Faculty Turnover Practices 8/02
A GFP member is seeking input from other members regarding the following:
All AMCs have to manage the process of faculty turnover and patient management. He is
curious as to how other AMCs notify/communicate with patients when doctors leave the
AMC either to enter practice in the community or go to another AMC.
Questions include:
1) How are patients notified that a physician they have been seeing is leaving the
institution?
2) What provisions are made for another AMC physician to see the patient when the
primary physician (primary care or specialist) is leaving to a) Enter practice in the
community or b) Leave for another AMC?
3) If patients are notified by some type of mailing, what does the letter state and how is a
patient list determined?
4) If patients are already scheduled to see a departing physician after the physician's
termination date, how are patients notified? Are they automatically given an appointment
with another AMC physician in that division/section?
Contact
Brian
Smith
School
U South
Florida
Reply
1) Patients of the departing physician are sent a letter explaining that the MD is
leaving the practice. The letters may be individualized by the departing
physician, and are usually signed by the departing physician's Chairman.
2) If the service of the departing physician can be provided by a colleague, then
the patients are referred to the colleague (in the letter) - regardless of where the
departing physician is going - the community or another AMC. If the service
cannot be provided, then the patient is generally advised to seek care in the
community. In some cases (specifically if the departing physician is the only
physician who provides a highly specialized service, there is no planned
replacement for this physician/service and he/she is remaining in the
community) patients are given that physician's new address/number. This is
only done with Dean and Chairman approval, and rarely occurs.
3) The letter describes the circumstances (leaving the Practice, retiring,
relocating, whatever), provides the appt. schedule number if a colleague is
going to assume responsibility for these patients or advises the patient to seek
care in the community. A 30-day notice is usually provided. Patients are also
advised on how to go about obtaining their medical records.
The patient list is determined by running a query (usually 2 - 3 years) from the
scheduling system. Labels are generated from the query, which makes sending the
actual letter easier.
4) Many departing physicians have schedules that extend out for months. All
patients (whether they have appts. scheduled are not) are notified by letter of
the departure of the physician. The appt. schedulers basically follow the
cancelled clinic/bump & reschedule procedures. If a colleague of the departing
physician is going to assume responsibility for the patients, the schedulers will
attempt to reschedule the patients on the day/time of the cancelled appt. This is
frequently not possible because the clinic schedule and/or master schedule of
the new provider may not accommodate this. No patients are automatically
given an appt with another AMC physician.
Jane
Schumaker
MC
Wisconsin
1) The Department sends a letter to all of the current and active patients.
2) Patients are given the option of choosing another provider regardless of where
the physician who is leaving is intending to practice.
3) The letters are individually tailored to meet the specific situation of the departing
provider. It usually just indicates that their physician is leaving our practice and
asks the patient to call and reschedule with another provider. The patient list is
determined by generating a list of all the patients seen by that provider in the last
two years.
4) Most often, letters are sent and then followed up with a
phone call from the clinic in an attempt to reschedule with another
provider. In some instances, the clinic automatically reassigns the
patients to another physician. This is a decision of the individual
department.
Michael
Vivoda
Loyola
1) A letter is sent from the central office of the group practice.
2) The letter sent is customized to the situation and is actually quite generous to the
faculty who are staying in the area.
3) The letter states the facts about the departure of the faculty member and gives
details on how to continue care with the departing physician or to transfer care to a
new physician. A medical records release form is also enclosed to facilitate records
transfer as well.
4) This rarely happens, but each situation is handled uniquely.
A draft of a generic letter that will be sent to patients in the event of a physician's
departure is sometimes made a part of the physician's employment contract.
Steve Selby
Mount Sinai
When a primary care MD leaves the institution we advise the patients aligned with
that MD a few weeks in advance by letter. We offer the patients some names of
other primary care MDs in our system to transfer their care to. The patient list we
use tends to be their "active patients" (i.e. seen in last 18 months) who have
identified the MD as their PCP (primary care physician). We try to keep current
with "PCPs" to assure receipt of documentation from specialists treating their
patients.
David
Posch
Vanderbilt
1) Normally by letter.
2) We normally say we are prepared to continue to provide care and transfer
that care to physicians we will list.
3) We cite the facts, Dr Blank is leaving as of x date and can be reached at. We also
say we are delighted to continue to provide your care and cite how to get an
appointment with an alternative doctor. We sometimes give some background on
the alternative doctors. The list is normally based on patient contacts from the prior
12 months as appointed to the departing MD.
4) We call the patients to inform them and to try ton reappoint them to an
alternative MD.
Allen
Bolton
U of Alabama
1. All patients receive a letter from the clinic.
2. (a) if docs leave for a practice in the same community, a letter
from the doc goes to the patient notifying them of his/her new practice;
additionally a letter from the clinic goes to the patients offering to
incorporate them into other physicians' practices here (b) if the doc leaves
for another AMC (there are no others in our region), they are offered other
physicians in our system via a letter from the clinic.
3. What the letter states is in answer #2. Patient lists are assembled
from medical records and the appointment schedule.
4. Patients are automatically given another appointment and are
notified via a mailed postcard.
John Caire
Louisiana State
U
1) With a letter notifying them of the physician's departure, but also explaining that
our extensive staff of qualified physicians can continue to provide for their health
care needs.
2) As noted in 1) we make the patient aware of this option and attempt to keep
them in the system.
3) The list is determined from the physician's billing records from the past year.
4) Appointments are with a different physician are not automatic, but the patient is
given the option.
