Practice of Medicine

Article

The Importance of Patient Follow-Up

May 6, 2015

With patient “no-show” rates estimated to be between 5 and 55 percent[1], doctors are struggling to provide adequate patient follow-up care. Physicians have asked questions like, “What’s my liability when patients miss scheduled appointments and / or do not comply with their plan of care?”  

Missed appointments and patients’ failures to follow up, do create potential liability risks for their physicians. Physicians may take the following actions to improve follow-up visit compliance now:

  1. Make reminder calls – Patients are busy too, and timely reminders do help patients remember and keep appointments. You may want to explore using an automated appointment reminder system if you currently aren’t using one.
  2. Reduce wait times – Maintaining reasonable patient wait times continues to be a universal challenge; when wait times are excessive, they become a major source of patient dissatisfaction. Reduced wait times leave a better impression on patients; shows respect for their time; and may increase the probability the patient will return for follow-up appointments.
  3. Create a welcoming reception area while protecting the patient’s privacy, particularly at intake.
  4. Let patients know how long their wait times may have been extended and give them the option of rescheduling or coming back at a later time.

 

What about patient “No Shows?

We suggest you:

  1. Inform patients of the specific need for follow up and document those discussions in the medical record. Patients need to share in the responsibility to follow the agreed upon treatment plan, and to return as advised for ongoing assessments of health, illness and treatment outcomes.
  2. Make reasonable attempts to contact the patient when appointments or recommended tests are skipped. It is important to make an effort to contact the patient, reschedule the appointment, and/ or to reinforce the importance of any required tests. Be sure to document each attempt to contact the patient, and any explanation the patient may give.
  3. Implement a tracking system, electronic or paper, for patients who have been identified with a need to follow up. The purpose of the tracking system is to alert the provider to the patient who needs to return to the office and by what date. The patient will remain active in the tracking system until one of three potential outcomes occurs: (1) follow-up is complete; (2) informed refusal is documented, or (3) there have been reasonable attempts (usually three) to encourage patient compliance. Document all attempts to contact the patient. We advise the last contact attempt be in writing, clearly explaining why the follow-up is necessary, and the potential consequences of failure to do so.
  4. Dismissing a patient from care is a physician’s last resort when all of the above mentioned efforts have failed.

It’s important to develop a follow-up system that works for you, your organization and your patients, to ensure your patients’ missed appointments and “no shows” don’t fall through the cracks, and to reduce your professional liability for potential missed or delayed diagnoses, or delayed treatments and / or referrals.

[1] Lerner, M.D., Barron H. 2014, November 2. When Patients Don’t Follow Up. http://well.blogs.nytimes.com/2014/11/13/when-patients-dont-follow-up/?_r=0

 

Disclaimer

The information provided in this resource does not constitute legal, medical or any other professional advice, nor does it establish a standard of care. This resource has been created as an aid to you in your practice. The ultimate decision on how to use the information provided rests solely with you, the PolicyOwner.