Both you and the patients are free to choose whether you have a relationship or not. In most cases, you are completely within your right to decline to take on a patient if you don’t feel it’s not a good fit. However, if you accept someone as a patient, and later decide that it isn’t a good fit, it is extremely important that you correctly terminate the relationship. Patient Termination Letter.
Deciding to end your physician-patient relationship can be fraught with emotional baggage for both your practice and patients. That’s why it’s so important that the letter you send to notify the patient of the termination be as business-like and non-confrontational as possible. An antagonistic or accusatory tone within your patient termination letter will only heighten the risk of an ethics investigation or a patient lawsuit – neither of which you want.
Before You Notify Your Patient Patient Termination Letter
Crafting an effective patient termination letter doesn’t have to be complicated, but before you begin there are several important items that you should consider to ensure the process goes off without a hitch.
- Check State-Specific Requirements:
Before you share your issues to your patient, make sure you have a solid understanding of your state’s requirements regarding terminating a physician-patient relationship. Unfortunately, as with many issues you face each day, requirements differ between states. In some states, patient abandonment can equal medical malpractice (i.e., CA, DC, DE, MO, NY, OH, TX, etc.). They can also differ within the same state related to government programs (i.e., Medicaid vs other plans). For example, Colorado mandates that patients on its Medicaid program can only be terminated for cause and must receive 45-days’ notice – as opposed to the typical 30-days’ notice required in most states.
Note: If you have trouble locating your state’s requirements, try contacting your state’s medical society for recommendations. Also, check out the following article for more help on the subject.
- Give the Patient Time to Change:
Remember, sending a patient termination letter should be a measure of last resort. Before sending a notification that you are ending the relationship, give the patient multiple chances to correct the issue. Provide the patient a clear outline of your concerns, and a process by which they can fix the issue(s). It is also important to give a clear measurable process for determining if the relationship will continue or not. For example, if you are ending the relationship because of too many no-shows, when you notify the patient of the issue you should clearly explain that additional no-shows cannot be tolerated, and if they occur, you’ll have no choice but to terminate your relationship. - Document Everything:
As with everything in your practice, if it isn’t documented, it didn’t happen. It is important to document every interaction with the patient, no matter how seemingly insignificant. This is especially true when vocalizing your relationship concerns before you even consider sending a patient termination letter. Every phone call, email and in-person interaction should go in the patient’s file to avoid the dreaded he said/she said scenario should that patient turn litigious. Be very specific about what you communicated and their response. - Look for Extenuating Circumstances:
Patient abandonment allegations often hinge on timing. If the patient is in a critical stage of care for a serious medical condition, is pregnant or recovering from surgery, it’s often best just to grit your teeth and wait for a more appropriate time to sever the relationship. - Notifying Your Patient:
Simply telling a patient to find another provider doesn’t cut it. You must send a formal patient termination letter spelling out the specific terms of his or her transition to another practice. Send it via certified mail with return receipt requested and save the receipt. - Notifying Your Staff:
Once you send a patient termination letter, it’s important to notify your staff of the patient’s impending departure. This way everyone is on the same page. So, if your patient calls your staff will know how to respond.
Crafting an Effective Termination Letter
You’ve researched your state requirements regarding terminating a patient relationship, verbally spoken to your patient about the problems, given them time to change their behavior, and documented each conversation/interaction during the process, but nothing has changed. So, you are ready to end the relationship and send them a formal patient termination letter.
Here are several important elements you should include in your patient termination letter to avoid futures problems.
- Give a Reason: Not every state requires you to specify why you’re terminating the physician-patient relationship, but enough do that its worth including as a precaution. Common reasons cited are the:
- Patient’s failure to follow medical advice
- Patient neglecting to show for scheduled appointments
- Patient behaving inappropriately toward staff
- Physician is retiring or moving his practice
- Patient’s failure to pay for care
Remember to keep your comments concise and unemotional when writing your patient termination letter. Adding emotion into the mix at this point will significantly increase your chances of a patient abandonment lawsuit.
- Interim Care Provisions: Clearly state that your practice will continue providing medical services until the end-of-care date. It is important the patient doesn’t feel like you are kicking them out. Terminating a patient from your practice is a process, and this should be made clear in your patient termination letter. There could be situations that you believe justify only having the patient contact your practice during the interim care period if it’s an emergency. However, before you do so, it is extremely important that you determine your state’s requirements regarding interim care.
- Remind Them to Take Their Meds: If the patient has a condition that warrants medication, remind them not to let their drug regimen lapse during the process of finding a new provider, or once they leave your care. Even though you are ending the relationship, it is important that the patient still feel like you care about their medical health (which you do).
- End-of-Care Date: Specify a cut-off date for care in your patient termination letter. Most states require 30 days after the letter was issued, but state-specific and extenuating circumstances might come into play that merit giving the patient more time. For example, if your practice is highly specialized and/or located in a rural area where a suitable alternative is hard to find to may take more time for your patient to find similar care somewhere else.
- Referrals: To assist your patient with transitioning to a new practice, include a list of available resources in your patient termination letter (i.e., public health programs, local medical societies, regional hospitals, etc.). You can also encourage the patient to contact their insurance provider for a list of recommendations. Generally, it is not a good idea to refer a patient you are terminating to a specific practice or physician. If it doesn’t work out, you’ll have both the patient and the new practice angry with you.
- Transfer Records/Information: Be sure to make it clear in your patient termination letter of your willingness to send the patient’s records to a physician at their request. Include a record transfer authorization form, directions on how to complete the form, and clear instructions of how to send the form to you. You may want to consider waiving any normal fees you might charge for copying or transferring records, as well. It can also be helpful to offer to confer with the new provider to ensure a continuity of care. Finally, it is incredibly important that you NOT hold records for unpaid balances. What the patient owes should have nothing to do with this process.
Sometimes it is easier to write your patient termination letter if you have a sample document to work from. To ensure your letter has state-specific requirements included, try contacting your state’s medical board or medical association. In many cases they have sample letters that have been already reviewed by an attorney and encompass your state rules.
As you can see, severing a physician-patient relationship is complicated business, and writing a compliant, effective termination letter is just one component of the process. Healthcare attorney and educator, Heidi Kocher, BS, MBA, JD, CHC, presents a 60-minute online training that walks you through exactly how to protect your practice when termination a physician-patient relationship. In her online training session, Fire Your Patient Without a Costly Abandonment Lawsuit, Heidi will teach you how to avoid discrimination charges from protected patient classes, preventing non-compliant patients from landing you in court and mitigating conflict of interest concerns. Sign up for this valuable training today!
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