Home Forums Discussions General Discussion May need to close practice for heatlh reasons

Dear AC group,

Due to a diagnosis of breast cancer, I am facing the possibility that Iwill need to close my practice. AS a solo physician who needw the time to do the treatment and not enough time to see the patients, there is a big cash flow problem.

Has anyone ever assisted in closing down a practice. I know in general what to do notify insurances, maintain records.

But where should I store my electronic data.

Any and all input would be appreciated.

So sorry to hear about your health problems. My thoughts and prayers will be with you.

Not sure of your situation, but you might consider using a locum tenens to cover while you are being treated.

If you plan (hope) to return to work this would be preferable to closing down completely.
Best wishes on your recovery.

Greg

My thoughts a prayers for you to get better! I wish you the best. Please keep us informed.

Thanks for the well-wishes. Here is the situation. I have stage 2 breast cancer diagnosed in time for my 48th birthday last September. I underwent a mastectomy and an excisional biopsy in November.

I took a leave of absence from my hospital starting in January so that I could complete the chemotherapy. But, due to the reduction in revenue, cash flow is TERRIBLE.

I have consulted with my accountant attorney etc to look at options. I still have 4-6 weeks of radiation to complete.

If I do have to close down shop, (very possible) how do I maintain my records. I have a network in my office with the charts on a server... can a server be set up in an alternate location (given that I will need to get rid of my building... I bought not rent)

Do I need to still pay for AC subscription for the next few years even though I won't be using it for data entry (assuming practice closes)

If anyone has any insight into this that would be great. I am not a technophile like some of the folks here... so keep it simple.... the chemo does some strange things to my brain....

Thanks in advance. The last dose of chemo is Friday... yippee...

There are several options.

1) Sell or lease your practice. Maybe if it is not worth much, give it away. That way the new doc can take over and you simply either walk away or work with them. Then you may have income coming from the building. You have a turnkey practice, with pateints to boot, there is value there.

2) Discuss with the hospital supporting your record base.

Depending on what the state rules are, there is a certain time records must be held, perhaps either another MD or the hospital will house them on a computer. You should probably check with either the state medical society or the state licensing bureau what are the requirements.

3) The AC subscription is for support and optional. If you are not using the system, you do not need support. You can always reinstate it without back cost (as far as I understand) when you return to practice (think positively).

I wish you well and you will be in my prayers as well.

Jennifer,

I am so sorry to hear about your situation. My thoughts and prayers are with you as well. If there is anything I can do.

For some of your questions (I am going to assume that everything is electronic). An idea of how many charts would be helpful.

As far as your records:

1. First, I would get someone or you could combined each record into one PDF (for each record not all together)
2. Put these all in one folder.
3. Back them up to two or three places. Like three or four hard drives. Back them all up to a DVD or two. You just don't want to lose any over time.

From here, you have several options:

1. As patients needed them, you could fax them. I wouldn't print them as that would be too expensive. But, some may need them that way.
2. You could have a young person, say 15 or 16 or whatever that wants to help you or make a little money on the side to burn one after the other to CDs. They would probably have to be part time employees or be bonded or something for HIPAA, but who cares to some degree. Each CD would have to be labeled with name and DOB and, of course, checked to make sure the PDF opened. These could be handed out to patients or mailed. Hopefully, practices in the area would work with you and just send someone by every 15 days or so to pick up the patient CDs. (I would be willing to mail you CDs if it helped or cases as well). The more expensive part of the mailing would be the padded envelopes for CDs. We could all chip in and send 25 each or so.)
3. I have heard of, but not seen because I haven't looked, of companies that hold records and release them as needed for a fee. Not sure how much.
4. As far as I know, you can move the records or server anywhere you want. Again, please put the files in two, three or four places. You may even want one DVD in a safety deposit box if it is going to be a long time. I know. Overkill, but you never know.
5. My understanding of paying for AC is for support and upgrades. You shouldn't have to pay for a copy that is just sitting there. Three things. First if it wasn't connected to the Internet, no one would ever know. Second, you are going to print all those records to PDF if you make the decision to close. And, third, I can't speak for Jon, but I am sure he would help you as much as possible and certainly wouldn't make you pay for AC if you aren't in business.

I am serious about any help or sending packets, CDs, etc.

Jennifer,

I am so sorry to hear about your troubles. I echo Bert by offering any assistance I can.

