Questions to Ask Before the Closure of a Medical Facility

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When preparing for the closure of a medical facility or any application where Protected Health Information (PHI) is stored, there are a number of steps you can take to reduce costs, minimize risk, and improve efficiency. Many healthcare providers we work with have no experience with closing a healthcare facility. It’s a daunting process, and missteps can lead to expensive mistakes and other consequences. That’s why it’s best to outsource records and ongoing management, release, and destruction to a provider with experience in this area. At Cariend, we have decades of experience walking clients through this process. In this blog post, we share some basic questions healthcare facilities and those responsible for records should ask before finalizing the closure.

Do you understand all the records you have?

In this instance, all means all. All types in all locations, including any records that may reside in offsite storage. This includes paper, film, electronic, medical, and non-medical records. If you are planning to work with a custodial management provider, an estimate of the volume of records is required to get an accurate cost to handle the records on an ongoing basis. Different types of records can have very different legal retention requirements, and these laws vary in every state. Examples of different retention segments include medical vs. non-medical records, employee health files, records involving litigation, pathology specimens, and business records. Failure to physically segment these records could lead to additional costs in a Custodial Records application, as unsorted records incur charges to either manually sort records to create the necessary segmentation, or simply storing all the records for the longest possible retention, even though certain records may be eligible for destruction sooner. Working with a custodial manager who uses indexing can save you money long term by properly sorting records and destroying them when their retention is up.  

Do you understand the legal requirements for each type of record?

The legal requirements vary – by state and by type. Your healthcare attorney, malpractice insurer, or state medical board can provide the necessary legal guidance for the retention requirements of your records. 

Have you properly prepared for notification?  

Notifications are typically required for patients of a medical facility, former employees, and to alert governmental or regulatory agencies where records can be obtained for activities such as litigation, audits, and worker’s compensation. As is the case with lots of medical issues, every state has different requirements for notification of closing healthcare facilities. What information is included in the content, what method of notification is required, and how much lead time is required before you close are all dictated at the state level. It is paramount that patient notification is handled correctly. Typically, an attorney, malpractice insurance, or state medical board can supply your office with the correct information.

Do you understand the process for ongoing release of information?

If you are looking to outsource ongoing custodial records management to a company, ask for a Business Associate Agreement (BAA) aligned with current HIPAA laws. At Cariend, this is standard practice, as it ensures your records and the ROI process will be handled completely within the HIPAA requirements. This has become a top topic issue given recent class-action litigation and further guidance from the US Department of Health & Human Services (HHS).  If you do not do due diligence on the front end, issues such as mishandling the records, security breaches, and charging more for copies than the laws allow, can result in fines that extend to you, because you will have signed a contract delegating the records supplier to act on your behalf. 

If you are considering managing the records for your closed business or medical practice yourself, be warned: the risk, cost, and disruption of this approach is substantial. The statutory retention requirements for most records span many years – sometimes decades –, and the time and effort to manage this process are significant and are oftentimes underestimated, mainly because the level of activity for a record set after a business or practice has closed can be significantly higher than when the business was operating. Especially for medical practices, any patient that goes to a “next” doctor for continuing care, will automatically need copies of their records, and even patients without acute situations may panic and request their records when hearing their medical provider is closed, simply out of fear that they may not be able to retrieve copies of their records when needed later. Furthermore, the laws require the records to be available for an unlimited number of times during the statutory retention period, so even if a patient received copies of their records at some point, they are still legally able to require additional copies throughout the statutory retention period. And it’s not just medical records that require ongoing management. Business records, including employment, financial, and legal documents, all carry requirements for storage and management after a business closes.

Are you willing to deal with process servers knocking on your door with subpoenas in the event of litigation requiring copies of the records? Are you willing to handle the requests of patients needing medical records while on a family vacation or during holidays? Finally, do you feel confident in your ability to store and handle records?  At best, it will be a significant impediment to your life for years. At worst, improper storage or release could expose or damage protected information, leading to fines or other penalties.

Have you come up with a plan for electronic records?

Without a plan for electronic records, you could be stuck paying an annual license fee for your EHR in perpetuity. If you use any software to manage your business that does not store data in a format that can be easily accessed by common business computing applications, the cost to maintain access to that proprietary system is much higher than performing a one-time export or conversion of the data to a generic format. You also risk losing access to the data in the proprietary format, if the system provider should discontinue the product, be acquired, or go out of business before the statutory retention of your records is met. 

There are many facets to handling records – and records are just one piece of the puzzle for a closure. To be sure, closing a facility is a complex and fraught time. When you outsource to a Custodial Records Management company, you can be sure that all facets of your records will be properly handled and allow you to focus on the bigger picture of the facility.  If you have further questions, please contact Cariend today.

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