Navigating chronic autoimmune diseases is rarely straightforward, and for many patients, the relationship with their rheumatologist is one of the most crucial in their care journey. Yet, it’s not uncommon for patients to transfer out of private rheumatology practices. Whether it’s due to logistical, personal, or clinical reasons, understanding these factors can help both patients and providers create more sustainable and satisfying care relationships.
As we have all experienced, patient transfers from rheumatology practices frequently center around care concerns. Patient-initiated transfers are often the result of frustration with the patient-provider partnership, lack of follow-up by the office for clinical concerns, or distrust of the care plan offered to them. Office-initiated transfers may often be provoked in response to a patient’s disruptive behavior or non-compliance with treatment or scheduled visits. However, the current healthcare climate has promoted an evolution in the reasons for patient transfers that requires new strategic approaches for both patients and offices alike.
1. Insurance and Financial Constraints: With the growing number of insurance payers and cost considerations, patients are more frequently changing insurance plans, increasing the chance that their plan is no longer accepted by their current provider. Furthermore, high deductibles, copays, and non-covered services in private practice settings can make continued care financially unfeasible.
2. Access and Availability: Rheumatologic conditions require ongoing management, and poor access can compromise care. Offices with higher patient demand but lower provider availability struggle with long wait times and limited availability. Staff constraints have also led to delays in medication refills and review of test results. Overly commercialized practices are also on the rise where patients feel like a number rather than a person.
3. Clinical Disagreements or Unmet Needs: We are no stranger to the patient who feels their needs aren’t being met, but the shift in expectations due to “Dr. Google” and “microwave cultures” has amplified the tendency of patients and providers to disagree with a diagnosis or treatment approach. While providers may lean more towards their preferred treatment modalities, patients have increased exposure to alternative or integrative therapies that may not be supported by the current practice.
4. Administrative Challenges: Efficient office systems are critical for chronic disease care, but today’s system amplifies challenges to providing timely and quality care. Administrative burden on providers and offices continues to rise due to the increase in biosimilar or step-edit mandates, prior authorizations, and appeals. Compounding this is the challenge of navigating insurance denials and third-party entities such as specialty pharmacies and Pharmacy Benefit Managers (PBMs). Patients are increasingly frustrated with long delays in getting medications while they attempt to navigate broken, complex, and unclear processes. In a search for solutions, patients may therefore transfer to another practice but be disappointed to find the recurrent theme across practices.
Final Thoughts
Patients transferring from private rheumatology practices are an expected byproduct of the healthcare exchange but as we move into the future, it is important that offices and patients remain aware of the reasons behind patient dissatisfaction and limitations of care. As we identify barriers, both offices and patients must be willing to have conversations about these challenges. When office staff are upfront and transparent about administrative hurdles or therapy limitations, patients are more likely to maintain trust in their providers and partner with them to reach solutions. Likewise, patients who are given an opportunity to share their perspective on challenges they face can benefit from providers and staff who can target solutions with more confidence. In the end, partnership between patients and offices will be the strongest force to slow the migration and preserve the healthcare experience.
Tags: education, NORM, patient transfers, rheumatology Posted by
