How long do medical records need to be kept after closing?
When a medical practice closes, most administrators find themselves asking the same question: “How long do I need to keep the medical records?” Regardless of industry or closure status, the word retention typically conjures up feelings of stress and panic. Often, retention policies are complex and designed to adhere to standards that can seem inarticulate or vague. Adding the pressure of winding down a practice or facility can make it an overwhelming task.
Retention policies exist to protect various stakeholders. These decisions are shaped by the business theory of stakeholder ethics. In the medical world, physicians (and those acting on behalf of them) have a moral obligation beyond that. Their dedication to the practice of medicine and to their patients is also influenced by the Hippocratic Oath. It’s important to consider the interests of all stakeholders when closing a practice or medical facility – patients, employees, shareholders, and others will need access to the records once the facility has closed. If records are discarded too soon, it may result in the stakeholder not being served properly. When a reasonable request is made, there is an ethical obligation to produce the record. When a good faith effort is not made, there is a case for incompetence or neglect.
The first step in determining how long to keep your medical records is to identify the records that you have. Then you must consider the business functions those records support. And finally, you must gather enough information to make reasonable decisions. There is no one-size-fits-all approach to retention, but as you move through the aforementioned steps, there are three important areas to consider.
Legal or Regulatory Requirements
Ensuring that you’ve satisfied all legal and regulatory requirements for retaining medical records can seem daunting at first, as there are many variables. However, once you’ve conducted the proper research, you’ll find that regulatory requirements are relatively straightforward and reasonably relaxed. Spend time researching industry-specific information related to your records, and that generally establishes the floor of retention requirements. As you investigate regulatory requirements for medical records, consider the following:
Location
Depending on the state where the practice is located, a quick search about retention on the internet may reveal what seems to be the correct answer. However, there are often other factors which can affect the length of time for storage. One common misconception about retention is that there are rules governing retention policies at the federal level. While HIPAA laws state that many of the various record types involved in managing a medical practice must be stored for six years, there is no HIPAA retention standard for medical records alone. That decision is left up to each state.
Types of Records
In researching the retention policy for your state, you may first encounter a general retention policy for medical records, but potential exceptions to the general policy may not be clearly listed. Examples include records involving pediatrics, pathology specimens, mammography, immunization, or situations where prior litigation exists. In these cases, at least some of the records may require longer retention than what is indicated by general state guidelines. It’s important to understand all the types of records a medical practice or facility may have and allow that to shape your retention decisions.
Statutory requirements that supersede state guidelines
Another regulatory factor that impacts the retention of medical records is whether the records include Medicare or Medicaid patients. Centers for Medicare & Medicaid Services (CMS) currently requires 10-year retention for these records. If your state’s general medical record retention requirement is less than 10 years, but your record set has a meaningful number of Medicare or Medicaid charts, you should consider storing the records for the longer term, or at least separating out the records with different retention to reduce storage costs.
Operational Requirements
Some states are vague or even silent on how long to retain medical records for closed practices. Beyond the legal requirements, there are several compelling reasons to store closed practice records due to the operational needs of the records. In an ongoing business or practice, this is where most of the consideration happens. What are the operational needs for retaining records? Aside from the legal requirement, how long should records be kept in order to provide appropriate care? The factors are somewhat different for a closing entity; however, operational needs still exist in very real and significant ways.
Continuation of Care
First and foremost, continuing care for patients should not be disrupted by a physician or practice that discarded records immediately upon closing simply because the state did not provide better guidance. Acute patients must have immediate access to records upon closure. In order to establish a relationship with a new physician, they will need their medical records from the previous practice. This is standard for all medical histories, but the need is particularly heightened when it comes to acute and chronic conditions. In those situations, lack of access to records or a delay in services can be life-threatening.
Sometimes, physicians in states with little guidance mail notices informing patients their records must be claimed soon after a practice closes, as the records will be otherwise destroyed in just a few months. This is not an effective strategy, as the practice will be bombarded with requests from some patients during the short claim window, while other patients who do not receive the mailing forever lose the opportunity to obtain copies of their records for continuation of care.
Credentialing
Aside from the records needed for medical care, former employees, including the medical staff, need access to business records, so they can move on with their lives and careers. After facing the initial shock of job loss resulting from the closure, hospital personnel shouldn’t have to deal with additional challenges of obtaining proof of employment, tax documents, or credentialing information. Inability to access employment and credentialing information contributes to healthcare professionals leaving a community after a practice closure.
Risk
Practitioners and administrators should also consider personal risk when closing a medical practice or facility. Aside from potential insurance, Medicare, or Medicaid audits that could result in payment claw-back without the supporting medical records, a practice could face litigation after closing, and the medical records may hold the key to the defense. Malpractice insurers typically offer a tail-risk coverage policy for closed medical practices. As a result, the malpractice insurer can be a great resource for guidance in choosing the specific retention for the closed practices they cover. The custodial records provider can also assist in developing strategies for effectively segmenting and managing the records to balance cost and the retention needs of the closed practice.
Historical or Archival Significance
The third consideration when establishing how long records need to be retained is whether the records have historical or archival value. Does your organization have a commitment or obligation to maintain records with historical significance? A very small percentage of the totality of records meet this standard. Records are only considered to be permanent if they are highly likely to have continuing scholarly value. Even then, maintaining records in perpetuity is not the most realistic practice. It is better to approach as indefinite or uncertain rather than permanent, and then establish a process and timeline for revisiting once enough time has passed to determine the long-term value. When planning a practice closure, there are many complex things to consider. Managing records shouldn’t be one of them. A trusted records custodian such as Cariend, can assist you in determining which records to keep, help you evaluate your state’s retention requirements, and consult you on how to best organize your records to optimize retention and reduce your project cost.
Retention of medical records with Medical Records Escrow
In order to minimize risks associated with a practice closure, Cariend, a leading US provider of healthcare records management solutions has teamed up with Escrow London to provide a Medical Records Escrow service.
With this partnership, together, Cariend and Escrow London helps closing healthcare practices by navigating the many nuances of records retention. For more information about retention requirements after closing a medical practice or how to best manage this process, please contact Escrow London or Cariend.
