The decision to close your medical practice is often difficult and strenuous. It may be done for several reasons: retirement, other job opportunities, relocation, personal health, etc. Whatever the reason, it is important to take the proper steps to protect yourself, your practice and most importantly, your patients.
Once the decision has been made to close the practice, the first issue to be resolved will be the timing of the closure. A target date should be set that allows for adequate time for an orderly closure. The physician should review and contemplate the time to address several considerations. These include, but are not limited to: notice to patients, record retention, malpractice coverage, and notifications to government agencies.
The first consideration regarding the target date for closure should be a review of contracts and leases. This may include facility leases, employee and staffing agreements, office contracts for services, contracts with health insurance providers (or other payors), equipment leases, etc. Often these agreements are for set periods of time (annual) or have provisions regarding notices to terminate. Consideration should also be given to accounts receivable and the amount of time it takes to collect on debts. Additionally, consider any tax related issues, and payroll taxes, when choosing a target closure date. Physicians should also review their professional liability insurance and the appropriate coverage for themselves subsequent to the closing of the practice (i.e. tail coverage).
After the review of these matters, decisions will have to be made regarding medical record retention. The medical records must be maintained and secured. They must remain retrievable and available to patients even after the closure of the practice. Missouri law requires that the medical records be maintained for at least seven years from the date of last professional services. The records for a minor child must be maintained for seven years after the last professional services were provided, or at a very minimum of two years after the child reaches the age of majority, whichever is longer. The physician may decide to maintain the records themselves, in which case they will need to arrange for storage and procedures for contact and retrieval by patients. The physician could make arrangements with another qualified healthcare provider (hospital or physician) to retain the records and provide access to patients. Alternatively, the physician could elect to use a qualified record custodian provider. When transferring the record retention duties to another practice, hospital or records custodian, a written contract should be entered by the physician designating the duties and terms of the custodianship.
Following the decision on medical record retention, physicians should then notify staff about the intended closure. A plan should be developed to provide for coherent communication with patients, other health care professionals, and business associates regarding the closure.
Of utmost importance is the notification of patients regarding the anticipated closing. Physicians should provide both oral and written notice to patients. Notices can be posted in the office, on the office website, other social media sites, patient portal, and on any other communications provided to patients. Staff and the physician should also be communicating reminders of the upcoming closure with patients during any encounter to discuss any anticipated issues the patient may have with the closure. Any such discussions by the physician should be documented in the records. Patients who are at higher risk should be encouraged to reach out and discuss the transition process.
Within sixty to ninety days of the practice closure, a notice should be sent to all active patients at their last known address. With the patients’ consent, the notice may also be sent via email and placed in the patient portal if there is a communication capability. The notice must provide the date of closure and contact information. It should advise the patient to contact the practice to discuss questions or concerns regarding the closure. The notice should explain the process to obtain or transfer medical records both before and after the practice closure. This includes the need for HIPAA compliant releases, and resources for patients to identify new healthcare providers with whom to establish care. The notice should encourage patients to establish care with a new provider in a timely manner. It should explain, where appropriate, the reasons for the closure. Patients should also be provided with adequate prescription refills (when clinically appropriate) to allow transition to a new provider. A copy of all notices sent to patients should be maintained in the patient records.
In addition to the written notice, the physician or staff member should thoroughly review medical records prior to closure. Confirm that all test results, labs and imaging have been relayed to patients and documented. Additionally, confirm that prescription refills have been properly delivered to the pharmacy. Also make certain that there are not any outstanding medical issues that need to be addressed.
If permanently retiring from the practice, the physician should notify state and federal agencies, and licensing boards. These may include the DEA, Medicare, Medicaid, and the Missouri Board of Healing Arts. Pursuant to Missouri statute 334.110 notice of license retirement should be provided by way of affidavit, which can be found on the Board’s website. Notice of inactive status can also be provided.
Taking the proper steps in closing a practice can reduce the potential risk to the physician and protect the practice’s patients, allowing for easier transition.
