Reinstating Patients Who Have Been Discharged

By Robert L. Moore, MD, MPH, MBA, Chief Medical Officer

“Redemption comes to those who wait.  Forgiveness is the key.”

Tom Petty’s 1999 ballad Lonesome Sundown (part of Echo, his tenth album with The Heartbreakers) was written after completing inpatient rehabilitation, recovering from a 3-year period of heroin use. The line about redemption and forgiveness is a reflection of his need to be forgiven so he could again create new songs and genuinely share his art.

Some Partnership HealthPlan of California (PHC) members have experienced hard periods in their lives when their actions cause distress to those around them. In the health care setting, this may lead them to repeatedly missing medical appointments or have verbal outbursts with medical office staff. Sometimes, their behavior leads to disenrollment from a practice.

These patients may sometimes turn their lives around, and be ready to re-engage productively in relationships with medical providers and offices. They are often ready to seek redemption and forgiveness from the medical office that disenrolled them.
At the June PHC Physician Advisory Committee meeting, several physicians related how their practices handle these situations. Here are some highlights:

  • Patients should write a letter (potentially with assistance from an advocate), requesting re-enrollment, acknowledging the reasons for their disenrollment, explaining how their life has changed and expressing a commitment to act differently.
  • The office/health center should have a process for reviewing such requests, ideally involving both clinical and administrative leaders.
  • Many practices require the patient to wait for at least a full year after the disenrollment to consider a request for reinstatement.
  • If the request is denied, the former patient is given a written response, indicating if and when they may apply again for reinstatement.
  • If the request is accepted, the patient has an orientation session outlining expectations of behavior, up-front. For PHC members, PHC needs to be notified, as well.

Tragically, Tom Petty ultimately died of an opioid-benzodiazepine overdose in October 2017, related to his attempts to treat severe pain from hip osteoarthritis, for which he was hesitant to have surgery. In the 18 years between his recovery from heroin addiction and his death, he produced 8 albums and 2 film documentaries—a pretty good redemption.

If your office doesn’t have a process for considering re-enrollment requests, please consider developing one to allow former patients who have turned their lives around to have a second (or third, or fourth) chance.

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