Terminate a Patient the Right Way

It is unfortunate for a physician or a medical practice to be faced with the decision to terminate a patient relationship. Patients have a number of responsibilities to the medical office including active participation in their treatment plan, timely resolution of their financial obligation and respectful interaction with all staff. Even though it is unpleasant, providers have to protect themselves and their organization from patients that refuse to follow the rules. It may seem to be a bit dramatic, but it is well within your legal rights to terminate a patient in certain circumstances without being accused of patient abandonment. A provider may terminate the doctor-patient relationship in the event that:

  • The patient fails to follow a course of treatment prescribed by the physician.
  • The patient repeatedly misses appointments, cancels at the last minute, or fails to show up at all. No shows not only throw off the schedule but also affects the financial goals of the medical office. When a patient fails to show up or cancels an appointment at the last minute, this results in lost revenue for the medical office.
  • The patient fails to pay any past due balances or make appropriate payment arrangements. Payment arrangements should be a part of the financial policy but many office managers may elect to set up patient payment arrangements on a case by case basis.
  • The patient is disrespectful or rude to the physician and/or the staff.

While it is important that all efforts to resolve any issues with the patient prior to terminating the patient relationship, once the decision to terminate has been made, there is a right way to do it.

1
Establish a Policy

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Have a written policy in place in the event that it would be necessary to terminate a patient relationship. This should be included in the policy and procedure manual in the first visit handouts that are given to every new patient. A written policy should have clear and concise reasons for terminating and the guidelines that will be followed.

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2
Provide an Opportunity for Corrective Action

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Before issuing any patient their walking papers, it wouldn't hurt to provide them with the opportunity to correct their actions. For those that miss appointments, they would be more likely to make the appointment if the office would stay open until 7 pm one day a week or could schedule a Saturday appointment. Maybe the patient that lost a job three months ago has found a new one and plans on paying his past due bills once he catches up on his home mortgage.

There may be many reasons that a patient isn't following the rules but just talking to them can make a big difference.

3
Provide a Written Notice

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If the patient fails to make sufficient efforts to correct their behavior within a specified time frame, it will become necessary to proceed by sending the patient a written notice of termination. Best practices recommend that this notice is sent certified mail with a return receipt.

Make sure the letter gives a brief description detailing the reasons for terminating.

4
Continue Providing Treatment for a Reasonable Time

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Once a written notice is sent to a patient, it is necessary to continue providing treatment to the patient for a reasonable time so they can find another provider. A reasonable amount of time is considered to be 30 days, but considerations can be made to extend the time frame if the patient requires critical or emergency treatment.

5
Assist the Patient in Transferring

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Offer to assist the patient in finding another physician by suggesting other physicians in the area of the same specialty. Also, have the patient authorization to have their medical records transferred to their new practice by signing a release of information.

Note: Make sure all information is provided to the patient's relatives or responsible party.

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