Risk Management Tips: How to Properly Discharge a Patient

Discharge of a patient from care can be complex. While we recommend that you seek counsel if you have specific questions, below are some guidelines:

1. Discharge should be stated to be effective as of the date of the letter.

2. You may use one of the three most common reasons why physicians discharge patients:
   1. nonpayment
   2. noncompliance
   3. a disruption in the physician-patient relationship

3. Become knowledgeable about the requirements regarding any restrictions on discharge imposed by the third party payors with whom you participate.

4. Discharge of each patient must be determined by the physician on an individual basis and based on reasonable documentation in the medical record.

5. You must give the patient at least 30 days from the date of the letter to call you for an emergency in order to avoid charges of abandonment. This time period could be longer depending on the patient’s condition and the availability of alternative care.

6. Refer the patient to the County Medical Society or a hospital referral source to obtain the names of other physicians.

7. When the patient to be discharged is in need of urgent or emergent care, continuous care without gap, is more than 24 weeks pregnant or has a disability protected by state and federal discrimination laws, the question of whether the patient can be discharged should be discussed with counsel, since discharge may not always be possible.

8. Documentation of problems which have led to discharge is a must.

9. Use the USPS certificate of mailing procedure, not certified mail, to send the discharge letter so it will not be refused/unclaimed and will be forwarded if the patient has moved.

10. Flag the office computer or other appointment system to avoid giving the patient a new appointment after discharge.

11. Provide the patient with prescriptions for an adequate supply of medication or other treatment during the discharge period.

12. Promptly send the patient’s records to the patient’s new physician upon receipt of a proper authorization.

13. Form letters and a memorandum on the discharge of patients may be available from your legal team for your use.

This “Risk Management Tip” was originally published in our Fall 2015 Dateline, which is available here. Need more information? MLMIC-insured physicians may contact Fager Amsler & Keller, LLP at the numbers provided at our website under “Legal Advice and Services.”