John H, sadly this will become a much more common scenario in the practice of medicine. I'm sure most of us here on the AC board will do the right thing, and not get rid of those patients.
However it will start impacting our bottom line and causes some of us to lose thousands of dollars of hard earned revenue. I'm sure it will be a decision that many of us will have to take a hard look at and at least consider.
I have never yet discharged anyone for bad data. However I've discharged a few patients for medical non-compliance. one example: A 23 year old male patient of mine presented with bilateral leg pain and numbness. I recommended MRI, and for 2 years he saw me every 3-6 months to ask for pain medication but refused the MRI. Finally I said "he would get the MRI or else." I made him get it, and a spinal cord tumor was seen. Then he was worried enough to consult 3 neurosurgeons. The N.S. at John's Hopkins went on record to recommend MRI's every 3 months. I had to harass the patient to get him to agree to one per year, setting AC reminder notices and proactively asking my staff to call him, and sending certified letters at my cost. After reviewing this ridiculous scenario with my malpractice carrier, they recommended I discharge him for non-compliance. He was a huge risk to me. He would be the 1st one in court to say "Dr. Lauer didn't care about the specialist's recommendation for q3mos MRI, he would barely order me one per year." While the record would reflect my over the top care, it would still be a lawsuit when he loses urinary and fecal control as well as reproductive capacity. By the way, I also picked up and diagnosed his hereditary hemochromatosis for which he refused all therapeutic phlebotomy!
