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Posted 3:52:36 PM. (C) Notifying patients seen in the last two years of the physician's discontinuance of practice BY EITHER: Although he did not directly treat any patients within the restricted geography, the urologist did perform various administrative functions relating to his practice out of a home office with that radius. Proactive [], American Medical Association (AMA) guidelines, https://www.cms.org/uploads/BME_Policy_40-8.pdf, https://drive.google.com/file/d/0B-K5DhxXxJZbZGZUdllNbUFvdDg/view, https://www.ama-assn.org/delivering-care/ethics#Chapter%201:%20Opinions%20on%20Patient-Physician%20Relationships, https://cdn.ymaws.com/lsms.site-ym.com/resource/resmgr/resources/lsms_resource_closingamedica.pdf, http://www.lsbme.la.gov/content/health-care-resources-practitioner, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140270/, https://www.msma.org/guide-to-closing-a-medical-practice.html, https://www.njconsumeraffairs.gov/bme/Pages/FAQ.aspx, http://164.64.110.134/parts/title16/16.010.0017.html, http://www.nmms.org/wp-content/uploads/2018/08/closing_your_practice_2016_revised_-_pcs_0.pdf, https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=9&ch=190&rl=8, https://www.texmed.org/Template.aspx?id=6676, State offers no guidance, but association guidelines available. URMCs Privacy and Security Executive Committee formed a task force to review the hospitals privacy and security requirements and the protocol for disclosure of PHI with respect to departing and incoming workforce members. If possible, consider posting your retirement in your local newspaper(s) as well as on your website and/or social media pages (if applicable). Unless your employment agreement provides otherwise, you may be able to notify patients that you are leaving the practice . Further, many retirement plans have vesting schedules that depend on the number of years one has worked with the employer. Apply Renew Maintain Practice Information Such property is confidential and, therefore, not to be used or disclosed following termination of the providers employment. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); What kind of notification should or do I have to give to patients if I am retiring, Hospitals are often growing, acquiring new facilities and systems to expand their reach and services. It is not just a piece of advice but also a legal requirement by several state and federal laws. Before you make any decisions, revisit your employment contract and your states laws regarding the issue. Though every clients situation is unique, a good place to start when planning for your practices records after retirement or closure is reviewing the legal guidelines for your state regarding patient notification. You should review the details of your plan so that you do not unwittingly forfeit significant amounts of retirement money. Some require an extraordinarily long notice period (such as one year) before the physician can qualify for deferred compensation payments. Texas Medical Board Rules Chapter 165.5(a)(1-3) Transfer and Disposal of Medical Records. The unique facts and circumstances related to a patients condition and care should be used to determine how much notice a patient should be given prior to the actual termination of the physician-patient relationship, and whether the physician should facilitate the transfer of care to another provider., Louisiana State Medical Society Guidelines The physician cannot abandon the patient. When Would My Healthcare Practice Use a Promissory Note? From tail coverage to giving notice, heres how to prepare yourself, your partners and your patients for your departure. Below we share both guidance from the State Board of Medical Examiners and information available from the Department of Regulatory Agencies (DORA) indicating regulatory penalties that could be assigned for not ensuring patient access to records. Texas Medical Board. Copyright 2005 by the American Academy of Family Physicians. Has caused to be published, in the newspaper of greatest circulation in each county in which the physician practices or practiced and in a local newspaper that serves the immediate practice area, a notice which shall contain the date of such retirement or sale that offers to provide the patients records or copies thereof to another provider of the patients choice, and if the patient so requests, to the patient. The agreement provided that for 12 months following termination of employment, the urologist would not engage in the practice of medicine within a 50-mile radius of the employer. You should note, however, that most states allow a patient to request that his or her chart be forwarded to a departing physician, in which case the physician can, at that time, receive the chart from the practice. All Rights Reserved. For example, the Ohio Medical Board has adopted specific rules about the content of the notice, which must include the following (Rule 4731-27-03): The Ohio rules require the health care entity to send the notice to patients, but it may satisfy its statutory obligation by providing patient contact information to the departing physician and requiring the physician to send the notice to patients. There is no specific time period required. URMC responded by sending breach notification letters to the affected patients and notifying the media. Colorado provides a combination of guidelines and state laws, and while their categorization in terms of whether its a law or mere guidance isnt completely clear, when considering the information as a whole it compels Colorado physicians to make provisions to ensure the physician (or estate) isnt liable for abandoning patients or their records. The office should also consider changing its answering message to alert patients According toSchneiderman, Other medical centers, hospitals, health care providers, and health care entities should view this settlement asa warning, and take the time now to review and amend, asneeded, their own policies and procedures to better protect private patient information.. Ultimately, a patient always has the right to seek out a provider of their choosing. However, here are a few baseline recommendations: For example, a common suggestion is to place repeating local newspaper ads to notify the public of a closing practice. 