Friday, November 9, 2012

Closing My Medical Practice

     Quitting most jobs is easy.  You walk away and don't come back, or you give two weeks' notice--and then walk away and don't come back.
     Quitting a solo medical clinic is more complicated. 
     As I leave behind my life and profession I am undergoing a slow-motion psychic shock, like the subsurface rumbling and shifting that precede an earthquake.  It's comforting to know that many people go through this in so-called mid-life.  I wait it out as one waits out grief, standing guard as the entire edifice of my self-as-I-know-it comes down.  I can report on this process, as though telling a story, but I am unable in the midst of it to give advice.
    Wrapping up a medical business has to start at least three months before closing the doors for good, but some experts recommended starting two years in advance, especially if the practice is transitioning to new ownership.
     First come the letters.  Every insurance carrier must be notified that I am no longer "participating" in the plan.  Here's a sample of the eighty-five letters I have sent to insurance companies:

     Dear Plan Administrator:
          Pursuant to our contractual agreement, this letter of October 26, 2012 serves
      as sufficient notice by Colasante Clinc, PA/Ona Colasante, MD for the action of
     terminating our contractual agreement to provide care to your membership. 
     This termination shall be effective January 31, 2013 with the closing of
     Colasante Clinic, PA located at 810 NW 16th Avenue, Gainesville, FL. 32601.
                            Respectfully,  Ona Colasante MD

Information relating to plan numbers, my NPI, license, and tax ID numbers are included in the letters, and I sent them return-receipt-requested.  That way the insurance carriers can't claim that I have abandoned their clients.  Next, I'll notify AHCA, the medical board, the vendors who send supplies, and the local pharmacies.  The building will probably stand empty, and the bank that foreclosed on the prior owner (caught in the bank loan mess) and had to take over my lease will try to lease or sell it cheap.
     It would be easier if another doctor, clinic or group were to take over the existing clinic--then my employees wouldn't end up on the unemployment rolls and patients could continue to get medical care at the same neighborhood location. 
     But who wants to take over a clinic that's "under investigation"?  It doesn't seem to matter that my "contaminated" Medicare number would follow me, and not attach itself to a new business in the same location.  It doesn't matter that a new physician wouldn't be affected by the government's interest in me.  The place has been blasphemed, and no one wants it.  I might as well have been the victim of voodoo.
     I have considered selling all the clinic equipment, but the market is slow and it would take a lot of time and hassle.  Besides, my bookkeeper says medical equipment depreciates by 40% in the first year.  Therefore, I've decided to donate all the equipment to nonprofit entities.  A few pieces are slated to go to Guatemala.  Anyone want medical equipment?
     I called an office meeting last week and told all my employees about my decision to close up.  I must have been saying, "I'm sorry, I'm sorry," a lot, because they asked me to stop.  "It's not your fault," they said.  "You're a great doctor.  This is a crime."  I asked them what they planned to do with themselves after January 31st.  Three said they would go back to school.  One is likely to tend chickens, plant a garden, and wait for fate to knock on the door.  Another wants to run for public office.  Another is leaving the country.
     I am going to take a lesson from the government, and make a resolution not to rush through life. If the FBI can take ten years to tell me why it raided my clinic, chaoticized my calling, and anathematized my name, surely I can take a few years to count grasshoppers, look after my dozen chickens, mark up all the books in my library, and imagine the future in the vast banks of clouds overhead.



  1. well hell. You have to do what is best for you and your family. You, your staff and practice will always be near and dear to my heart. Thank you for the nearly 2 + years...

  2. Hi there, I found your blog via Google blogsearch and your post is very interesting. Thank you.

    Please visit: