While dismissing a problematic patient from your practice is never pleasant, things can turn downright litigious if you fail to exercise caution. If you don’t want to get sued, here are several key items you must consider before terminating a physician patient relationship at your practice.
Timing is Everything
Although there are several crucial steps to correctly ending a physician patient relationship, the timing of your decision can make a substantial difference in the outcome. Failing to account for extenuating circumstances during the dismissal process can lead to a patient abandonment lawsuit or even an ethics investigation for your provider.
Stated broadly, your practice should not “fire” a patient that requires, or is expecting to require, near-term medical care. This can disrupt the continuity of care, potentially endangering your patient’s health and consequently increasing the likelihood of a lawsuit. Typically, this applies to patients who fall under the following categories:
- Pregnant
- About to undergo surgery
- Recovering from surgery
- Receiving chemotherapy
- Acutely ill
- Uncontrolled serious medical condition
The bottom line is that your patient must be in stable condition before you consider ending the relationship.
Note: The American Medical Association (AMA) considers it an ethics violation if a doctor fails to ensure continuity of care for their patients.
Questions Before Ending
Imminent medical need isn’t the only consideration when your practice plans to terminate a physician patient relationship. Be sure that your practice also knows the answers to the following questions before making this critical decision:
- Do you offer unique care?
If your provider offers specialized care that your patients can’t access anywhere else within a 100-mile radius, you might want to reconsider terminating the physician patient relationship. It doesn’t really matter if it’s because you operate in a rural environment or the services you offer are extremely niche — in these cases, it’s probably best to keep the problem patient for now.
. - Is your patient in a protected class?
Terminating a protected class patient can significantly increase your liability. Even if it played no part in your decision. Protected classes include Race, Color, National Origin, Religion, Age, Sex and Disability (mobility, physical or sensory disability, intellectual, psychiatric, or other mental disability, HIV/AIDS, epilepsy, rheumatoid arthritis, and cancer). In these situations, the patient should be kept on unless their needs outstrip the physician’s ability to treat them. The AMA also considers this an ethical violation, and courts have consistently favored protected patients who sued for being “fired.”
. - Does your patient have a “cut-rate” insurance?
You should consider carefully before your practice terminates a physician patient relationship from these “cut-rate” As the name implies, “cut-rate” insurance compensates your practice at a lower-than-average reimbursement rate. This sets the stage for a lawsuit claiming that you “fired” the patient because of the reduced amount you get paid. In summary, making a decision to contract with “cut-rate” insurance plans not only reduces your reimbursement it can also increase your legal risk.
. - Does your managed care contract have termination requirements?
If your patient is on a managed care plan, such as Medicaid, your payer contract will likely require you to jump through a number of hoops before you can dismiss their patients (this is true for private payers, too). Be sure you know the terms of your managed care contracts and follow them to the letter before dismissing these patients.
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Alternatives to Termination physician patient relationship
You’ve determined that the physician patient relationship isn’t working, but you certainly don’t want to end up in a lawsuit. Here are several additional strategies to help you better manage the patient dismissal process:
- Internal Referral: If feasible, try keeping the patient in question within your practice by transferring them to another physician. This probably won’t win you any popularity contests with the other provider, but it could potentially solve the problem, and keep you out of a lawsuit.
. - Recommend Telemedicine. Although transitioning a challenging patient from office care to telemedicine can resolve your issues, be sure to weigh your state rules. Before making this decision, you should consult your attorney to ensure you have all of your bases covered.
Note: For additional guidance on other key elements of effectively terminating a physician patient relationship, check out two additional blog posts. The first post helps you determine reasonable notice when informing a patient that you’re ending the relationship. The second post walks you through how to write a patient termination letter that won’t land you in court.
Consider State Rules and Optics
You probably think this is a lot to juggle for just one problem patient. You’re right, it is. But you must keep the end goal of avoiding a lawsuit in mind. Here are several additional items to consider when making your final decision to terminate a physician patient relationship:
- State Rules: Requirements related to patient termination can differ considerably by state. Many categorize patient abandonment as either medical malpractice or unprofessional conduct — either of which can trigger an ethics review by your state licensing board (example cases from Arizona and Ohio). Some states have patient termination requirements codified, as in this example from Virginia. While Maine is so lax that some courts have denied patients even have the right to bring abandonment suits forward.
. - Optics: If worse comes to worst and it looks like a lawsuit is inevitable, don’t disregard another significant consideration: OPTICS. Numerous circumstances can make it look like you released the patient without concern for their care. For example, your provider leaves for a long-planned vacation the day after your patient receives a termination letter. Even if a substitute provider is made available, you must consider how this will look in a multi-million-dollar lawsuit.
For more practical strategies on the best way to compliantly terminate a physician patient relationship, check out the following online training session by Heidi Kocher, BS, MBA, JD, CHC: Fire Your Patient Without a Costly Abandonment Lawsuit. This expert-led 60-minute training is in plain English, without confusing legalese. Heidi will walk you through exactly how to avoid being accused of medical abandonment and head off the costly and stressful lawsuit that can follow. Sign-up for this must-attend online training today!!
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