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AOA NOW: March 10, 2017
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March 10, 2017

After Halting Start, Trump Plunges Into Effort to Repeal Health Law
Source: New York Times
President Trump, after a halting start, is now marshaling the full power of his office to win over holdout conservatives and waffling senators to support the House Republicans’ replacement for the Affordable Care Act. There are East Room meetings, evening dinners and sumptuous lunches — even a White House bowling soiree. Mr. Trump is deploying the salesman tactics he sharpened over several decades in New York real estate. His pitch: He is fully behind the bill to scotch President Barack Obama’s signature domestic achievement, but he is open to negotiations on the details. In so doing, Mr. Trump is plunging personally into his first major legislative fight, getting behind a bill that has been denounced by many health care providers and scorned by his base on the right. If it fails, Mr. Trump will find it difficult not to shoulder some of the blame. “He understands the power he has as president to drive the legislative process,” said Representative Patrick T. McHenry, Republican of North Carolina and a top House vote counter, who was part of a meeting with Mr. Trump in the East Room on Tuesday. Read more about the proposed plan on the New York Times' website.



Financial Discussions
One of the most difficult discussions you will have with a patient is about finances. Most of the time, it falls to the billing personnel, but the "touchiest" ones will fall to the manager for various reasons. Your best strategy is to have both the financial problem and potential solutions determined before the patient ever enters your office. Have your financial options - such as a payment plan or an outside financing solution (e.g., CareCredit) - prepared for the patient if there is no other recourse. When the patient sees you are prepared to help, he or she should be appreciative, and the solution more easily agreed on.


Verbally Abusive Patient
Do you have a standard process for dealing with verbally abusive patients? While we strive to maintain a safe, approachable environment, sometimes patients can become frustrated or irate - and take it out on our staff. Learn what practices are doing in the instance of a verbally abusive patient below. Contribute your thoughts, and check out more great topics - or post your own! - on the AOA Discussion Forums.


Q: I have never had to deal with this situation and need some advice. I had a patient who was verbally abusive to my allergy tech and then proceeded to yell at me the same day. The doctor wants to discharge her. We have vials made up for her that are technically her property. I was thinking we could maybe discharge her when the vials are completed but I am concerned that she is the type of person who would file a lawsuit and I just want to make sure we do everything correctly. Thanks.

A: To my understanding the state law in Louisiana states that after the patient is in receipt of her discharge letter, the physician has 30 days to continue her care. This gives her time to secure a new physician. IF she does not secure a PCP then she would be referred to the ER.

A: I do not tolerate abuse of our staff under any circumstances and it has always resulted in patient discharge. Since you have vials already made up, you can choose to provide them to the patient via mail to avoid an opportunity for an unruly face to face interaction but then refuse services for injections, allowing them to go to their PCP or other medical office to get them for this vial only. I wouldn't allow that patient even one shot in my office for fear of further disturbance. The question will be how to handle future vials and that's something your physicians will have to decide. We would terminate services completely. Your other alternative is to just not bill for those vials (or void the claim if you already did) and just let the patient go.

Any time we consider discharging a patient, I contact our attorney just to be safe and I'd suggest you do the same here. Your attorney can prep the letter you send. In Michigan, we are required to advise a patient being discharged that we will be available for urgent or emergent services for a period of 30 days while they seek another provider. Routine requests for service (allergy shots) are not provided. We always include a copy of our medical records release form to facilitate them moving to another provider. For this type of patient discharge, our letter usually states they are being discharged from our practice due to inappropriate behavior towards our staff. Some attorneys suggest not stating a reason but ours believes it's better to spell it out because patients almost always end up calling if you don't say why. And who wants to take that call? Make sure your medical record has a clean, factual note about the unruly patient written by those who actually interfaced with her. Not a third party.

One last comment - we don't always know what else is going on in a patient's life which can certainly affect their behavior towards us even if it has nothing to do with us. Did the patient subsequently apologize? Try to make amends? Offer a reason for their rude behavior? If so, you might want to reconsider a discharge action. But if not, let them go. There's already enough going on without being on edge every time this patient comes into your office. Good luck.

A: I agree 100%. And like she said, make sure that your allergy tech and you have very good documentation in the chart about exactly what abusive behavior took place. It's said that if it's not documented, it didn't happen. If you're clear about everything on your end, I don't think she'd have a case against you.

A: I agree with the above and you might add a "generic suggestion" on where she may obtain assistance in continuing her care, such as your local medical society phone number for a list of physicians or the address or phone for another local agency which might have a referring list of physicians. This way you are not only being available for 30 days for ER care but you cannot be accused of "abandoning" them further without resources to find another physician.

A: I agree with the above. We too have to provide the patient with 30 days of care if needed. You could always offer up your direct line to the patient contact and let you know where she would like her serum mailed to. This is never easy, but often best for both parties.


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Educate yourself and your office with AOA webinars. Learn about several upcoming titles below. Visit the AOA Webinars page to register. Secure your education for 2017 with the 2017 AOA webinar subscription for the low member rate of just $349.

March 22 @ 1 p.m. Eastern | "
MACRA Legislation and the Quality Payment Program: What You Need to Know!" presented by Virginia F. Brooks, MHA, CPHQ
April 26 @ 1 p.m. Eastern | "
Employment Changes in 2017: What Does the New Administration Mean for Your Office?" presented by Lori Kleiman, SPH

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