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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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