Practice Management

Getting an associate to refine his coding habits

QAn internal audit revealed that one of our group's doctors tends to overcode. What's the best way to bring this physician in line?

A If you've set up a Medicare billing compliance plan, as suggested by the HHS Office of Inspector General, then your compliance officer should be the one to talk to him. Otherwise, have another doctor and your group's coding expert discuss the results of the audit with the errant physician, giving him a chance to explain his coding decisions and the documentation he used to support them.

In addition, explain what fines he and your group could incur if the government or an insurer accused him of fraud. For the next few months, review his claims for irregularities before submitting them.

Your group will have to refund any overpayments to HCFA or commercial insurers. Contact an attorney who specializes in health law to discuss how to handle the refund.

The best way to tell employees about new practice policies

QOur five-doctor group is adjusting our paid-leave policy. Would it be sufficient to issue a memo outlining the changes, or do we need to hold a staff meeting to explain things in detail?

A Hold a meeting and have a physician—not your office manager—explain the changes and the reasons behind them. This will allow employees to ask any questions they might have. After the meeting, distribute a memo describing the changes so that you and your employees will have written documentation of the new policy.

If a surgery patient asks not to be informed of the risks

QBefore surgery, I've had anxious patients tell me that they'd rather give their consent without being told about the risks involved. So far, the nurses and I have always been able to calm them down and get them to listen and ask me questions before signing the form. Could I be liable if a patient ever flatly refuses to be informed?

A You could be. Malpractice experts warn that the type of patient who refuses to be informed is the same type who'd sue you after a bad result.

A handful of states do permit doctors to skip informed consent, if the discussion could have a negative impact on the patient's physical or emotional health. But this exception is rare. So if a patient flatly refuses to be informed, ask him to sign a statement expressing his wish to proceed with surgery despite his refusal. Then make a note of the refusal in his hospital chart. Include what was said, where the conversation occurred, and the names of those present. If possible, also tell the patient's spouse, other relative, or friend that you were unable to have an informed consent conversation with him.

When you risk insulting a referral source

QThe wife of a physician who refers numerous patients to our group sent us an unsolicited proposal to advertise our practice in the newspaper. Not only is the proposed ad amateurish, but we hadn't budgeted for this type of marketing. Still, we're concerned that turning down the proposal may jeopardize future referrals from this woman's husband. What should we do?

AThank her for thinking of you, but explain that you didn't budget for such advertising this year. This strategy risks much less damage to your referral relationship than if you ended up having to fire the wife for a less-than-adequate job.

How to keep a loudmouth from dominating staff meetings

QOne doctor in our practice tends to drown out other voices in our group's weekly staff meetings. How can we rein him in without offending him?

A Have a senior physician speak to him privately and tell him that he needs to give others a chance to talk. In addition, head off problems by having your office manager create detailed meeting agendas that specify how much time will be allotted for each topic. Appoint a formal chair to moderate meetings, and charge that person with making sure the group sticks to the agenda. When the loudmouth tries to dominate the discussion, the chair should cut him off by thanking him for his input and inviting others to offer their opinions.

Are giveaways a good way to promote your practice?

QMy multispecialty group is considering ordering pens and magnets with our practice name and phone number printed on them. We'd give away these items at company health fairs and other activities we participate in. Is this a good way to spend our marketing dollars?

A It depends on how much money you have available to dedicate to advertising. These types of items can help build a group's name recognition.

But don't squander money on throwaway promotional items at the expense of an eye-catching Web site or practice brochure that describes the qualifications of your physicians, your practice's services, what insurance you accept, and your group's location and office hours. See the next item.

Promoting your practice online

QWe hear about people surfing the Internet for a personal physician, so our four-doctor group practice wants to establish an online presence to attract new patients. But we don't have the resources or staff to offer a full-fledged Web site. Can your consultants recommend a few simple and inexpensive ways for us to get started?

A Establishing a Web presence isn't as daunting as it may seem. Most Internet service providers offer members a no-cost opportunity to create a personal Web page on the ISP's server.

Physician-centered subscription services (such as Medscape and WebMD) also help set up Web sites at no cost. These sites generally act like an Internet Yellow Pages ad, providing a Web address (URL) that patients can access for information about your office location, hours, telephone numbers, diagnostic and treatment services, health plan affiliations, and physicians' credentials.

Down the road, when you have more time and resources to invest, you can go interactive, adding e-mail access for patients to make appointments and request prescription refills, and offering links to sites you recommend.

However basic or sophisticated your site becomes, updating the information it provides is critical, especially if your office hours change or you add a doctor, NP, or PA.

Is a shabby office driving away patients?

Q Our office manager thinks that our rural multispecialty clinic is losing patients to an urban center located an hour away because our facilities look outdated. How can we test this theory?

A You'll need to hire an outside consultant to survey patients. You won't get enough honest feedback if you do it yourself. The consultant should contact both active patients and those who have left.

Brace yourself for the results. It's highly unlikely that a shabby waiting room is what's driving patients to see a physician an hour away.

Edited by Kristie Perry,
Senior Associate Editor

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;9:134.