Skip to main content
MJH Life Sciences
  • Login
  • Register
  • Login
  • Register
Home
  • Topics
  • Health IT
  • Careers
  • Law/Malpractice
  • Compensation
  • Pearls
  • Staffing
  • Contribute to Site
MJH Life Sciences

SUBSCRIBE: eNewsletter

Discharging Problem Patients the Right Way

  • Rodney K. Adams, JD
  • Lucien W. Roberts
May 4, 2016
  • Patient Dismissal, Law & Malpractice, Managers Administrators, Patients, Pearls, Risk Management
  • Physicians Practice

Discharging patients is not fun, but it is often prudent and necessary. Because of the legal and ethical implications in patient dismissal, it is helpful to possess practical guidance on just how to correctly terminate a patient.

I find that most patient terminations fall into one of four buckets:

• Patients who are verbally abusive or threatening to providers or staff;

• Patients who are noncompliant with their care — missing appointments and/or recommended testing;

• Patients who "doctor shop" and often are most interested in obtaining medications; and

• Patients who do not pay for the care you provide.

Regardless of why the patient is being terminated, the letter itself is straightforward and contains four elements:

1. The notification itself

2. The effective date

3. The reason for the termination

4. An offer to provide a copy of the records to the physician assuming the patient's care

Notification and effective date

Begin with a straightforward sentence stating the patient is being discharged from the practice. The letter should include an effective date that is at least thirty (30) days beyond the date the letter is mailed. Healthcare attorney, Rodney K. Adams recommends that this period be extended 45 days to 60 days if you practice in a specialty or geographic area where it may take patients longer to find another physician, or if you are providing current care for an ongoing condition.

During the period between your letter and the patient termination date, offer to provide emergency care only. Our practice refills necessary prescriptions but otherwise avoids the provision of non-acute care during this period. 

You are not required to suggest alternative providers in your letter, nor do I recommend doing so. I do not like it when other groups refer their "problem" patients to us, so I do not advise our problem patients to contact specific physicians or groups. Our discharge letters simply say we are providing ample time for the patient to find another provider.

Transparency

I think it is appropriate to provide a reason for the patient's discharge. Even if the patient does not like the reason, they have a right to know why they are being discharged.

More patients are being discharged because they are unable to pay their bills. It's unfortunate, but it is a reality. There is nothing illegal about doing so, notes Adams. Just as patients who do not show up for appointments are breaching the physician-patient relationship, so too are patients who receive care but do not pay for it.

Finally, patients have a right to a copy of their medical records. Your letter should offer to make a copy of these records available to the patient or their new physician. You do not need to provide a copy of your medical records with the termination letter.

Other points to remember

• You should document the patient's termination in your practice management system to alert your staff not to make appointments going forward.

• It is not necessary to send a discharge letter via certified mail, notes Adams. Many patients will not accept or open certified mail.

• A small subset of payers require that you notify them when discharging a patient. I have never found this to be an issue, but you might review your payer agreements for such language.

Rodney K. Adams, JD, is a healthcare attorney with LeClairRyan in Richmond, Va. He is the author of "Virginia Medical Law" and other publications and may be reached at [email protected].  

Lucien W. Roberts, III, MHA, FACMPE, is administrator of Gastrointestinal Specialists, Inc., a 23-provider practice in Central Virginia. For the past 20 years, he has worked in and consulted with physician practices in areas such as compliance, physician compensation, negotiations, strategic planning, and billing/collections. He may be reached at [email protected].

Click the following links to download sample patient discharge letters. Sample Discharge for Rudeness; Sample Discharge for Non-Payment; Sample Discharge for Non-Compliance; Sample Discharge for Doctor Shopping.

Related Articles

  • New rule on 'bad actors' means more work for practices
  • Ignore a civil investigative demand at your own peril
  • Managing the risks of telemedicine
  • Your EHR can save you from malpractice litigation
  • Legal explainer: Proposed changes to the Stark Law, Anti-Kickback Statute

Resource Topics rightRail

  • Resource Topics
  • Partner Content
  • Medical Billing & Collections
  • Coding
  • Patient Relations
  • EHR
  • Law & Malpractice
Across Generations: Millennials & Baby Boomers Advance Healthcare Communications
A buyer’s guide to alternative payment models
How adopting a virtual business office delivers new efficiencies to one medical group
Unpredictable pairings: A new approach to community health
Addressing the outsized effect social and economic factors have on health
Connect with Us
  • Column 1
    • Home
    • About Us
    • Contact Us
  • Column 2
    • Editorial Info
    • Editorial Board
  • Column 3
    • Advertising Info
    • Reprints
    • Advertising Terms
  • Column 4
    • Terms of Use
    • Privacy Policy
Modern Medicine Network
© UBM 2019, All rights reserved.
Reproduction in whole or in part is prohibited.

We've noticed that you're using an ad blocker

Our content is brought to you free of charge because of the support of our advertisers. To continue enjoying our content, please turn off your ad blocker.

It's off now Dismiss How do I disable my ad blocker?
❌

How to disable your ad blocker for our site:

Adblock / Adblock Plus
  • Click on the AdBlock / AdBlock Plus icon on the top right of your browser.
  • Click “Don’t run on pages on this domain.” OR “Enabled on this site.”
  • Close this help box and click "It's off now".
Firefox Tracking Prevention
  • If you are Private Browsing in Firefox, "Tracking Protection" may casue the adblock notice to show. It can be temporarily disabled by clicking the "shield" icon in the address bar.
  • Close this help box and click "It's off now".
Ghostery
  • Click the Ghostery icon on your browser.
  • In Ghostery versions < 6.0 click “Whitelist site.” in version 6.0 click “Trust site.”
  • Close this help box and click "It's off now".
uBlock / uBlock Origin
  • Click the uBlock / uBlock Origin icon on your browser.
  • Click the “power” button in the menu that appears to whitelist the current website
  • Close this help box and click "It's off now".