A dental office can close for a number of reasons. A dentist may be beginning the process of retirement. Or a dentists may be selling their practice to another dentist or group of dentists. In some cases a dentist office may close due to poor performance or lack of clients. In any of these cases, the dentist has a number of obligation to their clients, as well as to many other entities with whom the dentist may hold contractual relationships. Some of these obligations are enshrined in law or public policy, so following them is crucial. Closing a dentist office is not simple, and there are many steps to consider.
The Decision to Close an Office
Deciding to close an office for any reason is a big decision and may be rather emotional for the dentist and their clients. Like any business, and especially medical practices, clients may form a relationship of trust with their provider.
If a dentist has long time clients, it may be difficult for a client to find a new dentist whom they can trust. That’s not to say a dentist can’t close their office. But it does mean that a dentist’s obligations may go beyond the legal basics to a more ethical concern about their clients. If possible, it is great to provide referrals to new dentists that the closing dentist trusts. Passing on clients in this way can continue a relationship of trust and help clients make the move with confidence in their new provider.
Closing any business can mean undoing a tangled set of business and contractual relationships. These include professional associations, closing out balances, and many other details. For this reason, it is always best to seek some form of legal counsel when closing a business. Using legal counsel can help a business owner avoid any issues down the road, including lawsuits that may result from unfulfilled obligations or other issues associated with ending one’s business relationships.
In the case of dentists, there are several legal bodies that may govern a dentist’s closing specifically. In addition to the regulatory bodies involved in any small business closing, a dentist will need to follow the guidelines of some medical and dental specific organizations. These guidelines are meant to protect patients from being left high and dry by a medical or dental provider. They are also intended to protect a medical or dental provider from legal action or obligations from clients and others resulting from the closure of their business.
Obligation to Patients
One set of guidelines that govern the closure of a dental practice comes from the ADA, the American Dental Association. Its Principles of Ethics and Code of Professional Conduct Section 2.F prohibits dentists from simply abandoning their patients.The specific wording of this section requires that dentists provide clients “adequate notice and the opportunity to obtain the services of another dentist.” This can be done in a number of ways. It is important to get this step right to avoid allegations of patients abandonment. In general, any notice should be given at least 60-90 days prior to closure.
It is recommended that a dentist not rely on any one form of notice, but use multiple methods of notifying clients of the impending closure. General notice can be given by posting a notice in a prominent place in the dental office. Of course, this only works for patients who will be visiting the office within that 60-90 day period before closure, so this is only a partial answer. Another possible form of general notice is to take out an ad in a local paper. However, readership of newspapers, and especially local newspapers, is dropping, so this too should only be part of a larger strategy.
The most reliable way to inform clients of an impending closure is to contact each one individually. This can be done proactively be sending written and/or electronic notice to all clients who have visited in the last year. This method is ideal because it creates a written record of notice. This is important in case of any future claims of abandonment. Other methods include conversations with clients who visit (make sure to document the conversation in the medical record), verbal notification of clients who call to make appointments, and written notice on any invoices that are sent out. In any case, documenting the notice can be a key to avoiding any claims of malpractice due to patient abandonment.
Giving Notice to Other Organizations, Agencies, and Legal Bodies
To properly and responsibly close a dental practice, you will need to notify a number of organizations, agencies, and legal bodies. On the state level, most state dental and pharmaceutical boards require some advance notice of a closing. Medicare and Medicaid also require notification. It is easy to forget, but it is also necessary to notify the Drug Enforcement Agency (DEA), since dentists have the ability to prescribe legally restricted medications. Some of these organizations can be notified electronically, while others require written notice. It is recommended to contact each organization to learn their policy for notification.
It is also a good idea to notify any business with which you have contractual relationships. This can include insurance partners and providers. Each business will have its own policies regarding payment of invoices, so it is important to contact them directly to ensure you get paid before you close.
It is also necessary to contact your malpractice insurance provider. The insurance status will need to change so that you are not paying for current malpractice insurance, but are still covered for claims made regarding service before you closed. You will have to talk to your insurance agent to go over the details of those changes.
A dentist should also contact other organizations with whom they have relationships, such as professional associations, referral sources, hospitals where the dentist has admitting rights, as well as labs and surgical centers with whom the dentist may have a relationship. Finally, as with any business, the US Postal Service should be notified to ensure that mail addressed to the closed office is redirected to the appropriate location or returned to sender.
Dealing With Patient Records
Technically, all patient records are the property of the medical provider. However, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) gives patients the right to request and receive their medical records. A medical provider can charge a reasonable fee for the duplication of records. That fee can be regulated by state law, so it is important to check before setting a fee. However, if a client has outstanding payments or fails to pay the duplication fee, the provider is still required to hand over the records within 30 days of the request, with a one-time extension of 30 days available with written explanation of the delay.
When It All Goes Wrong
Failure to follow these guidelines when closing a dental office can lead to a whole host of problems. Claims of abandonment may be filed as malpractice claims. Furthermore, failing to properly close out contractual relationships may put the dentist in danger of lawsuits.
In this case of a dentist from Statesboro, all of these common sense steps were neglected, and patients were left high and dry with unfinished dental work and nowhere to turn. Some clients filed complaints with the state body that regulates dentists. But a TrustDALE investigation has found that a whopping 97.5% of complaints are dismissed or decided in favor of the dentist. Sound a little unfair? You bet it is! You can follow Dale’s investigation on the TrustDALE Facebook Page.
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