Signing Off and Signing Out

Whether signing out to a colleague for the weekend or permanently closing a practice, there are a number of matters to be considered.

Patient Notification

Primary responsibilities for most practice changes focus on good communication with patients. Patients should be told what the changes will be, when they will occur, and how these changes will affect their continued medical care. Keeping your patients informed will avoid claims of abandonment.

If the change in practice entails temporary coverage by another physician, be sure that the patient is provided with the covering physician’s name, phone number, and the duration of the substitute health care provision.

When the change is permanent, a more formal process is necessary. A notice about closing your office should include at least these elements:

• Importance of continuing medical care
• Information about acquiring a copy of the medical record
• Date of final closure
• Method(s) for referrals (usually the local medical society)

Medical Record Management

Short-term medical care transfer might include a brief oral update to the covering doctor about what to expect with current and acute patients. Office records should be made available if necessary. Hospital-based patient records should have documentation of the change, usually on the physician order form.

It is wise to provide a method for documenting patient phone calls to the covering physician that can easily and quickly be added to the patient’s medical record. Any patient encounter should be documented as is customary. Unless the matter is emergent, release of medical record information should be delayed until the temporary coverage ends. Long-term changes require a process for the safety and security of the medical records while providing ready access.

Change Options

When seeking temporary coverage, try to seek a physician who shares your specialty. If the specialty is either surgical or obstetrical, a backup cover may be advisable in the event that your primary physician is actively involved with another patient. It is also a good idea to seek a physician with privileges at the same hospital. When selling or closing a practice, similar guidelines are prudent. If the doctor buying the practice shares your specialty and privileges at the same hospital, it will help ensure your patients’ continuity of care.

Little Things Mean a Lot

An overlap of physician coverage is one of those little things that means a lot to patients. If at all possible, introduce your acute or active patient population to the new physician; it will make a great deal of difference to your patients. A pre-established process for billing is another little thing that means a great deal. Determine who will be responsible for billing patients thus avoiding double billing.

Remember to notify other practice associates of your impending absence. Provide dates of departure and return to applicable office staff, referring practitioners, answering service, local hospital, clinics, nursing homes, etc.

On returning from a temporary change, take the time to establish whatever may have transpired in your absence. Check with the covering physician for patient contacts. Review documentation in medical records to avoid failure to follow patient care issues. Listen to feedback from those who worked with the covering physician for the success or failure of the temporary change. Remember that all of the above may be applied in reverse when you are the covering physician.

Notifying The Doctors Company

Anytime a practice closes permanently, it is necessary to notify The Doctors Company Underwriting Department. This will ensure that past and future claim coverage will be addressed. A packet of informative materials on closing your practice is available by calling The Doctors Company Patient Safety and Loss Prevention Department.

Help is a phone call away. Please direct patient safety and loss prevention questions to the regional risk manager in your area or call us at (800) 421-2368, extension 1243, in The Doctors Company’s home office.

J4232 5/05