Assuming Care of a New Patient
by Donna Knight, CPHRM, CPHQ, Princeton Insurance Healthcare Risk Consultant
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Assuming care of a new patient presents unique practice management, quality of care and liability issues. Whether prompted by a physician departing from your group practice or from the community, patient decision to change physicians, or new managed care contracts, assuring quality continuum of care should be the goal of the practice. Implementing standard processes within your practice can help you achieve this goal.
Practice Management Issues
When assuming care of a patient the standard of care is to request and review a copy of the patient’s medical record from the prior provider. Although the record provides for continuum of care, it presents itself with several practice management issues:
- The time & reimbursement constraints.
- The staffing requirements to coordinate information gathering.
- The record may not be available at the time of the initial visit.
While these issues are significant to the practice, they may pale in comparison to poor patient outcomes, patient distrust and potential liability. Implementation of a standard process similar to the one described below may facilitate timely, quality of care.
To prepare patients for their first visit, staff should advise patients by phone and letter that you must review their prior medical records. The patient should be instructed to arrange to have these forwarded to your office from their current health care provider. In some practices the staff also mails a medical history questionnaire and patient registration form to the patient to be completed and returned prior to their first appointment. If their appointment is less than one week away, the patient may simply bring the completed forms and medical records with them. Depending upon the clinical circumstances, if you do not have the necessary records before the patient’s visit, you may decide that the patient may have to reschedule their appointment or you may proceed with the visit with the plan to schedule a follow-up visit as soon as possible. Your documentation should reflect that the information was not received and the plan of action, including timeframes for completion.
Quality of Care Issues
The thought of scouring through mountains of information in a medical record to identify relevant information is daunting. However, consider that physicians who routinely do not review prior medical records, but instead rely on the patient’s account of their clinical history, may risk missing pertinent clinical information that may lead to poor patient outcomes. Some patients may be poor clinical historians and/or may not completely understand significant information or instructions shared with them by prior physicians.