How Can Physicians Minimize Risk When Leaving a Group Practice?

One of the most common questions asked by physicians who call the MICA Risk Consultation Line is: What steps should physicians take when leaving a group medical practice? While the process might seem straightforward, skipping important steps can increase the likelihood of patient harm or overlooked regulatory obligations. As a result, physicians who fail to take the necessary precautions when leaving a group practice increase their risk of a board complaint, lawsuit, or quality-of-care complaint filed with a third-party payor.

For example, consider a surgeon who left a practice with at least one patient still in her post-operative global period. The patient experienced a post-operative complication after the surgeon’s departure. When the patient contacted the practice to discuss the complication, she discovered that no other physician in the practice was experienced with the surgery performed by the surgeon who left, so the practice could not assign her to another physician in the group. The patient subsequently filed a quality-of-care complaint with her insurance company.

Physicians can reduce their risk of a similar complaint—and the risk of patient harm—by knowing what steps to take when leaving a group practice. This article provides a general overview of the recommended steps, from the time a physician starts considering leaving a group practice, through operational issues that can occur after the physician’s departure.

1. Review Your Employment Contract

Physicians considering leaving a group practice should first review their employment contract, preferably with an attorney. An attorney can provide guidance on how to satisfy relevant contractual requirements. Physicians should specifically consider the following when reviewing their employment contract:

• • Does the contract specify who is responsible for notifying patients of the physicians’ departure from the practice? The contract might specify whether the practice or the physician is required to notify patients of the physician's departure.
    
    
  • Does the contract include a non-compete clause or non-solicitation clause? Some contracts include a non-compete clause prohibiting physicians from practicing within a certain geographic area for a specified period of time. Likewise, some contracts include a non-solicitation clause prohibiting physicians from soliciting employees from the practice.
    
    
  • Does the contract discuss custodianship of patients’ medical records? The practice will usually serve as the legal custodian, but physicians should confirm that the contract does not specify otherwise.
    
    
  • Does the contract include any requirements regarding physicians’ notice of resignation? For example, the contract might require physicians to fulfill a specified employment period or to provide the practice with a certain amount of notice before the physician’s departure. Physicians should also confirm whether the contract specifies what damages the physician could be responsible for in the event of a breach, such as the cost of hiring a locum tenens physician for the remainder of the departing physicians’ employment period.
    
    
  • Does the contract include any repayment obligations for a physician’s early departure? For example, physicians should confirm whether the contract requires repayment of any signing bonus or retirement benefits if the physician does not fulfil the full employment period specified in the contract.
    
    

2. Provide Patients with Reasonable Notice of a Physician’s Departure

Patients require notice of the physician’s departure so they can decide whether to follow the departing physician to the physician’s new practice, or continue with another physician at the original practice. Physicians should consider the following issues related to notifying patients of their departure:

• • Determine whether notice will come from the practice or the departing physician. The practice might agree to send a joint letter to patients from the physician and the practice.
    
    
  • Provide notice to patients through as many methods as possible. Patients should be notified in writing, but practices might also agree to post a notice in waiting rooms, exam rooms, on the practice’s website, or on invoices sent to the departing physician's patients.
    
    
  • Notify patients of the physician’s upcoming departure as soon as possible, but preferably 90 days before the effective date. Patients should be provided with “reasonable” notice of the physician’s departure. What is considered reasonable can vary depending on the circumstances, including patients’ acuity and whether there are other physicians in the practice or geographic area who can accept the departing physician’s patients.
    
    
  • Include the following information in the departure notice provided to patients: the physician’s departure date, where the patient’s records will be located, how the patient can request a copy of their records, and, if permitted by the employment contract, the physician’s new practice location.
    
    
  • Save a copy of the notification letter in each patient’s medical record. In the event of a lawsuit or board complaint, this can serve as evidence that patients were notified of the physician’s departure and when the notification occurred.

3. Coordinate Patients’ Continuity of Care

To reduce the risk of a patient abandonment claim or patient harm, physicians leaving a group practice should take reasonable steps to coordinate continuity of care for their patients. Physicians should consider taking the following steps related to continuity of care:

• • Talk to patients with planned, but unscheduled, procedures or surgeries. Physicians can discuss whether the patient plans to follow them to their new practice, or whether the patient plans to schedule their procedure with someone else. Document this discussion in the medical record.
    
    
  • Help coordinate patients’ transfer of care if necessary. Physicians should take reasonable steps to assist in referring acute and high-risk patients. Physicians should also assist in transferring care for patients with pending follow-up appointments, labs, prescription refills, or imaging.
    
    
  • Consider referrals for patients that wish to remain with the practice. If the practice has no other physician who can absorb the departing physicians’ patients, this weighs in favor of providing patients with more notice of the physician’s departure so patients have time to establish care elsewhere.

4. Manage Patient Medical Records

To further assist with patients’ continuity of care, physicians should take the following steps to facilitate patients’ access to their medical records:

• • Let patients know where their medical records will be located. This information should be included in the letter sent to patients notifying them of the physician’s departure.
    
    
  • Offer patients the opportunity to obtain a copy of their medical records. Again, this can be included in the letter sent to patients notifying them of the physician’s departure. Physicians can also offer to facilitate sending the patient’s records to a new practice if the patient decides to leave the current practice.
    
    
  • Confirm who will serve as the custodian of records. If the physician’s employment contract does not address custodianship, the physician should discuss this issue with the practice before departure.

5. Address Operational Issues

Physicians should also address any outstanding operational issues that the practice will not handle. For example, physicians should consider the following:

• • Notify your broker or MICA’s underwriting department of your departure. Your broker or underwriter can discuss any impact to your policy, including whether tail coverage is recommended. MICA’s underwriting department can be reached at 877-215-6422.
    
    
  • Notify the following entities of your departure from the practice: CMS, third-party payors, licensing boards, specialty boards and organizations, the DEA, and any facilities where you had privileges.
    
    
  • Discuss how the practice will handle mail or emails sent to you after your departure. Physicians should also consider discussing whether the practice will allow the receptionist to provide the physician’s new contact information to any patients calling to schedule with the departing physician.
    
    
  • Update any supervision agreements with advanced practice providers. Physicians should discuss with the advanced practice provider whether they intend to continue with the agreement, and the agreement should be updated accordingly.

Additional Risk Management Recommendations

Physicians should also consider the following general risk management recommendations to help further reduce their risk when leaving a group practice:

• • Take steps to resolve any outstanding labs, prescription renewals, patient messages, and prior authorizations. Completing these tasks reduces the risk of a patient abandonment claim or that a patient suffers harm before establishing care elsewhere.
    
    
  • Ensure all documentation is complete. This includes completing any unfinished progress notes, documentation regarding test results, and patient communications.
    
    
  • Document transition of care. Documentation should include notice of the physician’s departure provided to patients and all steps taken to coordinate patients’ continuity of care, including facilitating referrals and providing copies of patients’ medical records.

Leaving a group practice is a significant transition for physicians that requires planning. By proactively reviewing their employment contract, providing patients with reasonable notice of their departure, coordinating patients’ continuity of care, and addressing operational matters before their departure, physicians can protect themselves and their patients from unnecessary risk.