In the midst of the current trend of physician-hospital alignment, and ever-growing numbers of physicians being employed by hospital and health systems, the Ohio General Assembly has passed a new law which changes existing Ohio law on the mechanics and scope of patient notification of a physician’s departure from a practice.
Ohio House Bill 417 (“H.B. 417”), which becomes effective March 22, 2013,1 imposes greater burdens on physician employers, whether traditional private practices or hospitals and health systems, than the current regulation.
Under current law,2 a departing physician is required to send patient notification letters when their employment has been terminated for any reason.3 The physician’s notice must be provided to all patients seen by the physician in the last three years, and must be sent at least 30 days prior to the last date the physician will see patients.4 In terms of required content, the notice letter must advise patients of their opportunity to transfer or receive a copy of their records.5 Current law also requires that notice be posted in the office and in the largest newspaper in each county in which the physician practices. Additionally, while not expressly part of existing law, an AMA ethical opinion provides that where the obligation to notify patients is placed on the physician, as under current Ohio law, the practice group should not withhold patient lists or other necessary information.6 Physicians who fail to provide the required notice or interfere a physician’s efforts to do so, could face disciplinary action under Ohio’s Medical Practice Act.
Through H.B. 417, the Ohio General Assembly has made several significant changes to this current law:
Burden to Provide Notice Shifts To Employer. The notice obligation is now on the physician’s employer, rather than on the departing physician, unless the employer requires the physician to do so and provides the physician with a patient list and patient contact information.
Look-Back Period for Generating Patient List Shortened. Patient notification letters must now be provided to all patients seen in the last two, rather than three, years.
Deadline for Sending Notice Extended. Patient notification letters must be sent by either the date of termination or 30 days after the employer is notified of the physician’s termination or resignation date, whichever is later; rather than 30 days prior to the last date the physician will see patients.
New Content Requirements for Patient Notification Letters. Patient notification letters have new content requirements, including (i) notice that the physician is leaving; (ii) the physician’s name and new contact information, if known, unless the employer has a “good faith concern” that the departing physician’s conduct or medical care would jeopardize the health and safety of patients; (iii) the date the physician ceased or will cease to provide services as an employee; (iv) contact information for an alternative physician within the employer or elsewhere; and (v) contact information which enables the patient to obtain information about their medical records.
New Medical Board Rules Mandated. Within six months, the Board must revise its rule governing patient notification to be consistent with H.B. 417.
Limited Exemptions. Not only does H.B. 417 place new burdens on physician employers, but it also provides fewer exemptions than current law. For example, current law exempts notice where the departing physician has transferred care to another physician in a separate group. H.B. 417 does not include this exemption.
Signs and Newspaper Ads no longer mandatory. H.B. 417 removes the current requirement of posting in-office signage and placing newspaper notice.
When physician-practice departures become adversarial, the issue of patient notification is often one of the chief sources of conflict and dispute. H.B. 417 will certainly change the dynamics of such disputes particularly with regard to the timing and content of the notice. The “good faith concern” provisions, which permit the employer to exclude the physician’s new contact information from the notice, provide further ground to heighten conflict among the parties. Additionally, the changes in the timing of the notice will likely result in patients receiving notice after the physician’s actual departure. While H.B. 417 imposes new burdens on the employer, these two items certainly give the employer advantages in terms of content and timing of the notice.
In light of H.B. 417, Physicians and their employers are well-advised to review existing employment agreements for compliance with the new law and to avoid unnecessary disputes concerning patient notification. In conducting any review, bear-in-mind that the Medical Board is required to adopt new rules which will give further detail and guidance before September 22, 2013. If you have any questions about this topic or any other health related issue, please contact an attorney from Dinsmore’s Health Care Practice Group.
(1) Codified at R.C. 4731.228.
(2) Ohio Adm.Code 4731-27-01.
(6) AMA Code of Medical Ethics Opinion 7.03.