On June 11, 2015, URMC reminded its workforce that all patient information was the property of URMC and could not be copied, shared, removed, or transferred without the permission of both URMC and the patient. The statute adopts the concept of a "records owner." A "records owner" may or may not be a physician. Notify patients in writing, through a letter carefully crafted with input from practice colleagues or the employing . A long notice period is often difficult for a non-retiring physician to give, but these issues deserve consideration. The usage and disclosure of patient information, including patients medical records, are often limited by another form of restrictive covenant in employment agreements: confidentiality clauses. 115(4): 325327 advises, practices must notify patients as soon as possible to facilitate continued patient care. 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. Pursuant to the Health Information Technology for Economic and Clinical Health Act, state attorneys general are empowered to enforce HIPAA regulations through civil actions against violators. 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., https://wvbom.wv.gov/Closingordepartingpractice.asp. For example, including the date in which your Drug Enforcement Administration (DEA) license will expire within the notification message could help patients avoid unexpected disruptions in access to life-saving medications. https://www.texmed.org/Template.aspx?id=6676, The Vermont Guide to Healthcare Law by the Vermont Medical Society advises, In order to avoid a claim of abandonment, the physician should take several steps to terminate the physician-patient relationship. By contrast, a non-solicitation provision prohibits the employee from soliciting the employers clients and personnel for other business or work opportunities. 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. Web Design Trundlemedia, Health Insurance Portability and Accountability Act(HIPAA). Professions and Occupations 32-3211 states, If the health professional terminates or sells the health professionals practice and the patients medical records will not remain in the same physical location, the procedure by which the health professional shall notify each patient in a timely manner before the health professional terminates or sells the health professionals practice in order to inform the patient regarding the future location of the patients medical records and how the patient can access those records., Arkansas Medical Society states, AMS recommends that a physician place an ad in their local newspaper announcing the closure with instructions as to how the patient can obtain copies of their medical records. A physician shall provide a patient written notice of the termination of the physician-patient relationship. Dont risk falling short on your notification message which can result in charges of abandonment. Your careful attention to these details will ensure a smooth transition to a new practice. According to the urologists former employer, such activities violated the non-compete. https://www.health.ny.gov/facilities/adult_care/dear_administrator_letters/acf_closure_guidelines.htm, The North Carolina Medical Society advises, practitioners and other parties that may be involved to ensure that: patients are notified of changes in the practice, sufficiently far in advance (at least 30 days) to allow other medical care to be secured, which is often done by newspaper advertisement and by letters to patients currently under care (Sample letter Attachment A); patients clearly understand that the choice of a health care provider is the patients; patients are told how to reach any practitioner(s) remaining in practice, and when specifically requested, are told how to contact departing practitioners; and patients are told how to obtain copies of or transfer their medical records., https://www.ncmedsoc.org/wp-content/uploads/2013/06/Closing-a-Medical-Practice.pdf, Rule 4731-27-03 states, When () a health care entity provides to patients a notice of the termination of a physicians employment, the notice shall be provided in one of the following ways: (1) A letter sent via regular mail to the last address for the patient on record, with the date of mailing of the letter documented; (2) An electronic message sent via a HIPAA compliant electronic medical record system or HIPAA compliant electronic health record system that provides a means of electronic communication between the health care entity and the patient and is capable of sending the patient a notification that a message has been received and is in the patients portal., https://codes.ohio.gov/ohio-administrative-code/rule-4731-27-03, State advises, Whenever a physician is leaving or has left practice and the actual office is being closed, several different methods of patient notification can be used. 1, 2. After all, employers typically exclude information that might prompt patients to seek the outgoing providers services at a new practice. The physician will have the opportunity to mentor new physicians. A physician in a multi-physician practice is retiring or leaving the geographic practice area. 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 Physicians are generally required to notify patients directly through one or more channels . All Rights Reserved. Confidentiality clauses usually define patient information and records generated during the providers employment as the practices property. 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. This comparative map shows the patient notification guidelines for all 50 states. Therefore, patients should be given reasonable advance notice to allow their securing other care. We understand the process can feel daunting. (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 If you mail notification letters to every patient and half return as undeliverable, can you feel confident that you provided reasonable notification? Notice to Patients on the Departure of a Physician September 2007 Texas Medical Board Regulations When a physician departs a group, the issue of continuity of care for patients should be considered. 