When problematic patient behaviors make it hard to continue providing care, a standardized approach that categorizes common problems and defines a course of action for each category can be helpful. Tier 1 problems might involve missing five appointments in six months or using abusive language with a staff member. Tier 2 problems might involve a continuation of Tier 1 behaviors or actions a staff member perceives as threatening. Tier 1 and Tier 2 problems should be discussed directly with the patient and documented. Tier 3 behaviors, which would warrant termination of the physician-patient relationship, might involve a continuation of Tier 2 behaviors or any violent or potentially illegal actions.
Termination typically requires reviewing the payer’s rules and sending a certified letter to the patient to explain that the relationship is being terminated and to find a new physician. A 30-day notice period is often required. Remember to inform other clinical or office staff of your obligations, such as facilitating records transfer to the new physician and providing care for emergent issues during the notice period.
Adapted from “Terminating a Patient: Is It Time to Part Ways?”
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