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://docs.legis.wisconsin.gov/code/admin_code/med/10/03/3/j. Health care entities must be prepared for the departure of physicians and other health care professionals. This will ensure that your departure date does not result in unnecessary forfeitures. 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. Are you a healthcare provider considering a new employment agreement with a non-solicitation clause? 219, or send a letter to Harris County Medical Society, John P. McGovern Building, 1515 Hermann Dr, Houston, TX 77004-7126. The Texas Medical Board (TMB), in an attempt to address this issue, adopted regulations that must be followed whenever a physician leaves a group. A number of patients called the Medical Center and complained about the letter they received. 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. These guidelines tend to put a heavy burden on the physician, leaving them to decide on their own, items such as: In all cases, even if a particular state offers no specific requirements or guidelines for closing practice notifications, every state is clear about seeking to penalize physicians for complaints of abandonment or untimely records access if the steps chosen by the physician fail to meet an unpublished standard. 456 057 subsection 13 states, records owners shall place an advertisement in the local newspaper or notify patients, in writing, when they are terminating practice, retiring, or relocating, and no longer available to patients, and offer patients the opportunity to obtain a copy of their medical record., https://www.flsenate.gov/Laws/Statutes/2011/456.057, Rule 360 3-.02 (16) states, O.C.G.A 43-1-19 and 43-34-37 authorize the Board to take disciplinary action against licensees for unprofessional conduct. Unprofessional conduct shall include, but not be limited to, the following: Failing to maintain patient records documenting the course of the patients medical evaluation, treatment, and response. Texas Medical Board Rules Chapter 165.5(c)(1-2) Prohibition Against Interference. According to the urologists former employer, such activities violated the non-compete. The content of the notice will depend upon state law. Practice Information Physicians and Surgeons A Physician or Surgeon (M.D.) 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. Whether the practice pays for tail coverage often depends on the type of termination effected. TMB rules for physicians who retire, close, or leave a practice. Except in cases of death or other incapacity of the practitioner, practitioners may not abandon a patient or abruptly withdraw from the care of a patient. Some employment agreements indicate that the practices general policies and procedures may be applicable even if they are contrary to the physicians employment agreement. A 68-year-old woman came to an orthopedic surgeon due to pain in both knees. Nor would purely personal communications between the employee and patient. According toRule 64B8-10.002(3), FAC : A licensed physician shall keep adequate written medical records, as required by Section458.331(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. There is no specific time period required. A non-solicitation clause only prohibits solicitation. 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. A notice in an email in a manner compliant with state . The comparison is intended to serve as a resource to help retiring physicians and closing practices navigate their obligations and avoid regulatory penalties as a result of the patient notification process. (C) Notifying patients seen in the last two years of the physician's discontinuance of practice BY EITHER: A provider who has not solicited a patient cannot, and should not, encounter barriers to providing treatment to that patient. Notice to Patients. (i) Sending a letter to each patient; OR Subsection: F9 states, If a licensee retires, moves from the area or decides to stop treating a patient or group of patients, the licensee shall: a. 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 practice may opt to send a letter to patients about the departure of a physician, but is generally not legally required to do so, and a physician also generally has no legal right to send such letter independently in violation of their contract (and using a practice patient list). No. This growth [], Filling out patient records requests at Cariend just got a whole lot easier. Some states even require or suggest 30 days prior written notice before a departure so that patients will have sufficient time to transfer their records if they desire to change physicians. Learn practical ways to communicate with disruptive or angry patients. Notify patients in writing, through a letter carefully crafted with input from practice colleagues or the employing . Likewise, physicians often agree to pay for tail coverage if they terminate their employment without cause. There is a range of activities and provider-patient communications that can continue after an exit without breaching the non-solicitation restriction. We can help you assess your rights and responsibilities. URMC responded by sending breach notification letters to the affected patients and notifying the media. What is the health care entitys responsibility when a physician departs? Further, many retirement plans have vesting schedules that depend on the number of years one has worked with the employer. At the mediation, the single specialty practice initially took the position that: (1) if a patient contacted them asking for an appointment with one of the departing physicians, the practice would . The health care entity has the dual role of safeguarding the medical record while facilitating continuity of care. 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. (I) Posting such notice on the physician's or practice website; OR When Would My Healthcare Practice Use a Promissory Note? It is, however, not uncommon for employees to solicit the departing physician prior to departure. 3. TMB rules for physicians who retire, close, or leave a practice 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). The sign or notice shall advise the physicians patients of their opportunity and right to transfer or receive copies of their records. 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. Water's Edge Dermatology, an AQUA Dermatology portfolio practice, is Florida's largest and mostSee this and similar jobs on LinkedIn. 