One of the most common inquiries I receive from physician clients is how to properly terminate a patient relationship. Perhaps it's a patient who refuses to honor payment terms or repeatedly cancels with little or no notice. Maybe it's a patient who refuses to follow through on a treatment plan. Most recently, the questions I receive are about terminating belligerent patients who are unacceptably rude or aggressive with physicians or practice staff.
A physician can generally terminate a patient as long as it is not for an illegal reason, such as discrimination, and as long as it is done in a proper and thoughtful manner. Patients cannot be medically "abandoned," and this is the key concern to be mindful of when planning a termination strategy.
First, every practice should have a policy in place of documenting issues with a patient in the medical record. Though some events may be significant enough to lead to an immediate termination, most patient concerns will involve a pattern of conduct that should be tracked. The practice should always investigate the patient issue thoroughly and try to find workable solutions before initiating a termination, such as whether there are undisclosed financial issues or other reasons for the patient's conduct.
Patients should also, when possible, be provided with a written notice related to the practice's concerns and the opportunity to correct the issues when reasonably correctable. Patients who do not comply with a plan of treatment, for example, may be the type of patient that will respond to a letter. Even patients who have been rude or uncooperative during practice visits can correct their conduct when called out on it specifically by their physician.
The practice should provide the patient with a written notice of the intent to terminate patient care and the last date on which care will be provided. The patient letter should clarify that the patient will be provided with at least 30 days' of care during which they should find another physician. This notice period may need to be longer depending on the patient's medical condition and the ease with which a replacement physician can be located in the geographical area.
Also, be mindful of state-specific laws regarding minimum-notice periods. This can be obtained by physicians from their counsel, local medical societies, and often, the malpractice carrier will provide guidance as well. In addition to the notice period, I always have my clients clarify in the patient termination letter that the practice will offer care during the notice period if needed, and will assist the patient in locating a new provider. This can include names of specific local practices or simply a referral to the state medical society's physician referral program.
A patient termination letter does not necessarily need to detail all the reasons why the patient is being terminated. In general, a statement that the practice believes it is the parties' best interest to terminate will suffice. If a prior letter has already been sent to the patient, they will already know the reason for termination. To the extent a patient insists on specific details, the physician can address this on a case-by-case basis, supported by adequate documentation.
Remember at all times that discussion of the patient and related issues must comply with HIPAA. This means the practice should not respond to possible patient posts on social media related to the patient's termination from the practice. When in doubt, or if contacted by the patient's lawyer, make sure you reach out to legal counsel.
For patients being terminated because of improper conduct, there can be a fear of how the patient will react if terminated. In such cases, I will often recommend that counsel send the letter in order to redirect any inquiries or issues away from the practice. This is usually successful and without incident because patients are embarrassed to receive a termination letter.
Despite this, doctors often fear terminating a patient no matter how badly they behave, which can allow such bad behavior to intensify. I recently had a patient who assaulted my client while he was examining her, with witnesses present. It was not the first time she had behaved badly in the practice. A police report was filed but the client continued to render care, despite my recommendations to terminate the patient from the practice. As expected, the patient's behavior escalated and only when my personal involvement eventually diffused the situation did it lead to the patient's removal from the practice.
A prompt termination of this type of patient should never be delayed by a practice because it is the best approach to protect staff and physicians. Physicians who may be concerned that the patient's conduct is related to mental health, addiction or other medical concerns can work with counsel to develop a specific termination plan.
It is never easy to decide to terminate a patient. It goes against everything physicians have been taught about caring for those who seek their care. However, operating a medical practice is a business and hard decisions sometimes must be made in order to protect a practice and its staff.
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She also works with providers in HIPAA, fraud and abuse, billing audits, government investigations, and contract disputes.
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Cite this: Ericka L. Adler. Ending a Patient Relationship Is Okay if Done Properly - Medscape - Jun 14, 2022.