Dismissing, or “firing,” patients from your practice is a difficult but oftentimes necessary decision that providers have to make. Make sure your practice follows these steps to ensure legal compliance and avoid patient abandonment.
Do determine if you will dismiss the patient as a group
If you’re in a group practice, decide if you’re dismissing the patient from the physician or from the entire practice. If you’re a part of an integrated delivery system (IDS), this may mean dismissing the patients from all specialists and practice sites.
Don’t discharge a patient without warning
Counsel the patient on his or her behavior (not paying his or her balance, several no-show appointments, harassment of providers and staff, habitual non-compliance, etc.) and let him/her know that if the behavior continues, he or she may be asked to leave the practice permanently. Some practices offer a three strikes rule before dismissal, which is especially effective for appointment no-shows.
However, there may be a situation where a patient is dismissed from the practice after a single incident that damages the provider-patient relationship, such as physical or sexual abuse, theft or other criminal activity.
Do develop a dismissal letter
Patients should be notified of their dismissal in writing with a clear explanation of the reasoning and the timeline for dismissal.
The letter should include:
• A recommendation of continued care — “I encourage you to contact a new physician as soon as possible” — and ways to find a new provider through their insurance company or a medical society
• An offer for emergency care within 30 days of dismissal while the patient finds another physician
• An authorization to release the patient’s medical records
It’s also a good idea to send a copy of the letter to the patient’s insurance company.
Do send the letter “certified” with a request for a return receipt
If the letter is returned, put a copy of the letter in the patient’s chart and send a second letter to the patient. If you have an EHR, flag the patient’s file if he or she tries to make an appointment after dismissal.
Do contact your malpractice carrier
They can help you construct your dismissal letter in a way that complies with your policy and any state requirements for dismissing a patient.
Don’t let anger or emotion control the decision
Providers and staff members are bound to have patients that “push their buttons,” but that’s not necessarily grounds for dismissal. Ethically, dismissal should be your last option, not your first choice.
Don’t forget to document
If you have a patient who starts to behave in a way that would warrant dismissal, keep a record in the patient’s chart of all correspondence, including phone calls, emails and letters, between your practice and the patient.