Evaluating a hospital's income guarantee, Could you lose money with that insurer? Don't leave patients lingering in exam rooms, When a PA wants to know how much he's bringing in
QThe hospital that recruited me to take over the practice of a retiring physician has offered me a one-year income guarantee. How can I determine whether the compensation arrangement is fair?
A Any income guarantee is more than fair, since it provides you with steady earnings regardless of your productivity.
Your agreement with the hospital should allow you to earn more if your work produces more revenue than necessary to break even with your salary, benefits, and practice overhead.
QWhat formula should I use to determine whether a health plan's fees actually cover the cost of providing services to patients?
A Compare the plan's conversion factor with Medicare's. If the plan's is higher, you should be fine. If not, you'll need to evaluate whether your group's cost-control methods will allow you to at least break even on the plan's patients.
QPatients in our two-doctor, six-exam room practice complain that they wait too long for a doctor once they get into the exam room. How can we figure out what's causing these delays?
A Create a time-analysis worksheet to record patient flow. Across the top, leave space to fill in the patient's name, reason for visit, scheduled appointment time, arrival time, and the time he's shown to the exam room. If the patient had no appointment, it's important to note "none" or "walk-in."
Below, set up columns for "time in," "activity," "time out," and initials. These columns will track what happened to the patient and how long it took.
For instance, your nurse would note that at 10 am ("time in") she entered the room to take the patient's weight, temperature, and blood pressure ("activity") and that she was done at 10:05 ("time out"). You should do the same.
Attach this worksheet to the chart of each patient who comes in. At the end of a week, you should have a good idea of how much time physicians and staff spend in the exam rooms and how much time elapses between encounters with patients. From there, you'll be able to make scheduling or other procedural changes to reduce waiting times. If you're still experiencing problems down the road, consider adding one or two more exam rooms.
QOur group's physician assistant has asked us to give him information on his billings and collections. Are we obligated to provide it?
A No. But why would you withhold it? The PA probably has a rough idea of what he's bringing in, anyway, so nondisclosure will only foster feelings of mistrust.
You can turn his request into a positive thing by agreeing to meet with him regularly to discuss his productivity and collection trends, and review which services are the most cost-effective for him to provide. These meetings may also reveal whether the PA is truly invested in the practice or just collecting a paycheck.
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;19:107.