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Elizabeth L.B. Greene quoted in Healthcare Risk Management "Avoid Patient Abandonment Claims with Education, Follow-up"


Acuity Dictates Necessary Steps
When patients miss appointments, the extent of follow-up necessary is influenced by the acuity of the patient’s medical condition, says Elizabeth L.B. Greene, JD, partner with Mirick O’Connell in Worcester, MA. When a patient misses an appointment for urgent care, it is appropriate for staff to call the patient to find out why he or she missed the appointment, explain the importance of the appointment, and make reasonable efforts to reschedule as soon as possible.

“The more urgent a patient’s medical condition or follow-up care is, the more follow-up the staff or physician is advised to undertake to convey to the patient the significance of the care to be provided, and reschedule the appointment,” Greene explains. “When the patient with an urgent medical issue misses an appointment and cannot be reached, written communication to the patient is appropriate. These communications are important for quality patient care as well as from a risk management perspective.”

Physicians and other healthcare providers should create a system in their practice for follow-up of missed appointments, Greene says. Depending on the number of missed appointments and the acuity of the patient’s medical condition, in some instances it may be appropriate to notify a noncompliant patient of the risk of termination from the practice.

In such an instance, it is advisable for providers to consult their practice risk manager or legal counsel for guidance. Every communication or attempted communication with a patient about missed appointments should be included in the patient’s medical record, including copies of any letters or emails to the patient. This is protective in case of an unfortunate medical outcome that leads to a claim.

Document Communications
When there is a plan for follow-up care or testing, clinicians should document communications with the patient regarding subsequent visits, necessary testing, and its importance, Greene says. This can help ensure patient compliance and will help the provider defend claims that may follow a patient’s noncompliance.

“Also, contacting patients in advance of appointments can help reduce some no-shows. The legal ramifications and risks of patients who no-show for appointments or are noncompliant is that they do not receive the medical care they need,” Greene notes. “Later, they or their surviving family members may file suit against the provider for abandonment, an alleged delay in diagnosis of cancer or other condition, or for an alleged wrongful death of a patient.”

Depending on the patient’s condition and the provider’s specialty, it might be necessary to call emergency contacts or social services after missed appointments.

“For example, this might be reasonable and appropriate in instances of patients who are impaired by memory, medications, or other issues when they no-show for care and the staff or provider cannot reach the patient,” Greene says. “When doing so, providers will want to be mindful of what information is shared in order to remain compliant with state and federal privacy laws.”