As a nurse practitioner, the time will come when you have to discharge a patient from your practice. This is normally not a problem when you are an employed nurse practitioner because your manager will take care of this for you. As a nurse practitioner entrepreneur though, YOU have to take care of this.

What is the best way to discharge a patient? There are two ways.

1. A discharge letter.
2. Having them leave on their own accord.

Why would you need to discharge a patient to begin with? Most of the time, it is because of non-compliance. We have all dealt with the non-compliant diabetic or the patient that refuses to follow your post visit instructions. To put it bluntly: these patients make your life a pain in the ass. Why bother with them? They are a liability in my opinion, and I am in this for the long game. Why deal with unnecessary malpractice and liability?

Another common reason is that the patient is a jerk, very rude, or downright dangerous. Again, we have all dealt with the patient who has angry outbursts or tries to nickel and dime you for everything. These patients are hard to deal with and can be dangerous to you or your staff.

There is also the patient that is high maintenance. You know the patient I am talking about; always calling your office, always wanting to be seen, has a complaint for everything, talks way too much and a 10 minute appointment turns into a 60 minute one, etc. These patients suck the life out of you. When you see them on your schedule, you fill with DREAD. Every one of you has a particular patient in your mind that meets this criteria as you read this, I know you do.

Then of course, you have the patient who does not pay their bills. Yes, you can discharge patients for this, there is nothing illegal about doing so.

Regardless of the reason, as a nurse practitioner entrepreneur, you must discharge patients from your practice from time to time to help preserve your sanity.

The most common way to discharge a patient is by sending them a certified letter in the mail outlining why you need to discharge them. This letter needs to contain 4 elements:

1. The notification: Simply state that they are being discharged from the practice for “whatever reason.”
2. The effective date: Include the date for when the discharge is officially effective. This needs to be at least thirty days beyond the date of the letter.
3. The termination reason: It is fine to tell the patient why you are discharging them. I think it is the most respectful thing to do. The patient needs to understand why the relationship is being terminated. This can be as simple as “non-compliance with the prescribed treatment” or “missing appointments.”
4. Record transfer: Offer to provide the patient a copy of their medical records so they can provide them to the next provider who will be taking over their care.

Include these 4 elements in the letter, mail it off, and be done with it…

There is another way to discharge patients though. I actually learned this from an MD mentor of mine who owns and operates a multitude of practices: Try to just have them leave on their own accord. How do you do this? By making your practice more tedious for them.

If a patient is non-compliant with treatment, then REQUIRE them to come to your office on a very regular basis for continued counseling, evaluation, and treatment. Only prescribe them enough medication to last them until their next evaluation. Chances are, they won’t show because they are not compliant anyways. If they do show up, then great! They are trying to better themselves, but most of the time, they won’t show up and will just stop coming to you because you made it tedious. Problem solved…

For example, when I had my Suboxone practice and had difficult patients (non-compliant, rude, late to appointments, etc.), I just required them to come in more frequently for a drug screen and only prescribed them 1 weeks’ worth of treatment at a time. Guess what? 9 times out of 10, they just stopped coming.

Another example is at my men’s health practice. I had a patient that I suspected was abusing their testosterone. He requested an early refill because he “dropped his bottle.” Okay, fine. I usually give them the benefit of doubt the first time if they show me the broken bottle, which he did. Well guess what happened? He dropped the bottle “again” 5 weeks later. Dude, come on… Do you think I am an idiot? So, I made him come in immediately for a testosterone level check the day he called to verify what his testosterone level was. Guess what happened? He never showed up because he knew that his level was going to be supraphysiologic. Problem solved… I don’t want these types of patients in my practice anyways.

If the patient fails to show up for their appointments on time regularly, then have a late appointment penalty and a no-show penalty. Once the patient racks up a couple penalty fees, then chances are they will just stop coming to see you. Problem solved…

If you are dealing with a high maintenance patient, then simply do not give them what they want. Have a FIRM time limit on appointments. If you need to be rude to leave the room, then do so. Refuse to give in to these patients demands. Patients like this NEED a provider’s life to suck, so simply do not be the one they can do it to. They will leave on their own accord.

For the patient who does not pay their bill, then charge them severe late payment fees and send the bill to collections. The patient will stop showing up and stop bleeding you dry. Problem solved…

Ultimately, you need to discharge the patients that are slowing down your practices progress as quickly as you can. It is not your job to babysit non-compliance, it is your job to provide quality care and operate a high revenue practice. Sometimes it is best to just send the patient a letter, and other times, it is best to have them leave on their own accord. That decision is ultimately up to you.