Closing a Dental Practice: Patient Safety Considerations

By David O. Hester, FASHRM, CPHRM, Director, Department of Patient Safety and Risk Management, The Doctors Company

Dental practices undergo closure for many reasons, including dentist illness, death, relocation, or the dentist’s decision to sell, practice solo, join another group or retire. As a service to our members, the Department of Patient Safety and Risk Management of The Doctors Company provides this information to make the transition easier.

What should be done in an emergent situation?
During any change in practice, the continuity of patient care to ensure that no patient is neglected is of paramount concern. If the change is abrupt — as in the circumstance of a death — the safety measures below will assist in ensuring patient safety and continuity of care.

Review all previously scheduled appointments to determine the appropriate action. Immediately contact a dentist of the same specialty to arrange patient care or provide patients with a list of dentists of the same specialty within the area. You also should take the following steps:

• Ensure the availability and accessibility of dental records as needed for the continuity of patient care.
• Post a notice of closure in the office and in the local newspaper. (Contact your patient safety risk manager for a sample notice.)
• Call all dentists who customarily refer patients to the practice and all contracted managed-care organizations, and the medical malpractice carrier.

Who should be notified if it is a non-emergent closure?
If the practice closure is non-emergent, notify the following individuals and entities:

• all patients and legal representatives in the “active” caseload; this includes any patient seen in the past six months to three years or others the dentist considers “active,” and any patient in an acute phase of treatment
• all peer dentists within the community
• local dental societies
• all third-party payers (including Medicare and Medicaid) and managed-care organizations
• the DEA (if you are retiring or if you are moving to another state)
• the state licensing board
• professional associations in which you hold membership
• your CPA or financial adviser
• your employees
• landlords, lenders and creditors
• insurers that cover the practice, the employees and the physical facility

How should the notice be communicated?
Draft a letter to each patient that contains all the necessary details. The same letter can be used for everyone listed above. (Contact your patient safety risk manager for a sample letter.) It’s recommended that letters be sent with return receipt requested and that a copy of the letter and return receipt be kept. If a patient is considered high risk, send the letter certified with return receipt requested. Post a notice in a local newspaper to inform inactive patients or those who have moved away. Include directions for obtaining acute, critical or emergency care if a new dentist has not been selected by the time the practice closes.

Is there a time limit for sending the closure notice?
Yes. In a non-emergent situation, send the notice at least 60 days prior to the anticipated closure. This gives patients an opportunity to locate a new dentist and to obtain copies of their dental records without undue stress.

What other responsibilities should be undertaken by the practice that is closing?

• Provide patients with easy access to their dental records by enclosing an authorization document in the notification letter you send to them. (Contact your patient safety risk manager for samples.) When the signed authorization is returned, you can provide copies and apply appropriate charges.
• Provide information on where the dental records will be stored in the future, the length of time (in years) that the records will be retained, and a permanent mailing address or post office box number for all future record requests. Arrange a secure storage place for the original dental records that is safe from theft, fire, flood or other weather-related disasters.
• Maintain the dental records in accordance with The Doctors Company’s recommendations: 10 years after the last adult visit and 28 years from birth for pediatric patients. The records should be easily accessible and retrievable.
• DO NOT give original records to patients. The easiest method is to find another dentist to take over the practice and turn the records over to that provider or turn the records over to another dentist of the same specialty.
• Stress the importance of continuing care for all patients. Provide information about where they can find another dentist, such as the Yellow Pages and the local or state dental society.
• Make provisions for the completion of all dental records.
• Place a notice of closure in your waiting room and in the local newspaper for at least one month, giving pertinent details of the closure.
• Consult with your personal or practice attorney and the state licensing agency to ensure that you have met all regulations.
• Destroy remaining prescription pads.
• Keep the narcotics ledger for a minimum of two years.
• Dispose of any drugs.

Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.