Terminating the Relationship
Termination may occur through a series of carefully articulated steps or through a single termination letter, but should be done with prudence and supported by internal documentation and examples of the patient’s actions sufficient to justify the decision.
Certain states mandate the steps that must be taken, including a notice provision—often a period of 30 days—that identifies the effective date of termination. A provider may first put a patient on notice for violations of specific policies, such as unpaid bills or routinely failing to show up for scheduled appointments, but other behaviors, such as threats of violence, may not merit advance warning of termination.
A patient relationship cannot be easily terminated under all circumstances, however. For example, if a patient is in a legally protected category, such as having a disability under the Americans with Disabilities Act or on the basis of race, color or national origin under the Civil Rights Act, the relationship may not be one that can be terminated without first helping the patient find an appropriate substitute for care. Additionally, if a provider is the only specialty provider within a geographic area and the patient would suffer significant medical hardship without the provider’s services, the relationship may be extremely difficult to terminate, because the patient cannot simply be abandoned.
If a patient is in a vulnerable medical state, including but not limited to postoperative, undergoing chemotherapy or in an acute stage of treatment that poses significantly higher health risks without continuing care, termination may be very difficult unless an appropriate substitute can be found. Even when a substitute is found, the relationship generally cannot be terminated until the new physician-patient relationship begins.
Finally, termination can be complicated if any state laws provide patients additional rights with respect to time for notice of termination, required referral and transfer of care, or if a patient has a health plan that requires the provider to request a patient transfer or requires additional notice beyond the state law’s required time period (60 or 90 days) before the patient can be discharged.
Elements of the Termination Letter
When ending the physician-patient relationship is appropriate, a physician must send a written notice to the patient. The letter should clearly state the relationship is formally being terminated using either generalized or specific language based on the patient’s actions. It must also, as permitted by state law, express that the patient has a responsibility for their own health to continue necessary medical treatment.
In addition, a termination letter should include:
