Closing or Relocating a Healthcare Practice

Physician practices close for many reasons, including physician illness or death or a decision to sell, practice solo, join another group, relocate, or retire. These patient safety and risk management tips can help make the transition easier.

For assistance, members of The Doctors Company can contact a patient safety risk manager at (800) 421-2368 or by email.

Retiring members can reference our Retirement Checklist for additional guidelines and to find information about Tribute^® Plan award payments.

For requirements specific to your situation, consult with your personal or practice attorney and state licensing agency.

Notifications in Emergent Situations

Of paramount concern during any change in practice is the continuity of patient care to ensure that no patient is neglected. If the change is abrupt, as in the circumstance of a death or sudden illness, the measures below will assist in safeguarding continuity of care. Once continuity of care has been addressed, notify the individuals and entities listed in the “Notifications in Nonemergent Situations” section.

• Transfer all inpatient care to another physician immediately. Use the services of the hospital risk manager if you are unable to locate an available physician.
• Review all previously scheduled office appointments to determine the appropriate action; immediately contact a physician of the same specialty to arrange patient care or provide patients with a list of practitioners of the same specialty within the area.
• Post a notice of practice closure in the office, on the practice’s website, and in the local newspaper. (See “Notice of Practice Closure.”) Follow state regulations for specific posting requirements.
• Send a letter to active patients notifying them of the practice closure. (See “Letter to Current/Active Patients for Emergent Situations.”)
• Call all physicians who customarily refer patients to the practice, all contracted managed care organizations, and local hospitals to advise them of the practice closure.
• Ensure the availability and accessibility of office medical records as needed for the continuity of patient care.

Notifications in Nonemergent Situations

If the relocation or closure is planned (nonemergent), advise the individuals and entities listed below.

• Patients (or their legal representatives) who are active in the practice. This includes any patient seen in the past six months to one year, others the physician considers active, and any patient in an acute phase of treatment.
• Employees.
• Business and contracted associates, including affiliated hospitals, healthcare plans, and hospital referral services.
• Third-party vendors, suppliers, and utility providers.
• Third-party payers and managed care organizations. Send written notification via certified mail. Review your participation agreements for continuation-of-care obligations.
• Professional associations, including memberships in local, county, state, or national medical or specialty societies.
• CPA or financial adviser.
• Landlords, lenders, and creditors.
• Agents or brokers and insurers that cover the practice, the employees, and the physical facility.
• Community entities, including local hospitals, the post office, and banks.

Government Agency Notification

Various state and federal agencies require notice of practice closure. Send written notification to the following agencies:

• State licensing board(s).
• U.S. Drug Enforcement Administration (DEA).
• Centers for Medicare and Medicaid Services. To deactivate Medicare enrollment, follow the tutorial in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS).
• If you have a National Provider Identifier (NPI), notify the National Plan and Provider Enumeration System (NPPES). For more information, see the NPPES FAQs.

Letters and Notices

Draft a detailed letter to each patient. Stress the importance of continuing care for all patients. Provide information about where patients can locate a new physician, such as a list from their health insurer, the local medical society, or the local hospital referral line. If you are relocating, include your new address and contact information.

You can adapt the same letter for every individual and organization on the list. (See “Letter to Current/Active Patients for Nonemergent Situations.”)

We recommend sending letters by first-class mail and keeping a copy of the letter in the patient’s record. If a patient is considered high risk or is in an acute phase of treatment, consider sending the letter certified mail with return receipt requested. Keep a copy of the letter and return receipt or returned letter in the patient’s record.

Send the notice at least 60 days prior to the anticipated closure to give patients an opportunity to locate a new physician, ensure that all prescriptions are adequate to cover the intervening period, and obtain copies of their medical records.

Post a notice of closure on the practice’s website and in a local newspaper to inform inactive patients or those who have moved away. (See “Notice of Practice Closure.”)

Write a short script announcing the practice closure or relocation that your staff can use when discussing the issue with patients. Also, change your office’s voicemail message announcing the date that the practice will close or relocate, and include any new contact information. You can also include an announcement on any social media accounts.