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. These assets belong to the practice and cannot be taken by the physician without the practices consent. How to text patients and colleagues without violating the Health Insurance Portability and Accountability Act. An example letter . For instance, general advertisements, mailings to certain zip codes, and routine marketing activities normally would not meet this standard. This will most likely include an employment agreement, a shareholders agreement (if the practice is a corporation) or an operating agreement (if the practice is a limited liability company) and, in some cases, a deferred compensation arrangement. Your contract may contain provisions against your soliciting the employment of existing employees of the practice. In healthcare, this tug of war can implicate another stakeholder: the patient. This settlement addresses several questions that often arise when a physician (or other health care professional) departs a hospital or medical group (health care entity). The physician fails to provide for continuity of prescription medications between the notice of intent to withdraw from the physician-patient relationship and the date on which the physician-patient relationship ends, if the prescription medications are necessary to avoid unacceptable risk of harm. Each state treats notification guidance differently, but their approach generally falls within four distinct categories. Make reasonable efforts to directly notify patients treated within the prior six months letting the patients know about the manner in which the patient can obtain copies of his/her records. 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. 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. A 68-year-old woman came to an orthopedic surgeon due to pain in both knees. https://www.msma.org/guide-to-closing-a-medical-practice.html. Say, for example, a provider leaves a dermatology practice to join a medical spa that performs cosmetic procedures not available at the dermatology practice. Thus, regardless of who is responsible for procuring tail coverage, that party should provide a certificate of insurance to the other party. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. The office should notify patients as soon as possible to support continuity of care for the deceased physicians patients.2 As a first priority, the office staff should call patients with scheduled appointments so patients with immediate needs for a physician can find another healthcare provider. The notice shall appear twice, seven days apart. Yes. The Florida Medical Association is not affiliated with the Board of Medicine. For the states that do not offer specific guidance on closing a medical facility and simply defer to AMA or state medical society guidelines, understand these are third-party sources are merely providing general guidance, and not legal or practice-specific advice. According to Rule 64B8-10.002(3), FAC : A licensed physician shall keep adequate written medical records, as required by Section 458.331(1)(m), Florida Statutes, for a period of at least five years from the last patient contact; however, medical malpractice law requires records to be kept for at least seven years. See the bottom of this page for a state-by-state comparison of the available guidelines. A non-solicitation provision is usually triggered only by an action. Assuming the physician is leaving the practice on good terms and with ample time to prepare for the departure, the key consideration is ensuring that patients are properly notified in a timely and professional manner. If the restrictive covenant specifically prohibits the physician from treating patients he saw while employed with his former employer, there is case law that indicates a physician may not be able to treat the patient regardless of who establishes first contact. 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. For providers who form more continuous treatment relationships (e.g., surgeons providing post-operative care to a patient following a procedure), patient abandonment liability can be limited by furnishing notice of termination of the relationship. Can a heath care practitioner refuse to treat a patient? Most practices only close once. For example, practices often agree to pay for tail coverage in the event that employment is terminated by the practice without cause. Mind These Legal Issues. For sound guidance on regulations and requirements, retiring physicians can call the KBHA at (785) 296-7413. In March 2015, the NP was preparing to leave URMC for a position at Greater Rochester Neurology (GRN). For example, some retirement plans require an employee to work the entire year prior to becoming eligible. 1. Likewise, physicians often agree to pay for tail coverage if they terminate their employment without cause. Or, in limited circumstances, the new practice may provide coverage through a new policy with a retroactive endorsement date. 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. They are often related to, but distinct from, non-competition clauses, or non-competesanother type of restrictive covenant common in employment agreements. Many states require that patients be notified when a physician is departing a practice. Just because a provider ends patient relationships following termination of employment and cannot, by contract, solicit the employers patients for further treatment, does not mean that the provider is necessarily at risk of liability for patient abandonment. Notice to Patients. Should patients be notified of the physicians departure? Ensure that their records can be transferred to another health care provider as requested by the patient, and c. Whenever possible, notice shall be provided at least 30 days prior to cessation of treatment; and (10) After transfer of the licensees medical records which meets the requirements of (9) above, the licensee shall be relieved of further responsibility for complying with requests for copies of records., http://www.gencourt.state.nh.us/rules/state_agencies/med100-600.html, State advises in Section 1-15, The doctor must notify the patient, in writing, that he/she will no longer provide care as a date certain, which cannot be less than thirty days prior to the termination date. Unless your employment agreement provides otherwise, you may be able to notify patients that you are leaving the practice . Notify other patients who won't be receiving a letter by placing a notice in the local newspaper with the largest circulation, putting a sign up in the lobby and preparing a patient handout. It is the position of the Washington State Board of Osteopathic Medicine and Surgery (Board) that transition from a medical practice is done with a minimum of disruption to the patient. When an osteopathic physician leaves a group practice, the patients of that physician must be notified., https://www.doh.wa.gov/portals/1/Documents/2300/RetentionOfMedicalRecords_And_PatientNotification.pdf, State advises, When a medical practice closure timetable allows, physicians should engage in a conscious and methodical winding down of a medical practice. (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. 