Will she be labeled an "ungrateful" patient?
At this month's meeting of the American Medical Association the House heard from Committee G with regards to "Resolution 710 - Identifying Abusive, Hostile or Non-Compliant Patients." This resolution was introduced by the Michigan Delegation in early May 2009.
This "identification", or label, is proposed in the form of a CPT code that would identify a patient, to anyone with access to his files, as a "non-compliant" patient.
In a press release from the International Cesarean Awarness Network (ICAN), president Desirre Andrews notes, "This resolution is alarming in its arrogance and its failure to recognize, or even pay lip service to, patient autonomy.”
With this type of labeling in place the American healthcare system could easily begin to reject patients for care based on the opinion of a doctor who thought the patient was "ungrateful." The resolution reads "The stress of dealing with ungrateful patients is adding to the stress of physicians leading to decreased physician satisfaction."
So, if the doctor didn't find his patient particularly grateful that day for his services he could essentially label his patient as "non-compliant?" What does this mean as a red flag to insurance companies? Will insurance providers drop patients based on the proposed CPT codes? Does the patient's care become compromised as other healthcare providers have access to medical files and assume prejudice?
According to the final paragraph this resolution has been resolved as such:
RESOLVED: That our American Medical Association ask its CPT Editorial Panel to investigate
for data collection and report back at Annual 2010 meeting: 1) developing a modifier for the
E&M codes to identify non-compliant patients and/or 2) develop an add-on code to E&M codes
to identify non-compliant patients. (Directive to Take Action)
Sources:
- Resolution: 710 Identifying Abusive, Hostile or Non-Compliant Patients, page 102 of Reference Committee G, accessed online June 14, 2009.
- Image: Andrew Richards
Comments
Amy,
I am a physician, and while I do not support resolution 710, I understand where it comes from. Most people cannot fathom the degree of noncompliance on the part of some patients. I have one patient with congestive heart failure who never takes his medicine, but who has been to the ER 400 times in the last 365 days, (that's right, more than one visit every day, not counting his office visits). He is on social security disability, not because of the CHF, but because of anxiety. He say's that he is too nervous of a person to work. This means that you paid for his 400 visits Amy. Resolution 710 is a misguided attempt to stem this kind of abuse of taxpayer dollars. There are certainly better ways. On the other hand, I do not think it was anyone's intention to label someone for asking questions or seeking alternative therapies. I am certain that some idiot colleague somewhere will do just that though.
Oh, did I mention that when I work in the ER, I am often attacked by violent patients strung out on Methamphetamine and PCP? I am 52 years old and have been punched a number of times and stabbed once in the "line of duty". Most of medicine is NOT a nicely decorated office in the suburbs. Our center city emergency departments and clinics are basically war zones.
When I was interning at a state mental hospital I saw and heard about many assaults on staff by patients. It is a part of the job for staff members. These staff members might be assaulted by a patient and then be expected to care for the same patient the following day. I think this is very tough and yet, it is their job. So, I'm sorry that ER staff also has a tough time. I'm sorry that working with people can sometimes be tough and sometimes scary. but I don't think it is ok in any way to label patients as uncompliant for any reason. Especially since, if it was just physical abuse drs were worried about then surely they could have written the resolution to address labeling violent patients, not ungrateful patients.
Concerned,
I think that we agree. See both posts.
While I can certainly understand the frustration with patients like the other commentors mentioned, I'm afraid I've had some bad experiences with being coerced and forced into unnecessary cesarean surgeries due to my physicians' admitted fears of litigation and increased insurance premuims. If I was to refuse, I would've been dropped from care within a week of my due date (legally they can't do this, but it was threatened) and harassed even moreso by the doctor. It's a long story, but the OB system in this country is broken and it is patients like me who are suffering and will be *perfect* fodder for this resolution. Afterall, who would be more "ungrateful" than a mother who refuses a so-called "life-saving" (and hansomely profitable) c-section. FYI, c-section is a MAJOR abdominal surgery with many short AND long term risks to mother and child and it is the same if not MORE dangerous than having a normal birth after prior c-sections.
The reason that there are so many c/sections is because the OB gets his butt sued off if anything at all goes wrong, and subsequently opts for the more controlled environment. I have seen these guys get sued over delivering a Downs baby, because they did not push the older Mom harder to have the amnio, (he should have just kept insisting after I said no 4 times, I would have changed my mind). These guys and gals often feel that they can't do anything right. I was the last Family Practitioner in my community to stop doing OB, when my insurance premium went over $45,000 per year. At the time, I was the only one delivering medicaid moms, so then they had to drive 67 miles to the city to deliver. Just wanted to point out that there are many sides to a story, and your doctor had every reason to be concerned. Some OBs today are in court more than in the office. Sad thing is, after all the hassle, they are vindicated over 80% of the time.
Sad thing is, after all the hassle, they are vindicated over 80% of the time. RandyK37922
That is sad indeed. And not for the reason you think.
After 6 years and $100,000, I was finally diagnosed with Rheumatoid Arthritis. I am an in-utero DES baby, who missed the early die-off, but am part of the developing autoimmune group (see Warren Report, 1988). I had scarlet fever at age 3. I presented myself with elbow nodules, pain, swollen joints, confirmed severe acute pancreatitis, and confirmed Hashimotos's thyroiditis. How compliant did I need to be?
Also, RandyK37922, Did it occur to you that perhaps your insurance rates are so high, because of all the unnecessary c-sections that doctors in your field are doing, for a veriety of reasons, that go wrong? Maybe because a repeat c-section actually has much more risk than a vbac? Maybe because you induce the mom and take the baby too early? What about consumer's insurance rates? We pay awfully high premiums too due to the payouts for all the mothers that fall victim to your money grubbing invasive unnecissary treatments. If a mother listens to you and lets you forcibly remove her baby, too early and with a major operation, because you falsely think it's better than her actually giving birth, and something goes wrong, should you be held responsible? Hell yes! And if I as a mother with the CHOICE to not go through a procedure like that have every right to say NO. Does that make me non-compliant? No, it makes me a thinking human being who made the choice I thought best for ME and MY child
I work in a Hospital. Leaveing AMA is the patients choice and let me tell you even though they were leaving AMA I still had to take them down to the pick up area. Many times I was called everything but a white woman. Many of my nurses felt very threated. a lot of thoese patients were drug seeking and when they didn't get what they wanted they became volient. I think then Docs. should be able to refuse service. NOW just because a patient is queastiong and trying to make sure what is happening is the correct thing SHOULD NOT be labled as non complient. You do have to advocate for yourself.
Anon1
Hold on there girl. I agree with you. I do not do ANY c-sections, I am not an OB. I was just pointing out their reasoning. I didn't say I agreed with it, but whether you believe it or not, they are often unjustly sued. The jumping to hasty conclusion thing is part of the problem. I am a mild mannered country FP in the middle of nowhere in Southern NC. I am not money grubbing either, take care mostly of impoverished patients in fact, and often take food for payment. You are awfully quick to judge, which I think is also a problem in medical relationships. Your OB certainly shouldn't have put you in that position, but from the way you talked to me, makes me wonder if your story is a little embellished. To you, I was a money grubbing C-section pusher before you even knew what kind of doctor I am. That is just irrational thinking. Lets have a nice rational, logical discussion, and keep the emotions out of it. Then we will make some progress.
Lace,
I am so sorry that this happened to you. Were you labeled as non-compliant? This is an area in which I am very interested. What part of the country do you live in? If you ever want to discuss your illness you can e-mail me at generationsfm@me.com. Our practice deals with many unusual rheumatological conditions.
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