WAY more trouble than they are worth.

Anyway, the 1st two folks were informed by a letter officially terminating
services & were also over missed appointments creating a very loooong drawn
out process of proving prosthetic services that should be completed in
a decent amount of time (NOT 3,6 or 8months!). This last one was told over
the phone twice because we never got to really do anything outside of
initial consult/eval & ordered prosthetic liners in preparation for casting.

Don’t be afraid to fire troublesome patients! The one time I did not
listen to my office manager’s instinct about someone caused a horribly long
& drawn out nightmare…a lot of time & some monies lost….. just trying
to do my best for someone. AND those folks are never appreciative of what
you do for them. Never.


I am not aware of any guidelines and I am QUITE familiar with all O&P
policies. You ARE obligated to provide adjustments and repair through the
warranty period of the device. Ours is 90 days.

I’ve had to release patients several times and I find it best to do it in
writing as a mailed letter. Keep the letter very short and factual and VERY
POLITE. I generally say that “just as patients have the right to choose
their providers and make their own decisions in healthcare, so do we.” I
then usually try to put the onus on the patient. I will state that we have
failed to satisfy their needs or that they don’t seem happy with the care
we are providing or whatever. *Take the blame.* This is important in
minimizing risk of being sued as well as the lovely social media comments
that are sure to follow if the patient gets upset. Take the blame and be
very nice about it. I then apologize for not being able to satisfy them and
state VERY CLEARLY but very nicely that we choose to no longer provide
service to them. I then provide them the contact info of 2-3 other
facilities and state that another facility and/or practitioner looking at
the situation with fresh eyes would be a good thing.

Basically, you release the patient, but make it sound as though you are
doing THEM the favor. You always want patients to leave happy, even if
leaving permanently. 😊

We ran into this problem also. No matter what we did, it was never good
enough for the patient. After awhile this patient has become a liability.
Constant adjustments, time wasting office visits, free supplies,
unreasonable complaints, etc. We discharged him from the practice before he
caused us any damages, possible liabilities or damage to our facilities

I simply drafted a formal “Letter of Discharge” notifying him that we no
longer wish to provide services to him, as we felt he was being
unreasonable and non compliant with our plan of treatment. Due to these
issues and the Standards of Care our Facility lives up to, we felt we could
no longer treat him at his level of unreasonable requests that he continues
to require.

If he comes back to you trying to express displeasure, simply tell him you
cannot speak with him any longer because he has been discharged from the
practice and, if he wishes to continue complaining, he can contact your
attorney. This usually sends them away.

I think I read a policy in the Medicaid manual someplace, on how to do
this. It was a long time ago. Remember, you are a “fee for service”
provider, also, if you do not accept assignment, you can refuse treatment
to anyone you wish.


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