I think Bert's ideas are great. I would favor simply copying each patient's records to CD and sending them to the patients (or less costly, call and have them come pick them up). If they then require a paper record, they can do it or have it done themselves. Somehow denote in each patient's chart when and how their records were transmitted to them. You could use the function in AC such as when you send records to someone.

The one problem that has worried me about this plan is what happens if the OS or PDF or any other software program is no longer supported 7-10 years down the road? What if CDs or DVDs go the way of the Beta VCR? I guess you can relieve yourself of that concern if you give the patient the CD and then say "I provided their data to them, what happens to it after that is not my problem."

Lastly, transfer all of your patient data to external hard drives (make several copies), store in a safe place and stop worrying.

Hope things work out for you.

Jennifer
I am confident that you will overcome this incident in you life as you journey along. We have to HOPE for better things to come as HOPE never dies it just changes depending on our situation.
As far as your practice is concerned I might add to what others have suggested
1. Try and get a locum in your office until you are sure about the outcome of your breast cancer status. I would resist making any hasty decisions right now.
2 As far as the server is concerned - you can can take it home and attach a monitor to it and use it as a regular computer
3. As far as your patient data is concerned you can use one of your network computer as stand alone computer and back up your data from the server on its hard drive and also back your data as other have suggested on this board.
5 Finally when you are ready to get back to practice you can move your server back to your office.
6. If you decide you do not want to go back to your practice then you can rent your building as others on this board or sell the building and the practice
I wish you well and remember HOPE never dies it just changes- good luck- I know you will make a speedy recovery
If you need any help please let me know or send me a PM
Grenville

Jennifer
I am sorry to hear of your situation and wish you the best. You can join sermo(physician only website)for free and post a job opportunity or sale of your practice and building for free at that website. Maybe you would find a way to stay in practice. It makes me sad that you might/will close. I became a physician so that I could have my own business. I love my private practice and hope to be able to hang on in these difficult times.
Best of luck to you.

Jennifer,

AS has been mentioned, backup your database to an external drive (Segate, Western Digital, or similar) and put one drive in a safe-deposit box, or a fire safe if you don't trust your local bank.

http://jungledisk.com/personal/ offers a very inexpensive hosted & encrypted backup that starts low, just make sure and write your encryption key down somewhere if you choose to use a private key as well. Very low-effort for users, and would give some additional piece of mind if you are so disposed.

If you need some help in tackling the logistics of archiving your data, just send me a PM, and I would be glad to lend a hand.

I'm praying for you as you walk through this.

Jennifer:

I too will be praying for your quick recovery.

Have you contacted your local medical society or hospital? They might be willing to help with the locum tenens or with a potential future partner. You might also consider using a PA or NP to help you see your patients.

AL

Jennifer, I also will be praying for your strength and perseverence through all of your trials and challenges.

Agree with the back up of data. Is there a residency program that can place a senior resident in your practice while you are receiving treatment? Or, a med school that might be interested in setting up a clinical rotation for students, with faculty supervision?

I also would be glad to sponsor some CD's or DVD's if they are needed.

Tom Young, DO
Creston, Iowa

@ Bert

Thank you for your insight. My current practice has roughly 700 patients. My charting is all emr. I do have a server which houses the data on sight as well as using the OSBU through AC.

I have yet to copy charts to a disk or bulk scan them, how difficult an endeaver is this? I do like the idea of making a disk with the patients records and just giving it to them.. of course a receipt would be helpful for documentation.

What are the steps to copying a chart to disk?

I can backup to an external hard-drive and keep in separate location,

Remember I am not a technophile so the KISS principle would be greatly appreciated here.

Thank you Bert for your kindness in helping in this situation.

Jennifer,

I will give you what I would do. There are several ways to do it and lots of software, so I can only give my opinion. Certainly, others may chime in, and I would consider their ideas as well.

First, and this may definitely be different, while we keep the entire chart forever (as you should), we never print or copy the messages. We consider those "work product" for staff and many things on them would not be appropriate for a patient or the new doctor to see. Others may disagree and call it part of the chart. I just know that some of our charts have messages going back and forth that are more for staff. Certainly, they could be important in a court case from your end so definitely keep them.

After you have made a few backups using the AC backup and backing up the Imported Items folder a few times, I would suggest copying and pasting your Imported Items folder to whatever computer you are using to do this project. I would then do the following:

1. Pull up patient 1001 (or you can go alphabetically) and right-click on the patient's name. Select Pull Visit History.

2. On the right hand side, select Progress Notes Only, then Print Selection. You will need a print driver which can print to PDF. There are hundreds of free ones if you don't have one:

http://tinyurl.com/pdfprintdrvrs

You will need some type of PDF software which is capable of merging documents as well.

