Principles of Medical Ethics Opinion 1.1.5 (1) Notify the patient far enough in advance to permit the patient to secure another physician; and (2) Facilitate transfer of care when appropriate. If you are planning to make such a move, or to ask one of your partners to leave, follow these steps to avoid getting burned. Each state treats notification guidance differently, but their approach generally falls within four distinct categories. Anyone looking for information on this topic should be aware of the risk in assuming a simple internet search will provide clear and accurate information. Practice fined for response to social media review, Dallas dental practice fined $10,000 after publishing PHI in response to a patient review on Yelp, Texting patients while staying HIPAA compliant. 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. A letter placed in the patients monthly billing notice is one method. Thus, non-competition and non-solicitation clauses act together to prevent an employee from stealing the employers clients and staff and starting a new venture in the same industry or field. Or, in limited circumstances, the new practice may provide coverage through a new policy with a retroactive endorsement date. Failure to comply with the time limit requirement of this Section shall subject the denying party to expenses and reasonable attorneys fees incurred in connection with any court ordered enforcement of the provisions of this Section. Therefore, patients should be given reasonable advance notice to allow their securing other care. If possible, consider posting your retirement in your local newspaper(s) as well as on your website and/or social media pages (if applicable). A. Texas Medical Board (TMB) regulations say a physician leaving a group must notify his or her patients by: 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. The content of the notice will depend upon state law. 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. 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. However, it at least informs the patients that the provider is not responsible for their further care. At Cariend, [], When physicians retire or close their practice, there are many tasks to complete to ensure the process [], No matter the size or scope of their operations, hospitals and medical facilities are driven to reduce [], Hospital and medical facility managers recognize EMR systems as a necessary part of managing patient medical data. (C) Notifying patients seen in the last two years of the physician's discontinuance of practice BY EITHER: However, weve found its always useful to clarify what exactly non-solicitation and patient abandonment mean and what they do not mean. They are often related to, but distinct from, non-competition clauses, or non-competesanother type of restrictive covenant common in employment agreements. A critical criterion for patient abandonment claims is the need for further treatment. (1) Other licensed physicians remaining in the practice may not prevent the departing physician from posting notice and the sign; (2) A physician, physician group, or organization may not withhold information from a departing physician that is necessary for notification of patients. A noncompete covenant may prohibit you from practicing within a certain geographic radius of your current practice for a designated period of time, often two years. There may also be different rules for different types of medical facilities or practice types, such as hospital vs. private practice, or psychiatry vs. dentistry. Thus, regardless of who is responsible for procuring tail coverage, that party should provide a certificate of insurance to the other party. 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. A 68-year-old woman came to an orthopedic surgeon due to pain in both knees. . 4. Review advance notice provisions. 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.. As this case shows, the interests of an employer in enforcing a restrictive covenant must be balanced by a providers duty not to abandon their patients. Why? They worry that it will force them to abandon their established patients in violation of their legal and ethical obligations. In that circumstance, the list of names may be PHI. On the other hand, a notice directed to specific patients that informs them that the provider is leaving the employer's practice and identifies a new practice where the patient can receive the same or similar services is much closer to the line of solicitation. 1 Required notification of discontinuation of practice The American Medical Associations Ethical Opinion E-7.03 provides that [t]he patients of a physician who leaves a group practice should be notified that the physician is leaving the group., Health care entities must be prepared for the departure of physicians and other health care professionals. Placing a sign on the door of the closed practice only works if the space will not have future tenants. 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. Even if a communication is arguably solicitous, it might fall outside the scope of a non-solicitation clause if it pertains to services not offered by the employer. All rights reserved. Keep a step ahead of your key competitors and benchmark against them. Texas Medical Board Rules Chapter 165.5(c)(1-2) Prohibition Against Interference. You may start by searching for your state requirements, but quickly end up at a third-part source that has paraphrased or misinterpreted the laws. The health care entity has the dual role of safeguarding the medical record while facilitating continuity of care. For example, you would never want to be in a situation where you felt compelled to lie to a patient. The analysis will always depend on the particular circumstances involved. Notices to Patients When a Physician Leaves a Group Practice When a physician leaves a group practice, the physician has a duty and a right to notify his or her patients. In this way, the provider might avoid claims of patient abandonment. leaving a practice Within 90 days after a death . Many states require that patients be notified when a physician is departing a practice. 