Closing or Departing from Practice
Closing or Departing from Practice
The closing or winding down of a medical practice, or other departure from a practice or practice setting, can be a major change in a physician’s professional life. This change can occur for a variety of reasons:
- An independent practitioner retires or closes their practice;
- A physician retires or departs from a group or multi-practice setting;
- A physician joins a competing practice;
- A physician stops seeing patients on short notice because of a sudden health condition, a need to seek treatment for alcohol/chemical abuse or dependency, or because of actions taken by or with the West Virginia Board of Medicine such as a non-practice agreement, suspension or revocation of a license; or,
- A physician unexpectedly dies or abandons his or her practice.
Associated with this type of change are specific professional challenges and practical obligations. In addition to business and legal considerations, a practitioner’s departure requires careful consideration of how to facilitate continuity of patient care, and creation of a plan to ensure required maintenance and access to patient medical records. The purpose of this article is to highlight these and other important issues that should be part of a physician’s decision-making process.
Prepare for the Unexpected
Regardless of size or composition, medical practices should have safeguards in place to protect access to patient medical records and assist in the transition of patient care from the departing physician. This is especially important for independent practitioners and/or small practice groups, where the departure or sudden unavailability of a physician (because of illness, incapacitation or other unexpected absence) may have significant consequences to the practice and/or the patients of the practice.
Planning ahead for a potential closure or departure, particularly if a third party will have to carry out this plan, is often the only way that sudden and/or unexpected departures or closures can be effectively managed without adverse consequences to patients, such as a delay in receipt of or a loss of important medical records. When a physician unexpectedly passes away or abandons a practice, the physician’s estate and/or a collective professional community effort may be required to address the resulting void.
Physicians who are employed by groups or institutions may find that their employment agreement or contract delineates some of these responsibilities. However, a physician is responsible for ensuring that appropriate steps are taken to discharge his or her ethical obligations toward patients as he or she transitions from a group or practice setting.
Continuity of patient care is a primary concern. The transfer of patients in a group setting may be relatively uncomplicated. However, when a physician departs one practice setting to join or establish a competing practice, issues of patient choice may come into conflict with employment agreements. Care should be taken in the beginning of an employment relationship to delineate the rights, ethical obligations and responsibilities of the parties with respect to how a physician’s departure will be handled, and how patient notification and patient medical records will be handled.
Best Practices
When a medical practice closure timetable allows, physicians should engage in a conscious and methodical winding down of a medical practice. The following are suggested best practices for the planned closure of a medical practice.
First, ensure proper notice is provided to patients as well as all interested governmental entities and other organizations.
The following are best practices for notifying patients:
- Send current patients (i.e. established, continuing care patients who have been seen within the last year and/or patients who have future appointments scheduled) written notification of the office closure with instructions on how they may obtain access to their medical records;
- Place a notice on the door or near the reception desk of your practice at least 30 days in advance of the closure;
- Notify patients arriving for appointments about the closure by the physician or staff during their appointment;
- Notify patients at high risk without ongoing care as soon as possible by certified mail and/or telephone to ease their transfer to another provider. If telephone contact is utilized, the date and substance of the conversation should be recorded in the patient record;
- Place an ad in newspapers which serve the geographical areas of the practice’s patient population at least 30 days prior to closure with information regarding access to patient medical records; and,
- Post a notice online and send via e-mail, if the practice has a website or uses e-mail to communicate with patients.
Other Related Contacts
It may also be helpful to provide closure notification to all or some of the following entities:
- Vendors and service companies.
- The Centers for Medicare and Medicaid Services, if the practice is a Medicare/Medicaid participant;
- The U.S. Drug Enforcement Administration, if the practice maintains controlled substances on the premises. The DEA may be able to advise and assist you in ensuring that all controlled substances are safely secured or properly destroyed;
- All state Board of Pharmacy Controlled Substance Monitoring Programs which the practice utilizes or has utilized in the past;
- The physician’s professional liability carrier;
- The West Virginia Board of Medicine, which should be advised of: (1) the closure of or any change of ownership associated with a medical corporation or PLLC; (2) the cessation of drug dispensing practice at a medical practice; and/or, (3) the termination of any supervisory agreement with a physician assistant.
Physician Assistants
With increasing frequency, departure from or closure of practice often involves physician assistants. The relationship between a physician assistant and a patient is very important and may be long-term. This is particularly true for those PAs who work at sites where a physician is not always physically present.
Notification of patients by a practice regarding the departure of a PA should follow the same processes as noted above for physicians. If a collaborating physician is departing a practice, a PA must notify the Board of Medicine that the practice agreement with that physician has terminated. The affected PA may not practice at that location until or unless he or she, in conjunction with a new collaborating physician, submits a new practice agreement which is approved by the board.
Transfer and Retention of Medical Records
The closure of a medical practice or the departure of a treating physician does not void a physician’s obligation to make a patient’s medical records available to the patient or a subsequent provider. Closure notifications should provide patients with clear information about how to obtain medical records and should give the patient an adequate opportunity to request and obtain such records.
At a minimum, patients should receive 30 days' notice of how to request and receive medical records. Ideally, a closing practice can enter into an agreement with another local practice to be designated as the records custodian of unclaimed patient records to safeguard and distribute patient records after the final closure date.
For how long should medical records be retained? The easiest answer is, “indefinitely.” In this era of electronic health records and electronic data storage, that might seem obvious. But some organizations do have specific requirements.
The West Virginia Board of Medicine by rule requires physicians and podiatric physicians to “maintain a medical record for each patient which is adequate … to provide proper diagnosis and treatment, and/or keep such patient medical records for a minimum of three years from the date of the last patient encounter and in a manner which permits the former patient or a successor physician or podiatric physician access to them.”
The Centers for Medicare & Medicaid Services requires records of providers submitting cost reports to be retained in their original or legally reproduced form for at least five years after the closure of the cost report.
According to the American Medical Association’s Code of Medical Ethics, physicians should, “Use medical considerations to determine how long to keep records, retaining information that another physician seeing the patient for the first time could reasonably be expected to need or want to know unless otherwise required by law, including:
- Immunization records, which should be kept indefinitely;
- Records of significant health events or conditions and interventions that could be expected to have a bearing on the patient’s future health care needs, such as records of chemotherapy.”
The AMA also advises physicians to notify patients about how to access stored records, and how long those records will be available. Discarded records should be destroyed (shredded, incinerated) to protect confidentiality.
