Eric Butterman

A physician’s practice is more than a sign on a door. It’s a link to the community, it’s people, sometimes generations of them, who relied on medical wisdom here to help them feel better or maybe even to survive. It’s memories, it’s even family but, now, you want to close it in order to find your way to opening a new chapter. But, of course, it’s not as simple as making the decision and then turning off the lights.

It begins with your patients. “There are abandonment laws and you have an obligation to give them time to find another physician,” says 

, partner in law firm Troutman Sanders. “You don’t have to recommend someone but it’s something to consider.” For Charles Dinerstein, who closed his vascular surgery practice in 2012, he did provide recommendations, which he estimates took care of 10 to 15 percent of his patients. Whaley recommends giving 30 days notice at the minimum to patients and Dinerstein gave about six months.

You also won’t just be in touch with new physicians when it comes to records-you need to keep records for a certain amount of time, depending on your state. For Dinerstein, he says its eight years in his state as he had his practice in Freehold, New Jersey. “You need to answer the question of where the electronic medical record (EMR) will be retained and who responds to that requests,” Whaley says. “Engaging a third party with a medical custodian to respond on a physician’s behalf may be the answer.” Consider costly EMR contracts as well when it comes to the timing of your retirement. “A reason to start looking at retirement a few years in advance is because some of those contracts have longer terms that automatically renew,” Whaley says. “If the provider says they want to retire in six months and the EMR contract renewed for three years that could create some expenses for physicians that could have been avoided with more planning.”

For your employees, there needs to be consideration for time they would need but also for their retirement plan, that it follows its needs for them moving forward. “There are employment law considerations with respect to terminations that will vary depending on the size of the practice,” Whaley says. COBRA obligations, accrued PTO and benefit plans or retirement funds must be also considered for post closure and whether those need to be wound down, she says.

Dinerstein had one employee who had worked there over 20 years. “One of the things I was happiest about was we were able to find them work with a group-they had great talent,” he says. 

“You also need to give consideration when winding down to the revenue cycle for the practice,” Whaley says. “They see a patient and hopefully it’s no more than 30 days to file the claim and then you file the claim in 30 to 60 days, but then there are denials and requests for information. You may keep staff on to collect that outstanding A/R and work that down or you may hire an outside party.” Dinerstein also reminds to get in touch with your state as much as years later. He actually received a letter that the state had money of his from payments that had been sent to his office after they had closed their doors years before.

There is also the state board. You need to check with them on how long certain certifications are required to be kept up, In New Jersey, for instance, Dinerstein said there was a requirement for taking an ad out in the newspaper about the closure. 

Insurance also shouldn’t end on your last day as claims are also possible. Dinerstein had tail end insurance and you want to make sure with your broker that you are covered for years after. 

But, of course, you may not be retiring alone. “If you have a partner in the business and you are both retiring then closing the practice has similar considerations, but the potentially complicating factor is how to split any assets from the practice,” Whaley says. “If they are going to sell all of their exam tables, if they own the building, etc. Hopefully it’s spelled out in the corporate documents for the practice.”

Finally, be prepared in another way-for the next step and for the emotional component. 

“We talk about this on a regular basis…” says 

, Partner in law firm Lindabury, McCormick, Estabrook & Cooper, P.C. “Are you psychologically ready for it? When a physician stops practicing, it can be tough. I had a client retire…they were very active and did very complex surgeries and then they’re not. They’re bored and very anxious. They maybe could have been a consultant. I think looking back they would have done it differently. You go from a high intensity job to playing golf and tennis-that may not cut it for these physicians…I think you should start planning two years in advance to consider different alternatives and the one that’s right for you.”

Of course, even when you do, there’s still that last word: goodbye. Be ready because it probably won’t be easy. 

“A lot of tears were shed on both sides many times when I told patients I was retiring…” Dinerstein says. “It was a different job where you could see patients for many years. I look back on my time as a chance to help the community, enjoy the challenge of medicine and help my family. I was ready to move on, but…the memories mean so much.” 

Articles

Closing a practice for retirement is a hard decision as it is-here are tips to make closing your doors smoother.

The End of an Era: Closing your practice

Everyone has been through a lot. Besides your fear for people, your work took a strange turn in the irony that your business- helping with health issues-had a downturn 

 of a health issue. But we also know issues can happen from avoiding-such as missing the careful check-up which finds the unexpected problem and early or a patient not getting the heart to heart talk about making a lifestyle change which maybe just can’t come through the same way on a screen. Let’s face it: the everyday in-person appointment can win the day-and, potentially, save the life. Still, patients are skittish about possibly losing their life from the coronavirus. Patients are scared. Here we gain insight in making them feel comfortable when they’re finally ready to come to your office.