2) The state offers guidelines, but without any statutory requirements or law enforcing notification practices. This blog is made for educational purposes and is not intended to be specific legal advice to any particular person. Do not be seduced into foregoing the purchase of tail coverage. What is the health care entitys responsibility when a physician departs? In addition to sending letters, think carefully about how you will address this topic when you speak with patients. Many physicians believe these covenants will not be enforced; however, the courts in most states will uphold them if they are reasonable. A 24-year-old pregnant woman came to her ob-gyn with a headache and high blood pressure. The unique facts and circumstances related to a patients condition and care should be used to determine how much notice a patient should be given prior to the actual termination of the physician-patient relationship, and whether the physician should facilitate the transfer of care to another provider., While the KBHA does not make laws, this organization works closely with both bankruptcy courts and other official state resources, appearing as both a regulatory authority and an independent agency. Texas Medical Board. The notice to patients should be a minimum of 30 days. It also informed URMCs workforce of its policy that information regarding continuity of care was to be communicated to patients by URMC, not the individual health care providers. Board Rule 540-X-9-.10 states reasonable notification must be provided. The physician must notify the TMB and his/her patients, and advise who has custodianship of the medical records and how a copy may be obtained. The FMA also recommends that the practitioner terminating the relationship should provide assistance in locating another practitioner for the patient. The sign or notice shall advise the physicians patients of their opportunity and right to transfer or receive copies of their records. A physician can perform acupuncture under his/her medical license as long as he/she is properly trained and educated in the field of acupuncture. When scheduling your departure from the practice, take reasonable steps to ensure that you are not leaving any patients in a bind. It is imperative patients are notified well in advance of closure to ensure they have access to their medical records for continuation of care. Who should provide the notice? If you would like to learn how Lexology can drive your content marketing strategy forward, please email [emailprotected]. (4) Notices placed in the physician's office shall be placed in a conspicuous location in or on the facade of the physician's office as a sign announcing the termination, sale or relocation of the practice. For instance, providers who staff emergency departments, hospitalist programs, and urgent care centers render care that is episodic in nature. Your contract may require that you give your practice advance written notice of your departure. This means that if a malpractice event occurs during your employment but the claim is not filed until after you have left the practice, the malpractice insurer will not cover that claim because it was not made during your term of employment. In healthcare, this tug of war can implicate another stakeholder: the patient. Employment contracts usually reinforce this notion. All returned mail should be kept in patient file. The court, however, disagreed. Negotiations over non-solicitation restrictions can play out like a game of tug of war. What should be in the notice? Don't worry, I did that on purpose. All rights reserved, Prohibition Against Interference 165.5(c)(1-2). A number of patients called the Medical Center and complained about the letter they received. Litigating a covenant, either from the employer or employees perspective, is expensive. 1) The state has enacted law regarding patient notification. The sign shall be placed at least 30 days prior to the termination, sale or relocation of the practice and shall remain until the date of termination, sale or relocation. 1. Mailing letters to every patient in your statutory retention window may not be effective either, especially if your state has a baseline of 7-10 years for medical records retention. The employee pulls in the other direction, seeking to narrow the non-solicitation clause to reduce its impact on future work opportunities. If you are asking your partner to leave, you need to know the practices rights and obligations to him or her. The TMB has rulesprohibiting the practice or physician group from interfering. Contact information for providers remaining in practice, Necessary information regarding access to medication, How medical records will be stored and how they may be accessed, Contact information for the records custodian, Expected timeline for transitioning the records, Date records will become available and how long they will be available for request. The KBHA serves as a great resource to physicians. State advises, the following requirements regarding closures must be met: each patient, resident, next of kin, physician and sponsor must be notified immediately upon receipt of the Department of Healths approval. Copyright 2006 - 2023 Law Business Research. Consider patient needs. Texas Medical Board Rules Chapter 165.5(a)(1-3) Transfer and Disposal of Medical Records. It may, if it chooses, permit the physician to have