The authors of this article are Rodney K. Adams, JD, a healthcare attorney with LeClairRyan in Virginia, and Lucien W. Roberts, III, MHA, FACMPE, the administrator of Gastrointestinal Specialists, Inc. in Virginia.  

Discharging problem patients is not enjoyable, but it is often prudent and necessary. Because of the legal and ethical implications of dismissals, it is helpful to understand how to correctly terminate a patient.

When sending a termination letter to patients, begin with a straightforward notification sentence stating that the patient is being discharged and include an effective date that is at least 30 days beyond the date the letter is mailed. During this period, consider providing only emergency care and offering only to refill necessary prescriptions. Avoid suggesting alternative providers in letters to patients.

Inform patients as to why they are being discharged, especially if the reason is due to their inability to pay bills. Offer to provide the individual with a copy of their medical records at a later date if/when they get a new physician but not in the initial letter.

Importantly, patient terminations should be documented in practice management systems so that future appointments are not made. In addition, it is not necessary to send a discharge letter via certified mail. Furthermore, review payer agreements for any language requiring whether or not patients must be notified if they are discharged.

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