Departures from or closings of medical practicesCategories: Termination of/Reentry to Medical Practice Adopted: Jan 2000 | Amended: Mar 2018
Practitioners may have continuing obligations toward patients during and after their departure from or closing of a medical practice. A practitioner’s specific obligations will vary depending on several factors including employment or practice partnership status, contractural based obligations, practice venue, and other considerations. Nevertheless, the patient’s welfare, autonomy, and continuity of care must be the foremost consideration for all parties involved. Patients should therefore be given reasonable advance notice (at least 30 days) to allow other medical care to be secured. Good continuity of care includes preserving and providing appropriate access to medical records and may include making appropriate referrals. The practitioner(s) and other parties, such as group practices or physician employers, should work cooperatively to ensure requirements for continuity of care and patient autonomy are effectively attended to.
During these times practitioners and other parties involved must consider how their actions affect patients. In particular, practitioners and other parties have the following obligations.
It is the patient’s decision from whom to receive care. Therefore, it is the responsibility of all practitioners and other parties to ensure that:
• Patients are notified in a timely fashion of changes in the practice and given the opportunity to seek other medical care, sufficiently far in advance (at least 30 days), to allow other medical care to be secured. The Board does not have specific rules on which patients should receive this notification or how it should be accomplished, but a reasonable option would be to notify active patients the physician has seen within the past 1-2 years. Methods of notification which might be considered include newspaper notices, posting an announcement in public locations in the office, website announcements, front desk flyers, etc. Each medical practice and patient population is unique and the Board would expect practitioners to utilize the most effective means of patient notification for their particular situation.
• Patients should clearly understand they have a choice of health care providers and notice to patients of the departing physician should include an unambiguous statement that patients have a choice of from whom to receive medical care. It is unethical to withhold information upon request of a patient. If the responsibility for notifying patients falls to the departing practitioner rather than to the group or employer there should be no interference in discharge of this responsibility by withholding essential information.
• Patients should be told both how to contact practitioner(s) remaining in practice, and when specifically requested, how to contact departing practitioners.
• Patients are told how to obtain copies of or transfer their medical records and how long their medical records will be available.
The Board recommends that practitioners and practices prepare written policies regarding the secure maintenance, storage, transfer, data sharing, and retrieval of patient medical records recognizing that separate policies may be necessary for the storage of and access to paper and electronic medical records. Practitioners and practices should notify patients of these policies. At a minimum, the Board recommends that such written policies include:
• A procedure and timeline that describes how the practitioner or practice will notify each patient about (1) a pending practice closure or practitioner departure, (2) how medical records are to be accessed, and (3) how future notices of the location of the practice’s medical records will be provided.
• How long medical records will be retained and the procedure by which the practitioner or practice will dispose of unclaimed medical records.
• How the practitioner or practice will respond to requests from patients for copies of or access to their medical records.
• In the event of a practitioner’s death or incapacity, how the deceased practitioner’s executor, administrator, personal representative, or survivor will notify patients of the location of their medical records, how patients can access those records, and how and when unclaimed medical records will be destroyed after a specified period of time.
• The procedure by which the practitioner or practice will maintain medical record confidentiality and data integrity. Practice transitions are also times when there is increased risk of privacy breaches or inappropriate disclosure. HIPAA rules require that patients must be promptly informed about any security breach or unauthorized disclosure describing what information was breached, what steps patients may take to minimize adverse consequences of inappropriate disclosure of their personal health information placing the interests of patients above those of the physician, medical practice, or institution.
The Board further expects its licensees to comply with all applicable state and federal laws and regulations pertaining to a patient’s protected healthcare information.
*NOTE: The Board’s Position Statement on the Retention of Medical Records applies, even when practices close permanently due to the retirement or death of the practitioner.
Additional Resources: The Board has published a guide to closing a medical practice to assist licensees with meeting their professional obligations.