input as to the text of the notice. It may also resolve the issue in advance by including a provision in the physicians written employment or other affiliation agreement that specifies the details of the notice that the health care entity will send in the event of the physicians departure. If you use certified, return receipt mail, you can place a copy of the letter and return receipt in the patients file in case there is ever an issue of notification., https://www.albme.gov/resources/licensees/practice-issues, Alaska State Medical Board adopted AMA policy No. Some states even require or suggest 30 days prior written notice before a departure so that. These policies and others are discussed separately below. The FMA also . While it may be convenient to resign shortly before Christmas so that you can spend the holidays at home, it could be a monumental mistake if it results in losing nearly one years worth of retirement benefits. Can a heath care practitioner refuse to treat a patient? Can a medical doctor work as a chiropractor? In that circumstance, the list of names may be PHI. Under Florida law, when a licensed physician terminates practice, or relocates and is no longer available to patients, the physician must publicly announce their withdrawal from practice by publishing an announcement once a week, for four consecutive weeks. Whether the practice pays for tail coverage often depends on the type of termination effected. It is critical that you understand what you have promised to do and what has been promised to you via these documents. A critical criterion for patient abandonment claims is the need for further treatment. is an individual issued a license allowing them to practice medicine. If you are not familiar with your states requirements, contact a health care attorney in your area for advice. In Ontario and Alberta, for example, at least 90 days notice is required, unless the closure is unexpected or due to circumstances beyond the physician's control, in which case the notice must be communicated as soon as reasonably possible. Keep a copy of the notification letter in the patient's record. Ensuring that patients receive reasonable notification; Ensuring that patients are given an opportunity to obtain copies of their records or arrange for the transfer of their medical records to another physician; Specifying who has custodianship of the records; and, Advising how copies of the medical records may be obtained.. See permissionsforcopyrightquestions and/or permission requests. Texas Medical Liability Trust Resource Hub, Physicians who are retiring, closing, or leaving a practice can notify patients electronically and by posting a notice on their practice website, according to rules from the Texas Medical Board (TMB). Jennifer Bendokas, PA-C. Otolaryngology (ENT) 1110 Hospital Road Fort Walton Beach, Florida 32547 850.863.8275 Education Doctor of Medicine Science University of Lynchburg You and the practice have an obligation to provide proper care for your patients. a physician departing a practice to notify her patients that the physician is leaving, the address of the new practice, and offer the patient the opportunity to have medical records forwarded to the new practice. Health care entities must be prepared for the departure of physicians and other health care professionals. On the other hand, a notice directed to specific patients that informs them that the provider is leaving the employers practice and identifies a new practice where the patient can receive the same or similar services is much closer to the line of solicitation. State advises, Complaints of patient abandonment or neglect can be avoided by giving patients sufficient notice of the practice closure. Normal workplace stresses are exacerbated by longer hours, less pay and zero tolerance for error, which can lead to fractured relationships among partners or employed physicians in a group practice. Can Physician Assistants Own Independent Medical Practices? In contrast, patient abandonment is more prone to arise from the failure to properly act. Connecticut Code of Medical Records Regulations Number 19a-14-44 states, Upon the death or retirement of a practitioner, it shall be the responsibility of the practitioner or surviving responsible relative or executor to inform patients. Physicians are under a tremendous amount of pressure in todays health care environment as costs escalate, reimbursement declines and the malpractice crisis continues. The Physician should have 3-5 years of experience of running an OB/GYN practice with leadership skills. For example, you would not want to plan your departure during a week in which you are anticipating five deliveries. This will ensure that your departure date does not result in unnecessary forfeitures. Perhaps youre already a party to a non-solicitation agreement, and youre wondering how it will affect your future opportunities. Once the relationship is formed, Illinois courts consider abandonment to occur when the provider refuses to treat [the] patient [while] needing further treatment, without giving the patient a reasonable time to find substitute care. As a result of such abandonment, the patient must suffer injury. The statute adopts the concept of a "records owner." A "records owner" may or may not be a physician. Sources Nevada Revised Statues (NRS) 630.304 states, The following acts, among others, constitute grounds for initiating disciplinary action or denying licensure: (7) Terminating the medical care of a patient without adequate notice or without making other arrangements for the continued care of the patient. The content of the notice will depend upon state law. The notice shall appear twice, seven days apart. The case of Bloomington Urological Associates, SC v. Scaglia, 686 N.E.2d 389 (Ill. App. Can I take a copy of my patients records with me, in case