Recommended practices to better prepare for closing down your healthcare practice

If you’re planning to retire, it’s understandable that you would want to leave behind a good legacy with patients you have cared for. You’d want to make sure that your patients are successfully transferred to another provider, and that their new providers have everything they need from you to continue the care of your patients with minimal disruption. And, that if needed, they would have enough time to get in touch with you to discuss their questions about your patients prior to your retirement.

It would be unfortunate if some of you patients could end up missing your notification letters and be taken by surprise when they find out after the fact that you had already retired.

Your patients will probably be frustrated if they have to go to a lot of effort to deal with paper forms, having to send them by mail or fax, and then to have to follow up to make sure that they were received — in order to obtain their health records or to transfer those to another provider.

Current practices for handling HR and accounting records, and notifying staff members/employees, relevant hospitals and healthcare organizations, government agencies, state licensing boards, and other professional associations are well documented and tend to be mostly up-to-date. At the same time, practices for patient notifications have not evolved much over the years. It’s still common for patients to have to mail or fax their paper forms to their healthcare provider’s office to authorize release of their health records to their new provider. It’s still common for healthcare practices to notify patients by sending out letters in envelopes. Faxed forms sometimes get missed or misplaced. Envelopes sometimes get overlooked or left unopened. All of these issues can result in inconveniences and, at times, real difficulties for patients. While this may not necessarily create legal challenges for the healthcare providers, it may impact their legacy. On the other hand, it’s an unwelcome chore for the office staff to have to deal with faxes and envelopes, since it tends to be tedious. Manually tracking envelopes or documents received by fax (to make sure that the HIPAA requirement to provide health records within 30 days is properly met) is time consuming and error prone.

There are now more effective ways to notify patients. There are now more effective ways for patients to fill out forms to authorize release of their health records to their new provider. There are less expensive ways for healthcare providers to maintain automated phone announcements and announcements on their website after the retirement day, and there are less expensive and more effective ways to maintain a copy of their patient’s health records to meet the retention requirements.

We would like to describe a comprehensive model (see a quick video overview) for notifying patients that will make it easier for target patients to make necessary arrangements to find a new provider, to obtain a copy of their health records, to transfer their health records to their new provider, and to have a chance to set up an appointment with the new provider while there is still enough overlap for the new provider to consult your office, if any questions arise, prior to the retirement date.

Patient Notifications

Which patients should be notified?

As a general rule it’s good to notify patients seen within last 2 years, especially patients that are actively being treated and those who require regular prescription refills.

Which patients should be notified?

It’s a good practice to notify your patients 6 months prior to the retirement date if possible, and if not, at least 60–90 days prior to closure. This will provide enough time for patients to decide how to proceed, select a new provider, obtain the new provider’s approval to take them on as a new patient, and to transfer records to the new provider. More importantly this will give your patients an opportunity to see their new providers while you are still working, so that their new providers have a chance to reach out to your office for any input or additional information.

How to notify your patients?

We suggest that you consult a local attorney to understand the laws that govern patient notifications in your state. For example, in some states it’s a requirement to place announcements in local newspapers. We would like to describe a few common practices here:

• A formal letter still should be sent out to each of the target patients. A copy of that letter should be attached to the patient charts.
• Patients who’ve opted to receive emails from your practice can also be notified via email — which could be useful, especially in cases when patients are away from their mailing address, or when they are not checking their mail regularly.
• Your email signature can be updated with the notification about your upcoming retirement.
• Patients who’ve opted to receive SMS/text messages from your practice can be notified via a text message (especially for those patients who do not tend to use email).
• It’s a good practice to include a notification about your upcoming retirement in billing statements sent to patients.
• A telephone announcement can be added to the automated attendant (virtual receptionist) greeting, as well as to the voicemail greeting.
• In addition to adding announcements on your website and your social media pages (for example, if your practice has a Facebook page), it’s a good practice to publish a post on your Google My Business listing that will appear on Google Maps and Google Search result pages.
• A press release can be issued in the local area, if needed.

Which patients should be notified?

It’s a good practice to include the following content in the notification:

• The reason the practice is being closed (e.g., decided to retire).
• The date of the retirement or office closure.
• Information or your recommendation about providers to whom your patients can consider transferring.
• Information on who will be the custodian of their records going forward, and how long your patients’ records will be retained.
• Instructions on how patients can obtain a copy of their records and how they can transfer their records to another provider — before the retirement date and after. For example, you might specify that their new healthcare provider must agree to accept them as a new patient before their records can be transferred to the new provider, and that patients must provide their written authorization to have their records transferred to the new provider.
• Either a copy of the form or links to the online form to authorize release of health records (either for patient to obtain a copy of their records or to transfer their records to to another provider).

Handling Patient Records

Patient Rights

Patients have a right under HIPAA to obtain a copy of their health records or request the transfer of their health records to another provider.

• Before providing a copy of the health records, the patient and/or their authorized representative must be property authenticated, and their contact information must be verified and validated.
• Before transferring records to another provider, that provider must be authenticated, and their contact information (e.g., email address, fax number) must be verified and validated.
• Patient records should be provided in a requested format as long as they are readily producible in that format (otherwise in another available format), within 30 days in compliance with HIPAA security and privacy requirements (e.g., properly encrypted).