10. Review noncompetition covenants. Notification can be accomplished by a sign in the reception area, a note in the monthly billing statement, or an advertisement in a local newspaper. Continued, https://www.msbml.ms.gov/sites/default/files/Policies/3-22-19Policies.pdf, Missouri Med. Once a decision has been made to discharge a patient from the p ractice, the practice will need to notify the patient of the termination in writing. A physician must give notice to patients of his or her leaving or closing a practice, otherwise face a possible claim of patient abandonment. Abandonment also occurs when a physician leaves the employment of a group practice, hospital, clinic or other health-care facility, without the physician giving reasonable notice and under circumstances which seriously impair the delivery of medical care to patients., https://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/049/chapter16/chap16toc.html&d=, State advises, Publish a notice 90 days before closing a practice in a newspaper with statewide circulation, including information on how patients can get their medical records (when a physician is deceased, the heirs or the estate must give the same public notice within 90 days); Send a letter to patients that have been seen within the past year notifying them of the practice closure., https://health.ri.gov/healthcare/about/closingpractices/, State advises, Doctors should advertise in all papers, and notify all patients (no matter how long ago treated) the letter of closing. What should a hospital or medical group do now? For this reason, you should review the covenant as though it is entirely enforceable in accordance with its terms. 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. In healthcare, non-solicitation restrictions can extend to patients and other providers who refer patients to the practice or business. What determines a critical or high-risk patient? These functions included taking phone calls from existing patients with treatment-related questions. 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. Notifying Patients of Physician Leaving Practice In all the steps we discussed above, you may have noticed that informing your patients about your departure is crucial. The health care entity, which is the party responsible for maintaining custody of the medical record, should send the notice. 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. Copyright 2005 by the American Academy of Family Physicians. The next generation search tool for finding the right lawyer for you. Board Rule 540-X-9-.10 states reasonable notification must be provided. These rule changes also apply when leaving a group practice, as the departing physician is responsible for providing proper notification. Review your content's performance and reach. Copyright 2023 American Academy of Family Physicians. 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 employee pulls in the other direction, seeking to narrow the non-solicitation clause to reduce its impact on future work opportunities. This must be done by placing a notice in a daily local newspaper published in the community which is the prime locus of the practice. 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. The patients of a physician who leaves a group practice should be notified that the physician is leaving the group., https://www.commerce.alaska.gov/web/portals/5/pub/MED_Guide_Retiring_Closing_Leaving_Group.pdf, Arizona Revised Statutes Title 32. is an individual issued a license allowing them to practice medicine. Texas Medical Board. 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 . Harris County Medical Society. Doing so could subject the provider to claims of abandonment by the patient. Another helpful approach, particularly for specialized physicians, is to provide referrals to nearby practices or physicians offering similar types of care or services. Can a heath care practitioner refuse to treat a patient? For instance, general advertisements, mailings to certain zip codes, and routine marketing activities normally would not meet this standard. Every state has a long list of requirements to obtain and maintain a license to practice medicine, but when it comes to closing a practice, most states only offer (at best) guidelines for what to do when ending a practice, and some states offer no guidance at all. workforce on policies and procedures related to PHI and notify the Attorney General of future breaches. From tail coverage to giving notice, heres how to prepare yourself, your partners and your patients for your departure. Are physicians required to have a chaperone present in the room when examining patients. Dont risk falling short on your notification message which can result in charges of abandonment. (2). 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. BUT, the practice has a right to protect its patient list and other confidential data. See the bottom of this page for a state-by-state comparison of the available guidelines. 1) The state has enacted law regarding patient notification. Unprofessional conduct includes, but is not limited to, the following: (17) Abandoning a patient. Such clauses generally cover a specific geographic area and period of time. 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 This letter must be sent by certified mail, return receipt requested. 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. Practice Information Physicians and Surgeons A Physician or Surgeon (M.D.) Unless your employment agreement provides otherwise, you may be able to notify patients that you are leaving the practice . Consider patient needs. 