they need care from me in the future. Abandonment is the unilateral termination of the physician-patient relationship by the physician without giving the patient adequate notice of such termination and without giving the patient sufficient time to establish a relationship with a new physician. Continued. Notify patients in writing, through a letter carefully crafted with input from practice colleagues or the employing . (3) A copy of the posted notices shall be submitted to the TMB within 30 days from the date of termination, sale, or relocation of practice. Notice to Patients. Copyright 2023 American Academy of Family Physicians. Keep a step ahead of your key competitors and benchmark against them. Physicians are generally required to notify patients directly through one or more channels . The first example letter for notifying patients of a physician leaving their practice comes from Medical Center Clinic. Many states require that patients be notified when a physician is departing a practice. Copyright 1997-2023 TMLT. (Abandonment is defines as the termination of the physician patients relationship at an unreasonable time and without giving the patients the chance to find an appropriate replacement.) California health care entities should review CMA guidance before sending the notice. Readers should consult their healthcare attorney to obtain advice with respect to any legal matter. Section 5-5: If a licensee ceases to engage in practice: Publish a notice and the established procedure for the obtaining of records in a newspaper of general circulation at least once a month for the first three months after the practice closes and forward a copy to the Board. The following are best practices for notifying patients: Send current patients (i.e. It is important to be mindful when reviewing sample closure letters floating around on the internet that most fail to consider many items beyond closure date and how to obtain copies of medical records. A clean departure will save you headaches and possibly dollars in the immediate future and in the long run. Failure to practice in an acceptable professional manner consistent with public health and welfare within the meaning of the Act includes, but is not limited to: (j) termination of patient care without providing reasonable notice to the patient. A non-solicitation provision is usually triggered only by an action. In April 2015, GRN sent letters to the patients whose names were on the spreadsheet announcing that the NP had joined the practice and advising them of how to switch to GRN. (ii) Publishing a notice in the newspaper of greatest general circulation in each county in which the physician practices or practiced and in a local newspaper that serves the immediate practice area; AND This creates a quandary because although you may need new employees, you do not want to appear to be soliciting from the existing practice. Thus, their specialty naturally limits their exposure to allegations of patient abandonment when they leave their jobs. An official letter to your patients is highly recommended. All patients of record who have not requested their records 30 days before the person discontinues the medical-practice business or leaves the State must be notified by first class mail by the person to permit that persons patients to procure their records., http://delcode.delaware.gov/title24/c017/sc05/index.html, Florida Statute Title 32 Ch. 7.03. The answer is yes. Post the notification on the practice website. Title: Retention of medical records and patient notification upon closure of a practice Number: OP04 -29 References: Board Minutes January 23, 2004, April 2, 2004; November 7, 2014; September 11, 2020 . The notice must be published at least 1 time per month over a 3-month period in advance of discontinuing the business or leaving the State and must explain how a patient can procure that patients patient records. The legal guidelines regarding patient notification vary for each state. the state Medical Association or Board) has guidelines available. Laura Hale Brockway is the Vice President of Marketing at TMLT. However, the provider can arrange for the employer to give the notice on the providers behalf. A physicians list of patient names by itself is not PHI, but if the physicians practice only serves patients with a certain health condition, then it may be reasonable to assume that every patient on the list must have the condition. You should: (1) Notify patients by letter that your practice will end and give the effective date (2) Notify patients of the record location and how to access them (3) Advise patients that they must seek the services of another health care provider or refer them to another provider (4) Advise patients that their records will be forwarded to the provider of their choice upon receipt of a properly signed release form., https://www.oregon.gov/omb/Topics-of-Interest/Pages/Patient-Records.aspx, Pa. Code 16.61(a)(17) states, (a) A Board-regulated practitioner who engages in unprofessional or immoral conduct is subject to disciplinary action under section 41 of the act (63 P. S. 422.41). Many states defer to their state medical society or American Medical Association (AMA) guidelines, which are not legal requirements, and typically do not cover all of the potential variables that may exist in your situation. This may be a requirement in your state, but make sure your plan also includes more effective notification methods that contain modern avenues of communicating that will more likely reach your patients. Generally, tail coverage costs between 1.5 and two times a physicians annual premium. This example is conceptual. 