2.1.2: Departures from or Closings of Medical Practices

Licensees may have continuing obligations toward patients during and after their departure from or closing of a medical practice. A licensee’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 licensee and the group or employer should work cooperatively to ensure requirements for continuity of care and patient autonomy are effectively attended to. In particular, both the departing licensees and any relevant practice group or employer have the following obligations.

Permit Patient Choice:

It is the patient’s decision from whom to receive care. Therefore, it is the responsibility of all 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 licensee has seen within the past 1-2 years. Methods of notification which might be considered include, letters to patients, 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 the licensee and the group or employer to utilize the most effective means of patient notification for their particular situation.
• Patients clearly understand they have a choice of health care providers and notice to patients of the departing licensee should include an unambiguous statement that patients may choose from whom to receive medical care. It is unethical to take any actions such as withholding information regarding the new practice location of the licensee when requested by a patient. Both the licensee and any relevant practice group or employer are responsible for notifying patients, and no party should interfere in the discharge of this obligation by withholding essential information.
• Patients are told both how to contact licensee(s) remaining in practice, and when specifically requested, how to contact departing licensees.
• Patients are told how to obtain copies of, or transfer, their medical records.

Written Policies:

The Board recommends that licensees and practices prepare written policies regarding the secure maintenance, storage, transfer, data sharing, and retrieval of patient medical records in case of the closure of a practice, recognizing that separate policies may be necessary for the storage of, and access to, paper and electronic medical records. Licensees 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 licensee or practice will notify each patient about (1) a pending practice closure or licensee 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 licensee or practice will dispose of unclaimed medical records.
• How the licensee or practice will respond to requests from patients for copies of or access to their medical records.
• In the event of a licensee’s death or incapacity, how the deceased licensee’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 licensee 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 and other privacy rules require that patients must be promptly informed about any security breach or unauthorized disclosure describing what information was breached, and what steps patients may take to minimize adverse consequences of inappropriate disclosure of their personal health information.

The Board further expects licensees to comply with all applicable state and federal laws and regulations pertaining to a patient’s protected healthcare information.

Additional Resources: The Board has published “A Physicians Guide to Closing a Practice” to assist licensees with meeting professional obligations.