When a hospital lacks a specialist to give anesthesia, Establishing proof of financial hardship, How to calculate a bonus for a midlevel provider, Whether to pay productivity bonuses to staff, Can physicians order wholesale drugs and resell them to patients?
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Q I'm an FP in a small town where the hospital has no qualified anesthesiologist. When I do surgery, I have to use another FP or a nurse anesthetist to give anesthesia. If one of them bungled, would I share the blame in a malpractice suit?
A Yes. Because you'd be using somebody other than a qualified physician to administer anesthesia, you'd be considered the anesthetist's supervisor. So in the absence of an accredited specialist, you should be very careful about whom you select. Better yet: Refer patients to a different facility that has trained, qualified anesthesiologists.
Q The physician assistant our family practice hired last year has been a huge asset. We'd like to show our appreciation with a bonus that's a percentage of the revenue the PA generates, minus his expenses. What's an appropriate percentage?
A Consultants are cool to the idea of bonuses, saying that it's far more important to provide employees with competitive salaries and benefits. But if you feel that a bonus is warranted, a typical amount is 5 to 20 percent of net base pay (not collections).
Q Do you know what percentage of doctors pay bonuses to their staff? What are the pros and cons of productivity bonuses?
A According to our consultants, most doctors don't pay productivity bonuses. It's difficult to create a program that gives employees enough control over the criteria that affect whether they can meet their goals. It's better to motivate staff with competitive salaries and benefits and frequent praise for a job well done.
Q I'm concerned about the inability of my Medicare patients and those without prescription benefits to pay for drugs they sorely need.
Recently, while ordering office supplies online, I discovered how cheaply I could order generic drugs from wholesalers. Would it be legal and ethical for me to order commonly prescribed drugs in bulk from these wholesalers, then sell them at cost to my patients in need?
A It's certainly not unethical, and it's probably legal. But check with your state medical society to be sure no local laws prohibit you from doing this. Find out, too, whether any state requirements dictate how to store and package the drugs and who may dispense them. And check with your malpractice insurer to be certain you're covered for selling drugs.
QHow should I handle payment arrangements for uninsured patients who are referred to me by the emergency room? The hospital requires me to follow up with these patients regardless of their ability to pay. Should I ask for proof of indigence before writing off their charges?
AYes. But first ask these patients to pay at the time of service. If they can't, have your office manager ask them for pay stubsor proof of federal or state financial assistanceto establish income level and lack of insurance.
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;6:150.