terminating the physician-patient relationship, part 2

WHAT EVERY PHYSICIAN NEEDS TO KNOW:

TERMINATING THE PHYSICIAN-PATIENT RELATIONSHIP

PART 2

1 THE PROCESS

• Riskmanagersrecommendthatphysiciansdevelopastandardizedprocessfordismissingpatients.

• Priortoterminationoftherelationship,physiciansshouldevaluatethecasetoensurethatthepatientisnotinanacutephaseofcare,willbegivenappropriatenotice,andhastheopportunitytofindanotherphysician.

1 THE PROCESS

• Itisimportanttorememberthatthisprocessmustbetailoredtotheneedsoftheindividualpatient.Onepolicymaynotfitallwhenitcomestoendingarelationshipwithapatient.

2 PROCEED WITH CAUTION

• Befamiliarwiththetermsofthepatient’sinsuranceprovidercontractsbeforestartingthedismissalprocess.Someprovidercontracts–Medicare,Medicaid,andprivatehealthinsuranceplans–maystipulatethatthephysicianmustacceptcertainpatientsandspecifythestepsthephysicianmustfollowinordertoterminateapatient.

2 PROCEED WITH CAUTION

• Ifaphysicianisconsideringdismissingapatientwhoisinaprotectedclassorisdisabled,heorshemaywanttoconsultanattorneytoassesstheliabilityrisk.

• Counselingthepatientmayimprovenon-compliantordisruptivebehavior.

• Havetheconversationmorethanoncewiththepatientanddocumentitinthemedicalrecord.

• Letthepatientknowyoumayhavetoterminatetherelationshipifheorshedoesnotcomply.Directstatementscanbeeyeopeningforsomepatients.

3 COUNSELING

• Physiciansareencouragedtooffercounselingandpaymentplanstopatientsbeforedismissalfornonpayment.

• Theseeffortsshouldbedocumentedinthebillingportionofthepatient’srecord.

4 NONPAYMENT

4 NONPAYMENT

• Ifeffortstocollectareunsuccessful,practicesmaywishtosendawarningletterthatexplainsfailuretopaymayresultinterminationofthepatient-physicianrelationship.

• Beawarethepatient’smedicalrecordcannotbewithheldfromanotherphysicianorfromthepatientbecauseofanoverdueaccountbalance.

5 DISMISSAL LETTER

• Ifthecounselingprocessisnoteffectiveandthephysiciandecidestoterminatethepatient,thenextstepistosendadismissalletter.

• Thelettershouldbeprintedonofficeletterheadandsentbyfirst-classmailandbycertifiedmailwithareturnreceiptrequested.

• Keepacopyofthedismissalletterandthereturnreceiptinthepatient’smedicalrecord.

• Statethatthephysician-patientrelationshipwillterminateinaspecifiedtimeperiodandrecommendthatthepatientfindanotherphysician.Thetimelimitgivenwilldependonseveralfactors,suchasphysicianspecialty,sizeofcommunity,andavailabilityofotherphysicians.Thepatientshouldbegivenareasonableamountoftimetofindanewphysician.Thecurrentphysicianshouldremainavailableforcareuntilthespecifiedtimeperiodelapses.

6 WRITING THE DISMISSAL LETTER

• Thephysicianisnotrequiredtostateareasonforthetermination.Usually,riskmanagersadviseagainstincludingareason.Anypotentiallyinflammatoryremarksshouldbeleftoutoftheletter.Whilecomposingtheletter,physiciansmaywanttoconsiderwhethertheywouldbecomfortablewiththewordingifitwerelaterreviewedbyastatemedicalboard,anattorney,orjury.

6 WRITING THE DISMISSAL LETTER

• Describeingeneraltermshowthepatientcanlocateanewphysician.Itisnotadvisabletonameaspecificphysician,clinic,orgroup.Referthepatienttohisorherhealthinsurancecompany’slistofproviders,countymedicalsociety,oraphysician-referralservice.

6 WRITING THE DISMISSAL LETTER

6 WRITING THE DISMISSAL LETTER

• Includeanauthorizationforthereleaseofthemedicalrecord.Advisethepatienttodesignatethenewphysician,signtheform,andsendittoyourofficepromptly.Indicateintheletterthattherecordwillbecopiedandforwardedtothephysicianassoonaspossible.Sinceyouareendingtherelationshipwiththepatient,youmaychoosetoforegocopyingchargesforthemedicalrecord.

7 IMPORTANT NOTES

• Afinalstepintheterminationprocessthatcanbeoverlooked–informstaff,especiallytheappointmentscheduler,aboutthedismissalandeffectiveterminationdate.

• Ifphysiciansarepartofagrouppractice,considerformallyterminatingthepatientfromthegroup–notjustonephysician.Ifotherphysiciansinthegroupwouldprefernottoseethepatient,theterminationlettershouldclearlystatethattherelationshipwithboththephysicianandgroupareending.

7 IMPORTANT NOTES

• Ifapatientverballyendsarelationshipandthephysicianiscertainofthepatients’intent,formalwrittenconfirmationisrecommended.

• Ifatransferofcareisarranged,thephysicianshoulddocumentthenameofthephysician,thattherecordsweresent,and(ifpossible)thatthepatienthasanappointmentwiththenewphysician.

7• Remember,thoroughdocumentationofallactionsandconversationsisyourbestdefenseagainstallegationsofpatientabandonment.

IMPORTANT NOTES

8 PROTECTION FOR A NEW ERA OF

MEDICINEABOUT TMLT:Withmorethan19,000healthcareprofessionalsinitscare,TexasMedicalLiabilityTrust(TMLT)providesmalpracticeinsuranceandrelatedproductstophysicians.Ourpurposeistomakeapositiveimpactonthequalityofhealthcareforpatientsbyeducating,protecting,anddefendingphysicians.www.tmlt.org

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