1. This letter must be sent by certified mail, return receipt requested. As these examples show, non-solicitation does not mean no contact. Approximately sixty days prior to closure, patients who require frequent follow up should be referred to other physicians and patients with acute medical problems should have appropriate follow up arranged., https://www.maine.gov/md/sites/maine.gov.md/files/inline-files/2017summer_0.pdf, State advises, adequate time must be given to allow the patient to obtain a new practitioner. This makes it very unfair to a physician closing their practice and illustrates why the steps outlined here are important to help closing practices avoid trouble, ensure continuity of patient care, and achieve peace of mind. The notification letter should be professional and nonconfrontational, and it should set a tone that aims to maintain the best possible relationship with the patient. Notifying Patients of Practice Closure When closing a practice, you should send a notification letter to the patients you have seen in your practice within the last three years. In this instance, the departing physician and/or practice should send a letter notifying patients of the change, and offering to provide continuous care for the patients, or offering to transfer records to another provider upon request. Develop a plan for patient notification. A copy of this notice shall also be submitted to the Board not less than one (1) month prior to the date of termination, sale, or relocation of the practice. 9. https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=9&ch=190&rl=8, Additional Resources: Texas Medical Association advises, Texas Medical Board (TMB) regulations say a physician leaving a group must notify his or her patients by: Publishing a notice either: On the physicians or practices website or In the newspaper of greatest general circulation in each county in which the physician practices or practiced, and in a local newspaper that serves the immediate practice area; and Placing a written notice in the physicians office; and Sending patients the physician has seen in the last two years either: A notice in a letter or A notice in an email in a manner compliant with state and federal law. https://www.msma.org/guide-to-closing-a-medical-practice.html. Many states require that patients be notified when a physician is departing a practice. (ii) Sending an email to each patient, in a manner that is compliant with state and federal law. When a physician retires or dies, patients should be notified and urged to find a new physician and should be informed that upon authorization, records will be sent to the new physician. As we were assembling the resources for this document, we were amazed at the level of vague, incomplete, and even inaccurate material on the internet regarding notification requirements for closing medical practices. Practice Information Physicians and Surgeons A Physician or Surgeon (M.D.) Not only does this ensure a smooth transition from the current physician to the new treating physician, but it also reduces the liability of patient abandonment. Therefore, to ensure this occurs with a minimum of disruption in continuity of care, the physician terminating the physician-patient relationship should notify patients sufficiently in advance., https://www.mbc.ca.gov/Licensees/Close_Practice.aspx. Some states dont specifically list steps for closing a practice, but simply note the requirements for terminating a physicians relationship to patients. Often practices and departing physicians will agree on what to tell patients who inquire about the tenure of the departing physician. 1. https://www.njconsumeraffairs.gov/bme/Pages/FAQ.aspx, NMAC 16.10.17.9 states, Whenever possible, active patients and patients seen within the previous three years must be notified at least 30 days before closing, selling, relocating or leaving a practice. Accessed January 18, 2023. For TMB rules on notification requirements and more, refer to Chap 165.5 - Transfer and Disposal of Medical Records. Be aware that patient lists, patient charts and other patient demographic information are property of the practice, not the departing physician. The Florida Medical Association (FMA) recommends to a practitioner who wishes to terminate a relationship that the practitioner should give the patient adequate notice in writing, and the practitioner should remain available to the patient for at least 30 days in order to allow time for the patient to find a new practitioner. A provider who has not solicited a patient cannot, and should not, encounter barriers to providing treatment to that patient. Non-Solicitation and Confidentiality Clauses. This comparative map shows the patient notification guidelines for all 50 states. And 4) The state is completely silent on patient notification without any guidance available. Some states would recognize a tortious interference with contract if a physician were to raid the practice for employees. In this situation, the provider might not be precluded from soliciting that practices patients for services at the medical spa. The physician fails to give the patient at least 30 days notice in advance of the date on which the physicians withdrawal becomes effective. No. URMC began receiving calls from patients who were upset that their confidential medical information had been disclosed without their permission. In contrast, our goal is to help closing practices gain a better understanding of the process and guidelines when it comes to patient notification. A health care practitioner can terminate a patient relationship at any time, but the practitioner may not abandon a patient and should provide continuity of care in accordance with the prevailing professional standard of care. The requirements of this rule shall not apply to a physician who has retired from or sold his or her medical practice if: Such physician has notified his or her active patients of retirement from or sale of practice by mail. If the practice has social media, post the notification message there as well.