9. The newspaper ad may have been effective in 1990 when daily newspaper circulation in the US was over 62 million, but with that figure now less than 20 million and declining rapidly, newspaper alone is no longer practical. Whether the practice pays for tail coverage often depends on the type of termination effected. You should review the details of your plan so that you do not unwittingly forfeit significant amounts of retirement money. 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 . 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. Clearly, a provider is not susceptible to an allegation of patient abandonment each time arelationship with a patient terminates. 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. Such property is confidential and, therefore, not to be used or disclosed following termination of the providers employment. If you are asking your partner to leave, you need to know the practices rights and obligations to him or her. You'll quickly notice that it's actually not a letter that talks about a physician leaving, rather it's a new doctor welcome letter. 2, When requested, the practice should provide the departing physician with the contact information of his/her patients to ensure the departing physician is allowed to fulfill patient notification responsibilities, and to avoid TMB disciplinary sanctions for the remaining physicians and possible legal risk to the practice. 3. Keep a copy of the notification letter in the patient's record. All Rights Reserved. The Physician should have 3-5 years of experience of running an OB/GYN practice with leadership skills. A number of patients called the Medical Center and complained about the letter they received. There is no specific time period required. the state Medical Association or Board) has guidelines available. What should be in the notice? With respect to patients, solicitation generally requires a targeted, affirmative act by the employee to convince a patient to obtain services from somewhere other than the employers practice. In our experience at Jackson LLP, rarely are any two non-solicitation clauses alike. No. 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. For some, challenges come from [], All businesses know that protecting vital operational data and records is paramount in the digital landscape. Among the factors in the decision, the court concluded that physicians obligations not to commit patient abandonment militated against interpreting the non-compete as the employer proposed, stating: To conclude that telephone inquiries from existing patients to their physician constitute the practice of medicine in the context of a restrictive covenant would effectively force a physician to neglect or abandon his patients whenever they telephone or page him with medical-related questions, concerns, or emergencies at a time when he happens to be in the restricted geographical area. In contrast, our goal is to help closing practices gain a better understanding of the process and guidelines when it comes to patient notification. Cover your tail. A clean departure will save you headaches and possibly dollars in the immediate future and in the long run. Non-solicitation clauses are a type of restrictive covenant (meaning legally that they forbid a party from doing something). Hear from top leaders in medicine Mustafa Kinaan has shown his dedication to the Central Florida community throughout his graduate medical education (GME) journey. Employment contracts usually reinforce this notion. First, ensure proper notice is provided to patients as well as all interested governmental entities and other organizations. 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. 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. The notice shall provide the patient with 30 days to request a copy of his or her record or to designate where he or she would like his or her medical records transferred and shall request from the patient within 30 days written authorization for the destruction of his or her medical records., http://www.legislature.mi.gov/(S(qm1p2yrrhuxenh2d4yfgk1dd))/mileg.aspx?page=GetObject&objectname=mcl-333-16213, Mississippi State Board of Medical Licensure Policy 3.17 advises, whether by relocation, retirement, disability or death, the patient should be advised of the right to have the medical records sent to the physician of their choice. The FMA also recommends that the practitioner terminating the relationship should provide assistance in locating another practitioner for the patient. The notice should be in the form of a letter sent to the patient, preferably certified with a return receipt requested. At our healthcare law firm, our clients frequently voice concerns over the non-solicitation provision in their employment agreements. Nor would purely personal communications between the employee and patient. (B) Placing written notice in the physician's office; AND As the above discussion shows, solicitation and patient abandonment claims are not limitless. Do not be seduced into foregoing the purchase of tail coverage. In addition, an individual letter is to be sent to each patient seen within the three years preceding the date of discontinuance of the practice., https://portal.ct.gov/DPH/Public-Health-Hearing-Office/Regulations/Public-Health-Code-Medical-Records-Regulations, Delaware Code Title 24 1761 states physicians discontinuing business: shall notify that persons patients of record by publishing a notice to that effect in a newspaper of daily circulation in the area where the person practices. https://www.msma.org/guide-to-closing-a-medical-practice.html. If you had signed a non-compete, you would refer them to the other providers in your practice. The statute adopts the concept of a "records owner." A "records owner" may or may not be a physician. For many providers, mitigating the risk of patient abandonment requires formally ending the patient-provider relationship and providing information about how to receive the same or similar services. 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. The settlement arose from events in the spring of 2015. Are you a healthcare provider considering a new employment agreement with a non-solicitation clause?
