March 15–A Charlotte area father received an email from his pediatric provider in January with an "urgent" message to patients.
"Beginning March 1, 2018, any patient under the age of 18 who has not had their periodic well-child visit will be discharged from Carolina Family Healthcare," the email said.
The well-child schedule requires 10 visits within the first two years of a child’s life and then every year after that, the email said.
David Softley, whose seven children range in age from 10 months to 17 years old, was taken aback by the mandate.
"It was particularly annoying to me because at the bottom there was a big button that said ‘Request Appointments,’ ” Softley said. The new requirement "just smelled like a money grab" for the practice to bill patients or their insurance, Softley said.
Softley and his wife take their children to the doctor when they are sick. The family has had a great pediatrician at Carolina Family Healthcare, he said. "A doctor is important for us and we want to make sure we get a good one, we want to keep them."
Since well-child visits are covered by insurance, they do not cost anything out of pocket but can require missing work and spending the time to take the child to the appointment, he said.
Carolina Family Healthcare, in Ballantyne, said in its email to patients that well-child visits have benefits. That includes establishing relationships with the provider and tracking growth and development of children.
"We decided to require regular period well visits for children because not only is it extremely important to record your child’s growth over the years, but we need to keep their records current, even if they don’t immunize," Dino Kanelos, president of Carolina Family Healthcare, said in an emailed response to questions from the Observer.
Carolina Family Healthcare is an independent practice that offers a variety of healthcare services, including preventative care and lab testing.
The well-child schedule set by Carolina Family Healthcare is similar to recommendations from the American Academy of Pediatrics, but the national association does not have a policy on discharging patients for not meeting the schedule.
Two major Charlotte health care systems encourage patients to follow that schedule, but do not discharge them if they don’t comply. For example, Atrium Health, formerly Carolinas HealthCare System, said it encourages wellness visits at the American Academy of Pediatrics recommended intervals, but does not have rules or policies about discharging patients from practices for lack of compliance.
Similarly, Novant Health said that consistent preventative care, including wellness visits, is an important part of the health of the families and communities. "While recommended, well-child visits are not mandatory and we do not discharge patients for not having a wellness visit," a Novant spokeswoman said in a statement.
Atrium and Novant also said they do not have policies that require discharging patients if they do not get immunizations.
Jesse Hackell, a pediatrician at Pomona Pediatrics in New York and a member of a American Academy of Pediatrics executive committee on practice management, said well visits have a huge role in pediatric care.
"These well visits are crucial," said Hackell, adding the visits are a time to administer immunizations and give guidance to parents, like correct car seat use or the importance of sunscreen. That’s care people may not think about when they go to the doctor for a shot, he said.
Hackell said discharging patients over well visits is not common.
"I have not heard of practices discharging patients specifically for failure to meet the 10 visits in the first two years," he said.
However, practices will consider discharging families if they are always going to an urgent care center or somewhere other than the pediatric practice when the child has an illness. Or if they do not vaccinate.
"I would discharge somebody who never came in for a well visit, never do immunizations," Hackell said.
The best way to get kids in for regular well visits is a positive approach, emphasizing the need for immunizations, clearance for sports, monitoring growth and development, he said. All of that is aimed at benefiting a child’s health, Hackell said. The positive approach is better than a punitive one, which does not emphasize that pediatricians’ real role should be for the child’s benefit, he said.
The well visits also give parents an opportunity to raise concerns, including about their child’s development or behavior, according to the Carolina Family Healthcare email sent to patients. But the email advises patients to "Please be aware that, depending on the issues raised, an office visit may also be charged which may result in a co-payment."
That’s happened to Softley and his family, he said. Even though the preventative visits are covered by insurance, during one appointment another treatment occurred that changed the type of visit and resulted in a bill.
Softley said the new requirement at Carolina Family Healthcare is a "practice-first mentality."
"I was just offended at the whole idea that they would demand a certain number of opportunities to bill me or my insurance or anyone in order to have you as a customer," Softley said.
Softley said his family likes their current doctor so they won’t immediately change practices. But he says he isn’t going to bring in his children at the cadence the practice wants or recommends, if he doesn’t feel like it’s the right thing to do.
"We’re going to let them kick us out."
Cassie Cope: 704-358-5926, @cassielcope
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