Assuming Care of a New PatientBy Donna Knight. CPHRM, CPHQ, Princeton Insurance Healthcare Risk Consultant

Assuming care of a new patient presents unique practice management,quality of care and liability issues. Whether prompted by a physiciandeparting from your group practice or from the community, patientdecision to change physicians, or new managed care contracts, assuringquality continuum of care should be the goal of the practice.Implementing standard processes within your practice can help youachieve this goal.

Practice Management IssuesWhen assuming care of a patient the standard of care is to request andreview a copy of the patient’s medical record from the prior provider.Although the record provides for continuum of care, it presents itself withseveral practice management issues:

• The time & reimbursement constraints.

• The staffing requirements to coordinate information gathering.

• The record may not be available at the time of the initial visit.

While these issues are significant to the practice, they may pale incomparison to poor patient outcomes, patient distrust and potentialliability. Implementation of a standard process similar to the onedescribed below may facilitate timely, quality of care.

To prepare patients for their first visit, staff should advise patients byphone and letter that you must review their prior medical records. Thepatient should be instructed to arrange to have these forwarded to youroffice from their current health care provider. In some practices the staffalso mails a medical history questionnaire and patient registration form tothe patient to be completed and returned prior to their first appointment. Iftheir appointment is less than one week away, the patient may simply

bring the completed forms and medical records with them. Dependingupon the clinical circumstances, if you do not have the necessary recordsbefore the patient’s visit, you may decide that the patient may have toreschedule their appointment or you may proceed with the visit with theplan to schedule a follow-up visit as soon as possible. Yourdocumentation should reflect that the information was not received andthe plan of action, including timeframes for completion.

Quality of Care Issues

The thought of scouring through mountains of information in a medicalrecord to identify relevant information is daunting. However, consider thatphysicians who routinely do not review prior medical records, but insteadrely on the patient’s account of their clinical history, may risk missingpertinent clinical information that may lead to poor patient outcomes.Some patients may be poor clinical historians and/or may not completelyunderstand significant information or instructions shared with them byprior physicians.

Requesting and reviewing a summary from the prior physician thatprovides key points may save time. However, this standard process maynot provide safe, quality patient care or insulate from liability. Considerthose circumstances in which the prior physician may have overlookedand not included key information in the summary. Only through review ofthe prior medical record and current assessment of the patient would yoube aware of significant information that must be addressed with thepatient in the future.

The added benefit of implementing the standard process of medicalrecord review prior to the patient visit is physician and patient satisfaction –

September 2007

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you are not rushed or frustrated during the office visit and the patient hasyour full attention.

Liability Issues

Although it is general knowledge within the medical community that poorpatient outcomes may or may not lead to liability, awareness of factors infailure to diagnose or treat related claims has raised physician concern:

• The greater the volume of the medical record the greater the risk thatimportant clinical information could be missed.

• The possibility of assuming liability for acts of the prior treating physician.

Reviewing the medical record before the patient’s first visit will savevaluable time during the actual visit. This process may avoid the need toskim through the record during the visit thereby averting the risk ofmissing important clinical information.

Once the physician reviews the medical record an entry in the medicalrecord noting pertinent history and current healthcare plans and needsshould be made. An example of such documentation includes: “4/17/07.Assuming care from Dr. Smith who retired. Chart reviewed; continue medicalmanagement of diabetes; appointment scheduled in one month; orderlabs, consider nephrology consult if kidney function continued to decline.”

It is also important to accurately and objectively document a new patient’scondition at the time you assume care. This, combined with a thoroughreview of prior care treatment records, should “keep the record straight”regarding the care you provided in case the prior care is problematic.

Summary

Although time consuming, to promote safe, quality continuum of care andavoid allegations of failure to diagnose, treat or follow-up the physicianassuming care of the patient should obtain the medical record from theprior physician and review it before the patient’s first visit.

This article is intended to make healthcare professionals aware of newpatient risks and to serve as a general guideline in developing policies andprocedures. This article is not intended as legal advice. Readers shouldconsult professional counsel familiar with federal and state laws forguidance with specific legal, clinical or ethical questions.v

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