Ten things to know before launching a remote patient monitoring program

You want to make sure they’re wearing masks and, if not, that you have one at the ready. Papers filled out before patients arrive means less time at the office. “As we send them confirmation which identifies their level of comfort, we also ask them if they have a fever, any other symptoms, and also take them through the steps we expect them to do,” says 

But Sullivan says the visual of the office is also a key- they don’t see a crowd in the waiting room and there’s awareness of hand sanitizers and a wiping down of places that will be touched. Sullivan, who is a specialist in cardiology and internal medicine and chief strategy officer with health tech company DrFirst, says that as in a grocery store social distance still matters. People feel uneasy in those places if those guidelines aren’t met (if they don’t feel uneasy regardless) and they won’t feel any less so just because there are doctors around and it’s a medical facility. 

, MD reminds that when a patient is ready to make the step to come in, that even the steps from the waiting room to the examining room will need to be considered. “Think about taking the patient to the room,” says Thoburn, an adjunct associate professor in the department of medicine in the division of rheumatology at the University of Florida. “Does the nurse make sure to open the door so the patient isn’t touching the door handle? You don’t want to overlook even something small like that.”

, MD, Founder and CEO of the Center for Vein Restoration, hints that you shouldn’t be afraid to be even more conservative than guidelines, his office actually liking to keep patients at nine feet of distance. In their waiting room, they once had 10 to 12 patients, but are presently keeping it to two. Everyone else behind them waits in the car, he says. For a small waiting room, he recommends only having one patient sitting there at a time. 

Sullivan also reminds that handouts can make a difference. Patients will likely appreciate the education on guidelines they may not be aware of, along with your own suggestions, and it also just further shows that the practice is being run with knowledge and thoughtfulness.

Now more than ever, it’s important to listen to your patient. They may need to get out their fears-and seeing a familiar doctor nod their head in understanding could be worth its weight in medicinal gold. “You need to remember they may be coming here to feel better but they worry about what’s brought everyone else to the office, too.” Thoburn says. “They need reassurance and understanding during this difficult time.”

Even expect them to possibly be emotional because of the reunion-if they’re a regular patient, they’re used to seeing you and this step may let them know in one more way that life might get a little closer to the way it was, though we don’t know the ultimate picture of where it will be. And, hey, it may even be a little emotional for you, too-these aren’t just patients, these are people you may have known for years, people who kept you in business, people who helped you take care of those in your life even as you were taking care of them.

This is your chance at the first visit to remind them that we’re all in this together-including their trusted doctor.

Patients returning to the waiting room need reassurance-and rules. 

The return of in-person visits

You’re concerned about how patients are feeling when it comes to returning to your office during the coronavirus, but it may be easy to forget what the staff is going through. They feel a driving need to help but also want to stay safe themselves. Even those that told you they were raring to go may feel uneasy once they step inside and realize the office they imagined will not be the same. Here, we look at how physicians can help them so they can help patients.

From basics such as social distancing to cleaning, give them an unambiguous sense of how you will keep the office healthy. “I think engaging everyone in the process, having that process really outlined and sharing with everybody what you’re doing and the why behind it really helps promote a sense of team and collaboration,” says Dr. Savita Ginde, chief healthcare officer at Stride Community Health Center who is overseeing COVID-19 testing. “Everyone sort of knows their role in keeping everyone together safe and also I think provide some reassurance that there are steps being actually taken to help protect them as much as possible.”

Another area of discomfort may be that they were furloughed to begin with, which can leave a staffer possibly feeling less valued. How do you make a worker who is feeling uneasy to have a sense of being a key part of the team? 

“Like anything, communication is the key there,” says Dr. Sanjiv Lakhanpal, founder and CEO of the Center for Vein Restoration. “First, you’ve got to explain to them why were they furloughed. My experience has been that the best way to communicate is through honesty and transparency.” He says it may also be time to share the numbers of how many patients they used to see and what expenses typically were so they can understand the math just simply didn’t add up. 

Practicing social distancing in the practice and more

A major challenge is also giving staff a sense of how often you will need them. 

“As patients start coming back initially, they will be very few patients coming to any office,” Lakhanpal says. “An office that used to see 20 patients a day probably now will see 5 to 6 patients a day because as people are getting comfortable it will take time.” He warns against bringing back all the staff as it may crowd the place up. “As the patient flow increases, that’s when more staff should come in appropriate to what the requirement is for the patients’ well-being.”

Although fun office rituals such as the sought-after candy dish may be out, look for other ways to give that sense of belonging. Shared office memories and warm smiles sent that come with having worked together a long time doesn’t spread the virus-but they may just increase a feeling of team.

Your patients aren’t the only ones feeling uneasy coming back to a medical office during the coronavirus. 

Author | Eric Butterman

Articles

The End of an Era: Closing your practice

The return of in-person visits

Supporting your staff while reopening the practice