Practice Management

Don't let plans for a satellite office leave you star-crossed

Q My specialty group plans to open another office in a neighboring county. How can we determine what's an affordable rent to pay for such a space when we don't yet know how much we'll be earning?

A You've got the cart before the horse. The costs of medical office space have nothing to do with your group's potential revenues.

Before you implement expansion plans, determine patient demand for services at the new location, how much you could expect to earn, how much you'll need to spend to get this practice off the ground, and how much you'll need to spend to maintain it.

Tell staff that letterhead is for business use only

Q I've noticed my office manager using my practice stationery for personal correspondence. Could this lead to trouble?

AYes. Her casual use of your letterhead could cause both legal and public relations problems. Anything printed on your stationery could be construed as having your stamp of approval. Tell her to stop.

The cold, hard facts on selling your practice

QA hospital has offered to buy my practice at what seems a reasonable price. In addition, it's offered me what I consider an adequate compensation and benefits package. How can I determine whether to trust my gut feeling?

A Talk to a practice management consultant or your state medical society to determine whether the hospital's offer is truly adequate. In addition, ask doctors who have already sold their practices to the hospital how satisfied they are with their arrangements. If you decide to move forward with the sale, try to negotiate favorable early termination language, and a waiver of any noncompete clause.

Should you tape informed consent discussions?

Q To further protect myself against malpractice charges, I'd like to tape the informed consent discussions I have with patients. Do you think some people will find this offensive?

A It depends. If you have a warm bedside manner, recording this kind of discussion could reinforce its importance with a patient. If you don't, the patient may wonder why you seem anxious and defensive and conclude that you've been sued.

Explain that you'll give the patient a copy of the tape so he can refresh his memory of the discussion. But be sure you've provided an accurate assessment of the risks, since the tape could be used against you if you haven't.

You should also get the patient's signed permission to tape the conference.

Whether to lower fees for patients with stingy insurance benefits

QMy partner suggested that we develop a "comprehensive physical exam package" for patients who don't have wellness insurance coverage. He's proposed that this package include the same basic exam and lab tests that we currently offer other patients, but at lower-than-normal fees. Is this legal?

A Yes—but it's not a good idea. Health plans base their reimbursements on your fee profile, so lowering any of your fees could encourage insurers to lower their payments to you.

Instead, charge your standard fee for the package, then adjust it for "insurance-poor" patients, giving them a discount. Or allow them to set up payment plans.

Edited by Kristie Perry,
Contributing Writer

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 mepractice@medec.com (please include your regular postal address). Sorry, but we're not able to answer readers individually.

Kristie Perry. Practice Management. Medical Economics 2001;22:91.