When part-timers make sense for your practice, Persuading an HMO to play on your team, Is this the right system for discouraging no-shows? How the government can help you collect on ancient accounts
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Q Our practice needs another full-time medical assistant. Our office manager suggested we consider hiring two part-timers instead, because they'll save the practice the cost of benefits. Do your consultants agree? Should our help-wanted ad encourage both full-time and part-time applicants?
A Advertise for both, and base your decision on the quality and availability of applicants. You may not find two suitable candidates whose schedules complement each other and the needs of your practice. And keep in mind that part-timers often want a higher hourly wage in exchange for no benefits. You should do a cost analysis to see which approach makes the most financial sense.
Q My dentist uses a scheduling trick that I'd like to try: If his receptionist gets an answering machine when making a reminder call, she asks the patient to call the office to confirm the appointment. If the patient doesn't phone in after two days, the scheduler calls again and leaves a message stating that the appointment will be canceled unless the patient calls to verify that he'll be there. Is this a good idea?
A No. There are too many opportunities for miscommunication. A patient who arrives for an appointment your office canceled will be very unhappy.
If your practice has a lot of no-shows, try to find out why. You may just need a better system for confirming appointments, for instance. If there are just a few habitual offenders, your scheduler might mention the problem to them when they call for appointments and ask what your office can do to prevent scheduling mishaps.
Q A few months ago, you described a way to prod patients with outstanding medical debts to pay up if they've received insurance reimbursement. You suggested that doctors send such patients a letter stating that unless they make good on their balances, the practice would file a 1099-C form with the IRS. The IRS, in turn, would register the insurance check as earned income for the deadbeat patient. Can we do this with accounts that are two or three years overdue?
A Yes. Your letter should explain that the patient has 30 days to contact you regarding his outstanding bill, and that he may pay in installments, if necessary. Assure the patient that if he makes an honest effort to retire the debt, you won't contact the IRS.
QTo cut personnel costs, our group's billing manager proposed that the next time we negotiate a contract with our biggest health plan, we ask it to waive surgical preauthorizations.
AThis plan approves 90 percent of our requests. Yet negotiating the approvals takes countless hours of staff time from both organizations, and the potential savings are considerable. Would we be out on a limb with this proposal?
No. Your experience mirrors that of most practices. Health plans are notorious for resisting such proposals, but if you can document the 90 percent approval rating and the potential savings for the plan, you should propose the idea anyway.
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 email@example.com (please include your regular postal address). Sorry, but we're not able to answer readers individually.
Kristie Perry. Practice Management. Medical Economics 2001;14:100.