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Patient Safety Information for Closing a Practice

Physician practices undergo closure for many reasons, including physician illness, death, relocation, or the physician’s decision to sell, practice solo, join another group, or retire. As a service to our members, the Patient Safety Department of The Doctors Company provides this packet of information to make the transition easier. As always, we are ready to serve you. Please call us at (800) 421-2368, extension 1243, if we can assist you.

What should be done in an emergent situation?

Of paramount concern during any change in practice is the continuity of patient care to ensure that no patient is neglected. If the change is abrupt, as in the circumstance of a death, the safety measures below will assist in ensuring patient safety and continuity of care.

Review all previously scheduled appointments to determine the appropriate action: Immediately contact a physician of the same specialty to arrange patient care, or provide patients with a list of practitioners of the same specialty within the area. You should also take the following steps:

  • Transfer all inpatient care to another physician immediately. Use the services of the hospital risk manager if you are unable to locate an available physician.
  • Ensure the availability and accessibility of office medical records as needed for the continuity of patient care.
  • Post a notice of closure in the office and in the local newspaper. (Contact your patient safety/risk manager for a sample notice.)
  • Call all physicians who customarily refer patients to the practice and all contracted managed care organizations, local hospitals, and the medical malpractice carrier.

Who should be notified if it is a nonemergent closure?

If the practice closure is nonemergent, notify the following individuals and entities:

  • All patients and legal representatives in the “active” caseload. This includes any patient seen in the past six months to three years or others the physician considers “active” and any patient in an acute phase of treatment.
  • All peer physicians within the community.
  • Local hospitals and medical societies.
  • All third-party payers (to include Medicare and Medicaid) and managed care organizations.
  • The DEA (if you are retiring or if you are moving to another state).
  • The state licensing board.
  • Professional associations in which you hold membership.
  • Your CPA or financial adviser.
  • Your employees.
  • Landlords, lenders, and creditors.
  • Insurers that cover the practice, the employees, and the physical facility.

How should the notice be communicated?

Draft a letter to each patient that contains all of the necessary details. The same letter can be used for everyone listed above. (Contact your patient safety/risk manager for a sample letter.) It is recommended, if possible, that letters be sent by first class mail and that a copy of the letter with the return receipt be kept. If a patient is considered high risk, consider sending the letter certified with return receipt requested. Post a notice in a local newspaper to inform inactive patients or those who have moved away. Include directions for obtaining acute, critical, or emergency care if a new physician has not been selected by the time the practice closes.

Is there a time limit for sending the closure notice?

Yes. In a nonemergent situation, send the notice at least 60 days prior to the anticipated closure. This gives patients an opportunity to locate a new physician and to obtain copies of their medical records without undue stress.

What other responsibilities should be undertaken by the practice that is closing?

  • Provide patients with easy access to their medical records by enclosing an authorization document in the notification letter you send to them. (Contact your patient safety/risk manager for samples.) When the signed authorization is returned, you can provide copies and apply appropriate charges.
  • Provide information on where the medical records will be stored in the future, the length of time (in years) that the records will be retained, and a permanent mailing address or post office box number for all future record requests. Arrange a secure storage place for the original medical records that is safe from theft, fire, flood, or other weather-related disasters.
  • Maintain the medical records in accordance with The Doctors Company’s recommendations: 10 years after the last adult visit and 28 years from birth for pediatric patients. The records should be easily accessible and retrievable.
  • DO NOT give original records to patients. The easiest method is to find another physician to take over the practice and turn the records over to that provider or turn the records over to another practitioner of the same specialty.
  • Stress the importance of continuing care for all patients. Provide information as to where they can find another physician, such as the yellow pages, the local medical society, and the local hospital referral line.
  • Make provisions for the completion of all medical records, especially inpatient hospital records.
  • Place a notice of closure in your waiting room and in the local newspaper for at least one month, giving pertinent details of the closure.
  • Consult with your personal or practice attorney and the state licensing agency to ensure that you have met all regulations.
  • Destroy remaining prescription pads.
  • Keep the narcotics ledger for a minimum of two years.
  • Dispose of drugs.

 

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

J7254A 2/09


FIRST IN PATIENT SAFETY   |    www.thedoctors.com/patientsafety

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