HealthDay News — According to a research letter published in JAMA Internal Medicine, the majority of medical practices have dismissed patients.

Ann O’Malley, MD, MPH, from Mathematica Policy Research in Washington, DC, and colleagues examined the prevalence of and reasons for patient dismissal among primary care practices participating in a Comprehensive Primary Care (CPC) initiative and a matched sample of comparison practices. 

Practices’ responses to a survey from the last year of the 4-year CPC initiative were analyzed, with data included for all 443 CPC practices and 351 comparison practices. The researchers found that 89 and 92% of CPC and comparison practices, respectively, reported ever dismissing patients in the past 2 years. 

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Most practices reported dismissing only a few patients in the previous 2 years: about 10% did not dismiss any patients and 67% dismissed 1 to 20 patients. 

The reasons for dismissing patients were similar for CPC and comparison practices, except that comparison practices more often reported dismissing patients for violating bill payment policies (43 versus 35%). 

Reasons for dismissing patients included extremely disruptive or inappropriate behavior toward clinicians or staff, violation of chronic pain and controlled substance policies, or repeatedly missed appointments (81, 78, and 74%, respectively).

“Our study contributes new insight into an issue that will be increasingly important as insurers move to reimbursing for value rather than volume,” the authors write.


O’Malley AS, Swankoski K, Peikes D, et al. “Patient Dismissal by Primary Care Practices.” JAMA Intern Med. 2017. doi:10.1001/jamainternmed.2017.1309 [Epub ahead of print]

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