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 24-year-old pregnant woman came to her ob-gyn with a headache and high blood pressure. Often practices and departing physicians will agree on what to tell patients who inquire about the tenure of the departing physician. According to TMB Rules Chapter 165.5(a)(1-3): When a physician retires, terminates employment, or otherwise leaves a medical practice, he or she is responsible for: (2) Notification shall be accomplished by: (A) EITHER: If possible, consider posting your retirement in your local newspaper(s) as well as on your website and/or social media pages (if applicable). Additional Resources: The Kansas Medical Society advises physician, Develop and send a letter notifying patients of closing date and contact information of the custodian., https://www.kmsonline.org/resources/practice-operations/26-general-topics/120-transitioning-a-medical-practice. Your contract may contain provisions against your soliciting the employment of existing employees of the practice. However, it at least informs the patients that the provider is not responsible for their further care. We understand the process can feel daunting. It must protect the patients medical record and not release it without patient authorization. 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. The Medical Center suspended and ultimately terminated the nurse practitioner and treated the incident as a reportable breach. 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. Therefore, patients should be given reasonable advance notice to allow their securing other care. What determines a critical or high-risk patient? 2) The state offers guidelines, but without any statutory requirements or law enforcing notification practices. A non-solicitation provision is usually triggered only by an action. 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. 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. From tail coverage to giving notice, heres how to prepare yourself, your partners and your patients for your departure. 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. 2023 Jackson LLP Healthcare Lawyers. 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. 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. The cost of successfully defending a medical malpractice action is lifestyle altering. First, ensure proper notice is provided to patients as well as all interested governmental entities and other organizations. Those remaining in the practice must be careful not to interfere with the departing physician fulfilling these responsibilities. They are often related to, but distinct from, non-competition clauses, or non-competesanother type of restrictive covenant common in employment agreements. In these cases, patients do not expect the same provider to perform related services in the future. Thus, their specialty naturally limits their exposure to allegations of patient abandonment when they leave their jobs. 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. Can Physician Assistants Own Independent Medical Practices? Copyright 2023 American Academy of Family Physicians. 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. A physician may choose whom to serve. For assistance, members of The Doctors Company can contact a patient safety risk manager at (800) 421-2368 or by email. All of this increases the likelihood that you or one of your colleagues will leave your current practice. 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. 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. A physician shall ensure that emergency medical care is available to the patient during the 30-day period following notice of the termination of the physician-patient relationship., https://www.legis.iowa.gov/docs/iac/rule/09-22-2010.653.13.7.pdf, Kansas Board of Healing Arts (a regulatory board created by legislature for the purpose of education, administration, regulation enforcement) advises providers follow AMA Guidelines. Leaving a practice can be a stressful time in any physicians career. Texas Medical Board Rules Chapter 165.5(a)(1-3) Transfer and Disposal of Medical Records. Such an approach may frustrate the provider who is leaving. It is critical that you understand what you have promised to do and what has been promised to you via these documents. Leaving a group practice. 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. 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. 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. The settlement arose from events in the spring of 2015. For instance, general advertisements, mailings to certain zip codes, and routine marketing activities normally would not meet this standard. If the practice has social media, post the notification message there as well. 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. Indeed, this may be especially appropriate when the employment agreement defines patients treated by the employee as the employers. In healthcare, non-solicitation restrictions can extend to patients and other providers who refer patients to the practice or business. HIPAA protects information that relates to the past, present, or future physical or mental health or condition of an individual when there is a reasonable basis to believe the information can identify the individual. 8. The University of Rochester Medical Center (URMC) recently agreed to pay a $15,000 penalty for providing patient names, addresses, and diagnoses to a departing nurse practitioner (NP) without first obtaining authorization from those patients. 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. 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. Copyright 2005 by the American Academy of Family Physicians. An official letter to your patients is highly recommended. 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. Also, we advise that a letter is sent to all patients seen within the last year with the same information and possible suggestions for other physicians., State advises, It is the Boards position that due care should be exercised when closing or departing from a medical practice. 1) The state has enacted law regarding patient notification. Many states require that patients be notified when a physician is departing a practice. 