3. When you click on Print Selection, it will bring up a print window, click on the printer icon, then select the PDF print driver. Clicking here will bring up a dialog box asking where you want to save the file. Browse to the folder in the Imported Items folder labeled 1001.

4. Repeat process, this time selecting Summary Sheet on the drop down list of the patient. Using the same steps print this file to PDF saving in the 1001 folder. You now have the entire record minus the messages in the imported items folder with the patient's number.

5. You will have PDFs, .html files, possibly word files and others. This is where your merge software will need to come in. If you Google, "PDF Merge Files" you will find many free PDF programs that can do this. It may be the same software you used for the print driver. I have to confess here that I use Adobe Acrobat Pro 9.0 for all of my PDF needs, and it is costly but can generally handle any job. I am not sure exactly how some of the freeware ones would work, but with mine, I can highlight all the files in the imported items folder, right click and select Combine Supported Files in Acrobat. This merges all of my files into one PDF including the html files and the Word documents. After checking to make sure everything is included, I can now delete the other files, and I have the entire chart in one PDF file.

6. Continue on to 1002, 1003, etc. You can either rename the folders as you go or after. Once you finish all of the charts and you have them all in each folder, I would definitely back them up a few places, including a DVD if it will fit. It will probably be too big.

7. After you are assured that each folder has the entire chart and the folder is named correctly, you can burn them individually. There are many ways to go about this. XP Pro or other OS have their own CD burners. Sometimes, they don't work as well as they should. For whatever reason, I have Nero software on my machine, and I burn with it. Works great. But, you don't have to purchase Nero. There are many CD burners out there that are free:

http://tinyurl.com/freecdburners

8. Follow the instructions for whatever burner you choose and burn the folder to a CD. After it finishes the burn, it will ask you if you want to burn another. I would burn two. One to give to the patient and one to keep for yourself. It will also ask you if you want to keep the burn file for later. I would make a folder and keep each one in case you need to burn another CD and as one more backup.

9. Label the CD and put it in a case and store it somewhere in alphabetical order.

Please let me know if you have questions. I can also remote in if you need help. Of course some of this is dependent on the software.

Jennifer, I echo all the others' wishes for a speedy recovery and good health.

I would strongly encourage you (and others) to check out the free software program "PDF reDirect" (www.exp-systems.com).
With it you can easily do the things Bert described above. After installing, the print driver should show up as one of your options for a destination to which to print. As you go through the steps described by Bert starting at step 3, print each to "pdf reDirect"... it will open that program and begin a que of files that you want to "print" into a PDF... when you have finished "printing" each file (progress notes, summary, and/or each imported item that is needed in the new "chart") you can then name that file ("patient 1001") and save it as such. PDF reDirect will then combine all those into one pdf file as you named it onto your desktop (You can even set a password for the file... like the patients SS# or other identifier that hopefully only they would know... in case the resulting disk gets into the wrong hands).

If you just printed the chart notes/summary to that file, you would want to combine that with the imported items as Bert describes in step 5 to make one PDF file of the whole chart. Bert mentioned combining using Acrobat. If you still have ScanSnap s510 that I think you mentioned last year, it should have come with Acrobat Standard version 8... which can combine the files as in Bert's step 5 (you would just highlight all the various files, right click on the group, and select "Combine the supported files in Acrobat") to make one PDF.

Set a password for that file with PDF reDirect or Acrobat, and burn it to the disk as Bert describes. Either write on the disk, or include a .txt file on it, giving a hint to the password the patient would know.

Good luck, and let me know if you need a clearer description of the steps, or any other help.

Excellent post Chris. Very good information.

Jennifer,

If you really want to get fancy, especially if you do not have a CD or DVD burner and you have to purchase one anyway, you can make sure your burner is a "Lightscribe" one. This would allow you to use special disks that are Lightscribe compatible and with the correct software, you just flip the CD or DVD over and you can burn that patient's name and something like Medical Records. The burning process takes about five minutes.

I am not sure if the software is free. I think it comes with the CD burner. The disks are probably a little more. But, we will help you with that anyway. I use it any time I make a disk just because it looks so professional.

It is an extra step, and I am certainly not pushing it, I just wanted to make you aware that it exists. And, I or someone would make sure you got the software and disks if necessary.

But, in the end, you probably don't need it. Sharpie CD markers will do the trick. My handwriting is...well...I am a doctor...AND a guy so my handwriting is completely illegible.