Partnership with a midlevel provider, Who pays when a health plan mistakenly approves care? Plugging a practices money drains, Your liability when an employee has an auto accident, When a doctor's absence wreaks havoc with scheduling
Q A nurse practitioner and I are leaving our hospital jobs to go into private practice together. Neither of us wants an employer-employee relationship. Can a physician and an NP set up a partnership, professional corporation, or limited-liability corporation?
A Few states allow nonphysicians to own medical practices. But some permit practitioners in related medical disciplines to go into business together. Check with counsel for your state medical and nursing societies or a knowledgeable health care attorney.
Even if the NP is prohibited from medical practice ownership, you can establish a compensation formula that rewards each of you appropriately for the level of services you provide.
Q Over the last two years, I've noticed a dip in my take-home pay. I know I need to make changes in my practice, but where should I startwith the number of patients I see, managed care payments, collections, or overhead?
A Everything is interrelated. Assuming most of your revenue comes from managed care plans, home in on them first, to make certain you're not losing money on any of your contracts. If your practice is mainly fee-for-service (including Medicare), concentrate on building patient volume. Then go after collections and overhead.
If those efforts don't rectify the problem, you might also want to review your financial controls and cash-handling procedures.
QI pay registration and travel costs for employees who attend professional training seminars. If a staffer were to cause a traffic accident on the way to one of these classes, would I be liable for damage to the other car and its occupants?
A Yes, because the employee is acting within the scope of employment. Talk with your auto insurer about buying extra coverage to protect you in such a case.
Q What recourse should we give a patient if our practice cancels an appointment because a physician is sick or has a personal emergency? Is it good enough to reschedule within the week, or should we offer an appointment with another doctor for that day?
A After apologizing for the inconvenience, your receptionist should give the patient both options, but explain that a same-day appointment may involve a wait.
If you're not already doing so, try to call and reschedule patients as soon as you know the doctor will be absent.
Q More than once, an insurer that authorized treatment for a patient later informed my practice that the patient's coverage had expired by the time the service was provided. Should I try to recoup the cost of the care from the patient or the health plan?
A The patient. Health plans have no obligation to pay for the expenses of patients whose coverage has expired.
If the patient's bill is large, allow him to pay in installments. And if this is a frequent problem, have your staff verify patients' insurance a few days before the appointment.
Do you have a practice management question that may be stumping other doctors, too? Write: PMQA Editor, Medical Economics magazine, 5 Paragon Drive, Montvale, NJ 07645-1742, or send an e-mail to firstname.lastname@example.org (please include your regular postal address). Sorry, but we're not able to answer readers individually.
Kristie Perry. Practice Management. Medical Economics 2001;15:118.