How to prepare patient records for sharing?

In addition to exporting patient records from the EHR system, it’s a good practice to scan all paper copies and X-ray images. In this case, the original hard copies of paper records and X-ray images can be disposed of in compliance with HIPAA regulations (e.g., properly shredded).

Patient forms and records received through your website, as well as records received through email, fax and other means can be exported. The key is to get all the patient records well organized and keep them easily accessible, while maintaining the proper level of security protection.

Retention Requirements

We suggest consulting a local attorney to understand the laws that govern health record retention requirements in your state. There are US Federal and State Laws requiring patient records to be retained for a specific period of time. Federal HIPAA law requires 6 years, however most states have their own laws. The State of Connecticut, for example, requires patient records to be retained for 7 years. Health records must be always property protected in full compliance with HIPAA security and privacy requirements.

Patient Forms

It will be easier for most patients to use online forms (e.g., OfficeFLO EntreForms) to submit requests to obtain a copy of their records or to transfer records to another provider. This will also make it easier for your staff, since all requests will be documented by default. With software like OfficeFLO, your staff will also be able to track the workflow and due dates governed by HIPAA law requirements (to make sure that the patient health records are provided within required 30 days).

It’s a good practice to reference links to the online forms that can be used to submit authorizations to release health records on the website. You can include link references in announcements (e.g., forms.yourcaringdoctors.com/release), in Google My Business posts, in patient notifications sent via email or SMS/Text message, as well as in the formal notification letters sent to patients.

Telephony

Prior to the office closure

It’s a good practice to add an automated announcement that plays for each incoming call with a reminder about the upcoming retirement along with brief instructions on how to obtain or transfer the health records. Alternatively, an announcement can be added to the voicemail greeting.

The staff can also remind patients about your upcoming retirement during their phone calls or while texting with patients.

Prior to the office closure

The office phone service can be disconnected after the day of office closure, as long as an automated announcement with details and information for patients is maintained for at least a few months, or as long as the phone is forwarded to another provider’s office.

Phone service can be ported to another provider or service (e.g., OfficeFLO Entrecom) to avoid costly telephony charges after the office closure.

The automated telephone announcement can be customized to inform callers about your retirement:
E.g., “Please listen to this message. Dr. <Dr’s Name> retired on <Date of Retirement>. If you need to obtain a copy of your health records, or to make outstanding payments, <follow the instructions>. For additional information, please visit our website <website address>.”

Alternatively, calls can be forwarded to another office (if applicable) after playing an announcement for callers:
“Going forward the office of <Name of the provider or practice> will be providing care for our existing patients. If you’d like to be connected with the office of <Name of the provider or practice>, please stay on the line. Their direct number is XXX-XXX-XXXX.”

Email Service

Prior to the office closure

It’s a good practice to add a brief message to the default email signature with a reminder about your upcoming retirement that includes a link to a page where patients can get more information and details on how to obtain their patient forms or how to transfer their patient records to new providers. You can include recommended providers to consider, and so on.

After the office closure

All incoming email messages should be rejected with an auto-reply to inform senders about retirement and provide information with links:
“ATTENTION: <Dr’s Name> retired on <date>. This mailbox is no longer active. For more information about how to obtain your health records, how to make outstanding payments, and to see doctor recommendations, please visit our website at <website address>.”

Website

Prior to the office closure

It’s a good practice to add an announcement about your upcoming retirement and a dedicated page to provide instructions and details for patients, including

• Links to online forms to submit an authorization to release health records either to the patient or their new healthcare providers.
• Recommended providers and available options for where to seek care after the office closure.
• How to submit outstanding payments after the office closure.
• Who will be the custodian of the health records after the office closure and how long the health records will be retained, and how to contact the custodian after the office closure.

After the office closure

The website should be replaced with potentially only a single page informing visitors about your retirement. The page should include instructions and details for patients. It should be maintained at least for a few months.

Equipment with access to PHI

It’s good practice to create a full backup of the system hosting all your EHR records, and to retain this backup in case the snapshot of the original EHR data as of the retirement date may ever need to be accessed. The backup will need to be securely destroyed (wiped) as soon as the retention requirements for health records are satisfied.

All printers, scanners and fax machines that accessed PHI must be properly disposed of in compliance with HIPAA regulations. All internal memory must be physically destroyed or securely wiped out.

PHI stored on computer disks, USB drives, memory cards, or on the Internet must be properly deleted (securely wiped). Computers and reusable media can still be repurposed after the PHI has been properly deleted.

CDs and DVDs containing PHI must be destroyed.

In Conclusion

Prior to your retirement, the following action items need to be addressed:

• Announcements.
• Forms for patients to obtain or transfer their health records (preferably online forms).
• Porting of office phone numbers (if applicable).

After the retirement, the following action items need to be addressed:

• An automated telephone announcement.
• An email auto-responder.
• A website with instructions for patients.
• Digitizing/organizing patient records.
• Disposing of applicable copies of health records and equipment with access to PHI.
• Handling patient requests to obtain or transfer their health records.
• Handling outstanding payments.
• Shutting down the patient portal or disconnecting the provider.

For more up-to-date information, please visit officeflo.com/retire.