(HealthDay News) — As insurers place increasing emphasis on evaluating physicians based on quality measures, management of noncompliant patients is becoming more complex, and can lead to patient dismissal, according to an article published in Medical Economics.

Physicians should be aware of the issues behind noncompliance, differentiating between patients who aren’t making efforts to comply and those who lack the resources to comply. Other staff members such as nurses and social workers can try to identify the underlying problem. Lack of trust in care delivered can also be a reason for deciding to terminate a physician-patient relationship.

It is important to assure continuity of care during the transition period of patient dismissal, which should not be done when a patient is seriously ill. A consistent policy should be developed for provider-patient termination, including maintaining accurate and thorough documentation in the patient’s medical record of any noncompliance and related conversations. Other measures include speaking directly to the patient and sending a pre-withdrawal letter expressing concerns about noncompliance. The follow-up termination letter should be sent via certified mail to the patient and insurance carrier.

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“In the family medicine world, discharging a patient along those lines is not something that we do much at all,” said Wanda D. Filer, MD, president of the American Academy of Family Physicians, according to Medical Economics. “The value and importance of a healthy, long-term, comprehensive patient-physician relationship cannot be overstated.”


  1. Kreimer S. Dismissing patients: How to Do it the Right Way. Medical Economics. January 10, 2016. Accessed at http://medicaleconomics.modernmedicine.com/medical-economics/news/dismissing-patients-how-do-it-right-way