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. Some require an extraordinarily long notice period (such as one year) before the physician can qualify for deferred compensation payments. 3. 1. Review all documents you have signed. Courts have, however, held physicians liable for breach of non-solicitation agreements and misappropriation of trade secrets when Can a heath care practitioner refuse to treat a patient? 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. It may, if it chooses, permit the physician to have input as to the text of the notice. 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. Yes. A threshold requirement for a malpractice claim premised on patient abandonment is that there is a patient-provider relationship. 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. How long must a healthcare practitioner maintain a patients records? 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). Some practices display placards in the waiting room informing patients of a physicians departure. 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. Web Design Trundlemedia, Health Insurance Portability and Accountability Act(HIPAA). 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. 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. The practice should also provide a script for receptionists on what to say. This may vary from practice to practice. Accessed January 18, 2023. At our healthcare law firm, our clients frequently voice concerns over the non-solicitation provision in their employment agreements. 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. 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. is an individual issued a license allowing them to practice medicine. 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. The notice must include at least the following information: (1) a notice to the patient that the physician will no longer be practicing medicine as an employee of the health care entity and the date on which the physician ceased or will cease to practice as an employee of the health care entity; (2) except where the health care entity has a . They worry that it will force them to abandon their established patients in violation of their legal and ethical obligations. Some states even require or suggest 30 days prior written notice before a departure so that. Employment contracts usually reinforce this notion. Many physicians believe these covenants will not be enforced; however, the courts in most states will uphold them if they are reasonable. At the same time, physicians are in high demand and have tremendous professional opportunities, ranging from starting a new practice to joining an existing one. In addition to sending letters, think carefully about how you will address this topic when you speak with patients. In this way, the provider might avoid claims of patient abandonment. However, the provider can arrange for the employer to give the notice on the providers behalf. She can be reached at laura-brockway@tmlt.org. 1) The state has enacted law regarding patient notification. 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. The KBHA serves as a great resource to physicians. 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. Is a list of patient names without information about the patients medical condition considered PHI? If you mail notification letters to every patient and half return as undeliverable, can you feel confident that you provided reasonable notification? Board Rule 540-X-9-.10 states reasonable notification must be provided. This content is owned by the AAFP. The radius is usually determined by your practices location and could range from five miles in a suburban area to 50 miles or more in a rural area. This blog is made for educational purposes and is not intended to be specific legal advice to any particular person. If you are not familiar with your states requirements, contact a health care attorney in your area for advice. Abandonment occurs when a physician withdraws his services after a physician-patient relationship has been established, by failing to give notice to the patient of the physicians intention to withdraw in sufficient time to allow the patient to obtain necessary medical care. 2. Each state treats notification guidance differently, but their approach generally falls within four distinct categories. Become your target audiences go-to resource for todays hottest topics. This letter must be sent by certified mail, return receipt requested. 2) The state offers guidelines, but without any statutory requirements or law enforcing notification practices. State advises, Complaints of patient abandonment or neglect can be avoided by giving patients sufficient notice of the practice closure. As these examples show, non-solicitation does not mean no contact. (ii) Sending an email to each patient, in a manner that is compliant with state and federal law. Each patient should receive a letter and notices should appear in local newspapers at least three times over a few months or more. Dont risk falling short on your notification message which can result in charges of abandonment. In healthcare, this tug of war can implicate another stakeholder: the patient. 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. Post the notification on the practice website. 1. (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. 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. The office should also consider changing its answering message to alert patients 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. What if a given non-solicitation provision does not restrict a providers right to notify patients of his or her departure? 9. These policies and others are discussed separately below. 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. When scheduling your departure from the practice, take reasonable steps to ensure that you are not leaving any patients in a bind. Yes. The physician fails to allow for patient access to or transfer of the patients health record as required by law. Save my name, email, and website in this browser for the next time I comment. Before leaving, she asked for a list of patients she treated while employed at URMC, and URMC provided her with a spreadsheet containing the protected health information (PHI) of 3,403 patients. 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. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.