Denise
Fetters
Wake Forest U
This was recently done in our Geriatrics Department. We ran the list of
clinic patients. We separated those patients that doctors felt definitely should stay
in the clinic for a variety of reasons; we identified relatives of the faculty and staff
and other "VIPS". The remaining all received a letter stressing that a change in
provider was in their best interest in an effort to allow them to receive care in a
timely fashion given a recent decrease in providers. The doctors went out of their
way to be helpful in finding new physicians for these patients.
Additional information:
This recently occurred with our Geriatrics Department.
1. The department pulled a current patient listing of active patients
(15 months).
2. They identified practices in the area that are taking new Medicare
patients as Medicare makes up most of the patient population.
3. We did find out from those practices what insurance they do or do
not accept or participate with.
4. The active list of patients was provided to the providers and they
were requested to review and asked the question, "if discharged" whether
we would be put at risk. Those that were the sickest we retained.
5. We did not discharge any institutional benefactors, faculty or
relatives of faculty or alumni of School or hospital donors.
6. Ensured we were not discharging any patients inappropriately.
7. Sent the list to the P.R. Department to make sure we were not
discharging inappropriately.
8. We talked with publicity personnel for a script to use to make sure
that they agreed with what we were stating. This included that Medicare
rates were declining.
9. We provided Medical Records with a list of the patients as we knew
that those discharged patients would want a copy of their medical
record.
10. A letter with the date at the top was sent to those patients that
were being discharged providing them a 30-day notice to find another
physician. The letter was sent by certified mail and regular mail.
11. Green cards that were returned were filed in the patients' charts.
Denise
Bollheimer
U of Tennessee
1) This is handled in different ways depending on where the departing physician is
going.
(a) First, the clinical office staff starts telling patients months in
advance, if possible, that a change is anticipated. Sometimes the marketing
communications staff prepares a handout for use in the patient care office.
(b) Second, the Marketing & Managed Care VP oversees the development of
a mailing list, whose criteria depends on the situation. Usually we request
a list of the physician's patients who have received care within the last
18-24 months, who are still alive. We usually get information on the list
as to whether the physician was the just someone who covered for another
physician or whether the main relationship for the patient was with the
departing physician. We also usually determine the insurance classification
of the patient, as some patients require special handling, e.g., those
patients who must have care managed through a primary care physician. We
also sometimes sort patients by type of relationship, especially for
physicians with multiple locations or who are double-boarded (e.g., his
internal medicine patients might get one letter while his infectious disease
patients would get a different letter.) We have a specialist in Marketing
Communications who handles the direct mail and a specialist in Information
Systems who works with us to develop the lists per our criteria. They work
together very well.
(c) Third, we develop a letter letting the patients know that the
physician is leaving and which partners are still available to assume the
care giving. We give the patient instructions and guidance about medical
records access, how some insurance plans require that the new (replacement)
physician be an enrolled preferred provider, etc.
(d) Usually if the physician is leaving town, we scan the physician's
signature and write it from the physician's viewpoint ending it on Group
stationery. If the physician is going to be a future competitor, we write
it from the Group practice with his/her division or clinic as the signature.
2) (a) Enter practice in the community or
i. See "D" above. We try to steer the patients to remaining or new
partners at our Group assuming we have capacity. We also try to use this
situation as an opportunity to let the patient know about some positive
changes or services that will enhance the care or experience at UT Medical
Group. Regrettably, at times, we do not have capacity and thus give away
the patients, whom we worked so hard to obtain, to the departing physician,
almost promoting his new practice with our letter.
(b) Leave for another AMC? We are the only AMC in town; thus, this
scenario is usually easier for us. Usually we can absorb the patients with
existing or new physicians in the same specialty. We lose some patients but
not like the number we lose if the doctor stays in the community.
3) If patients are notified by some type of mailing, what does the
letter state and how is a patient list determined?
See "B above.
4) We usually have a systematic telephone calling process to reschedule
patients or to ask them if they would like to keep their same date, place
and time with another physician. Often a nice form letter is sent
confirming the new or confirmed appointment.
No they are not automatically given an appointment with another AMC
physician in that division/section?
Patricia
Monteleone
Saint Louis U
Patients are notified by letter from the Chairman indicating the faculty member's
new address and listing the replacement physician in the Dept who would be happy
to see the patient. It also indicates that if the patient wishes to see the physician
who is leaving they will have to request in writing that their records be sent
(especially if the
physician who is leaving is relocating in town.) The letter was written by our legal
counsel. I will be happy to send a copy to you for whoever is inquiring, just let me
know.
Ellen Meier
Shands
1) We send a letter
2) If another physician at same site has capacity, we direct/refer. If not, to another
facility.
3) Patient list if off our scheduling system - IDX. We designate a period of time to
go back and pull prior appointments.
4) Via letter if there is time - if not we call them. We do not automatically assign
them to another physician.
Douglas
Henson
U of
Pennsylvania
1. We do not have a specific policy, so each practice handles as they deem
appropriate. However, most primary care or continuing care specialist
practices send out a letter to active patients and provide our phone number
to schedule with another physician. Non continuing care specialist
practices here typically notify only active patients with future
appointments.
2. We will not notify patients of where the physician is going unless asked by
the patient. Our perspective is that the patient "belongs" (as does their
medical record) to the institution, not any individual. Of course we copy
records for patients upon their request if they choose to follow the
physician.
3. See 1.
4. Most patients are not given another appointment automatically.
Andrew
Rubin
NYU
This is a complicated question to answer in an e-mail - I do not know
what the process is for communicating with this group, but they can call
me directly.