Medical Records

The information below can help you in addressing medical records requirements:

• Make provisions for completing all medical records, especially inpatient hospital records.
• Provide patients with easy access to their medical records by enclosing a HIPAA-compliant authorization form in the notification letter you send to them. A copy of the records can be released to their new provider or the patient. (See the sample authorization form. Texas members: You can download the state-approved form provided by the Attorney General of Texas.) When the signed authorization is returned, provide the patient with copies and apply charges as permitted by state law. Do not give original records to patients.
• Provide patients with information on where their medical records will be stored in the future and the length of time (in years) that the records will be retained. Include a permanent mailing address or post office box number for future record requests.
• Arrange a secure storage place consistent with federal and state privacy laws for the original medical records that is safe from theft, vermin, fire, flood, or other weather-related disasters. (More information about medical record custodians is included below.)

Whether you are closing a practice or relocating, you must comply with state and federal laws that govern medical record retention (both paper and electronic formats). The possibility of a lawsuit after a physician has left or a practice has closed always exists. To help defend against any future claims, HIPAA-compliant medical record retention is paramount.

Some states have very specific guidelines or laws that must be followed. Where no statutory requirement exists, The Doctors Company makes the following recommendations for retaining medical records:

• Adult patients, 10 years from the date the patient was last seen.
• Minor patients, 28 years from the date of birth.
• Deceased patients, five years from the date of death.

Check any signed HMO or managed care agreements to ensure compliance with the medical records retention requirements of those agreements.

If a physician chooses to destroy clinical records after a set period of time, confidentiality must not be compromised. Use a record destruction service that guarantees records will be properly destroyed without releasing any information. Records that are destroyed should be listed on a log with the date of destruction.

When a practice closes, patients should be notified that they may designate a new provider who can receive a copy of the records. Original records should never be given to the patient.

Original medical records may be transferred to a custodian for storage. Custodians who agree to retain records can be replacement physicians, nonphysicians, or commercial storage facilities. Commercial custodial arrangements for retaining records are usually entered into for a fee, but all agreements should be in writing. A written custodial agreement should guarantee future access to the records for both the physician and patients and should include the following points:

• Fees for maintaining the records—including fees for retention and continued access to electronic records.
• The custodian will keep and maintain the medical records for the retention times specified above.
• The custodian will comply with state and federal laws governing medical record confidentiality, access, disclosure, and charges for copies of the records.
• The information contained in the medical records cannot be accessed without a signed release from the patient or a properly executed subpoena or court order.
• Copies of medical records will be released to a person designated by the patient only with the patient’s written request.
• If the custodian is another physician, the agreement addresses any future personal practice decisions (for example, retiring, selling, or moving) and makes provisions to ensure the safety of and continued access to the records by the original physician or the physician’s personal representative.
• The original physician or the physician’s personal representative will be notified of any change of the custodian’s address or phone number.
• Terms of the agreement apply to everyone in the custodian’s employment and facility.

Medical records should be inventoried prior to transfer or storage, and the physician should retain a copy of the inventory.

Medications

Any inventory of drugs must be disposed of, sold, transferred, or donated in accordance with federal and state requirements.

• Visit the DEA website to check federal requirements for disposal of unused drugs or drug samples.
• Contact your state Department of Health, Bureau of Controlled Substances, to check state requirements for disposal of unused drugs or drug samples.
• Keep records of medication disposal per federal and state requirements.
• Destroy remaining prescription pads.

Office Space and Equipment

• Evaluate the leasing terms for your office space and give appropriate notice to your landlord.
• Create a plan to sell or dispose of your medical and office equipment. Check for state requirements on the sale or disposal of any medical imaging equipment.

Legal Issues

If appropriate, you will need to take steps to dissolve your professional entity. This is usually done with the assistance of your accountant and corporate attorney.

• File the final annual report and final tax returns.
• Adopt a dissolution plan and file the appropriate certifications and/or forms with the state and federal government.