Wrapping up Your Medical Practice

  • There can be many factors behind the decision to shutter a practice. Regardless of the motivation, a physician has to follow certain protocols required by law when closing a practice. In this article we will cover the details involved in one of the most critical of these requirements— retaining and managing the patient record— as well as other crucial aspects such as patient notification and a summar

y of any applicable federal or provincial statutes involved in closing your practice.

Retaining Medical Records after Shuttering a Practice

Neither federal law nor the law of any province has any privacy clause that directly addresses how long records are to be retained after a practice closes. The CMPA does suggest keeping the medical record for 10 years (longer for minor patients). There are general guidelines that suggest how a physician’s office should handle the situation; these involve maintaining a clear, written, in-house protocol covering either the storage or obliteration of patients’ medical records. This protocol should keep the following in mind:

  • A policy covering minimum and maximum timeframes for document retention must be defined by the practice, as required by the Federal Personal Information Protection and Electronic Documents Act.
  • If storage of the record is no longer necessary for legal/business reasons, personal details contained in a file must be destroyed.
  • If a medical record needs to be retained indefinitely, there must be a clear reason or justification.

 

Associations like the CMPA or provincial colleges may provide general principles guiding the storage of medical records, however, a doctor should keep provincial statutes in mind, as well. If the statute does not address the issue, then the physician’s office can rely on CMPA principles. Even though they are not mandated, they provide a useful structure, specifically with regards to legal issues that might come up in the future. A physician can also look to regional medical associations to enhance CMPA guidelines.

Provincial Medical Associations –

No standing policy, for the most part; these entities usually suggest physicians reference provincial college protocols.

CMPA

-10-year storage recommended; original files are encouraged.

Provincial colleges – 10

-year guideline, as well, although some can go as low as 5 years in their recommendations.

Notifying your Patients about Your Practice Closing

In general, provincial entities adhere to a policy of prompt, well-defined notifications to patients when closing a practice. 3 months is a general guideline, but a longer period is encouraged. Types of recommended notifications include in-person notification, written notification by post, or telephone notification.

If the scenario entails the transfer of the practice to another doctor, notifications should introduce the patients to the doctor taking over the practice. When there is no physician is taking over a practice, it is acceptable and recommended to suggest local doctors to patients.

Third-Party Notifications

The physician’s office is required to alert the provincial college that the practice is shuttering; the college will also need to know where the records will be stored.

In the case of a group practice, there may be formal guidelines within the partner agreement. If there is not, it is best to arrange shutting down your practice when it will be convenient for your associates to relocate, or to give them enough time to find a new associate.

Employee Notifications

Labour standards define a minimum period for notification that is based on how many years the employee has been in your employ. If notice is not possible, payment covering what would have been the period of notice is required. Many practices go beyond the minimums as a matter of courtesy. Consulting a labour lawyer can be advisable to ensure that you are doing everything above board and preventing future litigation. You may want to consider keeping some employees on after closing your doors to oversee record transfer, bill reconciliation, and so on.

If you are transferring your practice to another doctor, it is suggested that current contracts still be cancelled and termination notice given. Some provinces require this under law. The new physician can start new contracts with any employee retained, with new start dates for vacation and termination entitlements.

Transferring the Physical Assets of a Practice

Equipment and furniture

There are three values that can be employed in assessing the worth of your practice’s physical assets:

Market Value

- The value assigned an asset by a reputable “assessor”, usually a vendor of comparable equipment.

Book Value –

The value determined by record, usually accounting.

Buyer/Seller-Determined Value

– The value agreed to by both parties.

Remember, if any of the equipment being sold is viewed as a medical device, it must be divested of under the regulations defined by the Food and Drugs Act concerning Medical Devices.

If there are leases involved with any of your physical assets, you can consider transferring the lease to the physician coming into your practice or, alternately, arrange the close of your practice in tandem with your lease’s end date. Remember, there might be fees involved in early terminations of leases.

Drug Disposal or Transfer

When disposing of any drug sample or product, a physician must take the utmost care to adhere to and consider environmental concerns and regulations. No contamination of local ground water should take place. Health products can also be handled by:

  • Transferring them to practice’s new doctor
  • Returning them to drug reps
  • Putting them in the hands of medical waste disposal professionals
  • Giving them to a pharmacy for disposal
  • Consulting local authorities

Making sure that patients retain access to their medical files is critical; continuity of care should be preserved whenever possible. There are some guidelines to keep in mind regarding patient record access or transfer:

  • A patient’s request for a record transfer takes preeminence and should always be heeded.
  • The transfer of any medical files should be done with due diligence and as quickly as possible.
  • When a patient does not place a request for transfer or cannot be found, the doctor’s next recourse must be to try to transfer the record to a nearby physician.
  • Medical files should NEVER be sold.

To protect the physician against future litigation, he or she should always retain an original copy of the record, as recommended by the CMPA.

Professional Storage Facilities

A bonded storage facility is an appropriate alternative when no transfer can be made. If you live within Labrador or Newfoundland, it is acceptable for records to be stored with a relative. Any bonded storage facility should have an agreement drawn up which the physician should sign. This agreement should cover:

  • A detailed description of the responsibilities of the facility
  • Explanation/clarification of the facility’s policy regarding security
  • Explanation/clarification of the facility’s policy regarding  patient privacy
  • A protocol covering destruction of records
  • A protocol covering record access
  • A detailed fee schedule

 

EMR Storage

It does not matter what format you use to store your patient’s medical records— your responsibility remains the same. In the event that your patients’ medical records are retained in a digital format, you should retain a license and/or access to any software involved, or make sure that you have a copy of the data contained in your EMR system.

It is likely that your EMR service will facilitate this process and make sure that you retain a copy of all data even if your license to the necessary software has expired. PDFs are the most user friendly way to retain your EMR data.

Make sure to retain your data in multiple formats, since technology changes so rapidly. For example, you can keep a disc copy, a copy on an external hard drive, and a copy on your local hard drive.

All personal information should be encrypted on EMRs. Encrypting one of your backups can also be a good idea. There are many IT experts that can facilitate this process, if you have any questions.

Having Closed Your Doors

Now that you’ve shut down your practice, you should consider maintaining the phone line associated with the office and setting up a message that lets callers know about the closure. A timeframe of 3 to4 months after closing should suffice. Make sure to include information in the message as to where patients can access their EMRs or files, if need be.

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