Practice Management Alert

Mentioning the reason for dismissal may not be best

To protect your practice from further losses, you need to know how to dismiss patients who chronically fail to pay their bills and continue to break the terms of mutually agreed upon payment arrangements.
 
A physician-patient relationship is an "at will" relationship that does not revolve around money, says Elliot Oppenheim, MD, JD, LLM Health Law, CEO and president of coMEDco Inc. in Santa Fe, N.M. This means that your physician is free to terminate her relationship with any patient as she sees fit, regardless of the reason or if the patient has paid his bills - although failure to pay bills is certainly a valid reason for dismissal.
 
Make sure your patient dismissal letter keeps you legally safe by including the following items:

Offer to continue care for 30 days after the date of the dismissal letter. Typically, 30 days is the amount of time providers offer, Oppenheim says. "You cannot immediately withdraw from a physician-patient relationship when that withdrawal will injure the patient" or compromise his condition, he says. And even if withdrawal won't injure the patient, continuing care for 30 days is important so the patient can't accuse you of patient abandonment.

Provide referrals to other physicians who may continue the patient's care - and offer to forward copies of the patient's medical record. There is a duty to do this if your physician has an existing relationship with the patient, Oppenheim says. If treatment has concluded and you haven't seen the patient for a long time, however, you can simply dismiss the patient without offering referrals.

Don't include a reason for dismissal. You shouldn't list a reason for terminating your relationship with the patient, because "the patient may vigorously disagree," Oppenheim says. For example, the patient may have thought he was doing fine paying his bills, even though he had only paid 10 percent of the total balance over the course of several years. Remember that any documents you provide to the patient can be used against you later, so play it safe by omitting a dismissal reason that may cause disagreement.
 
Exception: There is no legal requirement to provide a reason for dismissal in the fee-for-service arena. However, the story changes if your physician belongs to an HMO. Your physician can transfer the patient to another provider within the plan. However, if there isn't another provider available, "the doctor can't legally terminate the patient from the plan," Oppenheim says.

Letter template: Use the letter template below - provided by Wayne Miller, attorney with Compliance Law Group in Woodland Hills, Calif. - to guide you when faced with dismissing a patient.

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Dear [patient name]:

This letter is to inform you that I am withdrawing myself from your medical care XX days after the date of this letter.

Your condition requires continuous medical attention, and you need to be under the care of another physician as soon as possible [optional statement - use only if patient is now under treatment]. Should you have trouble finding another physician, we can provide you with the following physician referrals: [physician names here]. You may also contact the local medical association at XXX-XXXX for additional physician referrals.

I will continue to provide you with the needed medical care for the next XX days, unless you find another physician. As soon as you choose a new physician for your care, please obtain an authorization form from the new doctor, and we will
forward a copy of your medical record to his office.

Thank you,

[Physician name]

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Important note: The rules regarding withdrawal from a physician-patient relationship are state-specific, so some states may require other text not included in this letter, Miller says. Consulting with local legal counsel is the best way to ensure your dismissal letter is foolproof.