How to terminate the practice/patient relationship

Once a patient-provider relationship is formed, the provider has a duty to the patient to be involved in the patient’s care. However, sometimes this relationship just doesn’t work, and it is, therefore, in the best interest of both parties to terminate it. Example situations of when terminating the patient from the practice may be the best option:

• Abusive behavior toward staff or doctors
• Non-compliance with the treatment plan
• Failure to keep appointments
• Nonpayment of fees owed.

Here, I provide related caveats and steps to effective termination.

CAVEATS FOR TERMINATION

For optom patient cannot be dismissed if he falls within a protected class under federal or state statutes. Specifically, a patient cannot be terminated due to age, sex, race, color, national origin, religion, veteran status, citizenship or disability.

Providers can be sued for patient abandonment if the dismissal occurs during ongoing treatment, leaves the patient without effective care and causes the patient harm. As a result, if the patient is being treated for an active infection, it may be wise to wait to dismiss him until after the infection is resolved.

STEPS TO EFFECTIVE TERMINATION

For optometrists to safeguard from potential claims of discrimination and patient abandonment:

1. Have an office policy detailing potential reasons for termination, including the process of how it will be done, and educate patients on it. I think the doctor should educate patients about this policy via new patient paperwork. It should be explained so as not to come across too harsh.
2. Educate staff on the importance of documenting any behaviors not in compliance with practice policies.
3. Check managed care contracts for any specific related requirements prior to dismissing the patient.
4. Document the reason for termination in the patient’s record. (If the termination is challenged, the O.D.’s reason and staff’s documentation will be helpful in providing protection from litigation.)
5. Send a written notice to the patient by certified mail. First, it should contain a brief reason for the termination and a list of providers within a reasonable geographic area who can provide services to the patient.
   Second, the notice should state that a copy of the patient’s medical records will be sent to the new provider once authorized by the patient. (Make sure everything is documented appropriately in the chart with copies of all documentation.)
   Third, the notice should have an effective date for termination. In most circumstances, a 30-day notice is adequate, but state law may require a longer notice period. If the patient has threatened the provider or practice staff with violence, immediate termination is appropriate. Finally, store the return receipt from the mailed notice in the patient’s record.

ONE MORE THING

The patient’s chart should be flagged, alerting staff of the patient’s dismissal. Multiple-location practices should make clear to the patient that his termination is from all locations, not just one. My practice missed this several years ago, and a patient terminated from one location showed up at our other location and received care. OM

DR. GILBERT-SPEAR is the founder and director of The Visual Performance Center and is a consultant and speaker with various eye care companies. She recently obtained her juris doctorate degree from the Mitchell Hamline School of Law, with a concentration in Health Law and Compliance.