7.03. It may, if it chooses, permit the physician to have input as to the text of the notice. This may vary from practice to practice. The American Medical Association's 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 . Often practices and departing physicians will agree on what to tell patients who inquire about the tenure of the departing physician. 2023 Jackson LLP Healthcare Lawyers. 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. They worry that it will force them to abandon their established patients in violation of their legal and ethical obligations. The KBHA serves as a great resource to physicians. For assistance, members of The Doctors Company can contact a patient safety risk manager at (800) 421-2368 or by email. leaving a practice Within 90 days after a death . The court, however, disagreed. It must protect the patients medical record and not release it without patient authorization. Section 456.057, Florida Statutes, sets forth the requirements that must be followed when a physician retires, closes his office or relocates his practice. This letter must be sent by certified mail, return receipt requested. 1. 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. Posted 3:52:36 PM. Are you a healthcare provider considering a new employment agreement with a non-solicitation clause? The Physician should have 3-5 years of experience of running an OB/GYN practice with leadership skills. Common questions include: Navigating the line between non-solicitation and patient abandonment poses a challenge. TMB rules for physicians who retire, close, or leave a practice. Understand who owns the chart. 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. For example, you would never want to be in a situation where you felt compelled to lie to a patient. https://regulations.justia.com/states/wyoming/medicine-board-of/medicine-board-of/chapter-3/section-5/. 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. It is imperative patients are notified well in advance of closure to ensure they have access to their medical records for continuation of care. 1 Required notification of discontinuation of practice 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. 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. In any case, some of the most effective notification arrangements you can make include: As you look for notification guidance on the internet, carefully assess the credibility of the source for information. 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. Rarely do practices agree that patient charts are the property of the employed physician. There is a range of activities and provider-patient communications that can continue after an exit without breaching the non-solicitation restriction. 1. Review all documents you have signed. (i) Sending a letter to each patient; OR Is a list of patient names without information about the patients medical condition considered PHI? 4. Review advance notice provisions. The physician fails to allow for patient access to or transfer of the patients health record as required by law. Some states would recognize a tortious interference with contract if a physician were to raid the practice for employees. When preparing your notifications: Looking at the closing medical practice notification guidelines of all 50 states, some are silent on providing guidance, while others provide a vague range of recommendations. In contrast, our goal is to help closing practices gain a better understanding of the process and guidelines when it comes to patient notification. While some employers will contractually agree to pay tail insurance in certain events, a thorough review of your employment agreement, and sometimes the shareholders or operating agreement, will determine who is responsible for procuring tail coverage. is an individual issued a license allowing them to practice medicine. Don't worry, I did that on purpose. 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. 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). Dr. Randolph Zuber and his son defense attorney Blake Zuber have a long history of service to TMLT and the physicians of Texas, We are sad to announce the death of Randolph Clark Zuber, MD, a founder and member of our first Governing Board. All rights reserved. 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. 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. A non-solicitation clause only prohibits solicitation. The FMA also recommends that the practitioner terminating the relationship should provide assistance in locating another practitioner for the patient. Whether the practice pays for tail coverage often depends on the type of termination effected. Placing a sign on the door of the closed practice only works if the space will not have future tenants. It is not just a piece of advice but also a legal requirement by several state and federal laws. A threshold requirement for a malpractice claim premised on patient abandonment is that there is a patient-provider relationship. Save my name, email, and website in this browser for the next time I comment. However, it at least informs the patients that the provider is not responsible for their further care. She can be reached at laura-brockway@tmlt.org. 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. How long must a healthcare practitioner maintain a patients records? 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. In fact, you must notify them- you can't just leave and let them find out you're no longer their provider. the state Medical Association or Board) has guidelines available. The physician fails to give the patient at least 30 days notice in advance of the date on which the physicians withdrawal becomes effective. Which patients should be notified? However, there are several other elements that could be helpful to your patients as they are searching for their next provider, having their medications refilled, or other specific needs related to continuation of care. Those remaining in the practice must be careful not to interfere with the departing physician fulfilling these responsibilities. According to, Schneiderman, Other medical centers, hospitals, health care providers, and health care entities should view this settlement as, a warning, and take the time now to review and amend, as, needed, their own policies and procedures to better protect private patient information., Law Enforcement and Healthcare: When Consent, Privacy, and Safety Collide.