A contract for physicians who share expenses, Which records to transfer when a patient switches doctors, Why you can't sell your practice to your staff, Cutting the waiting time for office visits
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Q I'm a solo practitioner who's been sharing expenses and call with four other physicians. We think we ought to formalize our arrangement, and want to draw up a professional agreement. But rather than impose hard and fast rules, we just want it to provide simple guidelines. What should we include in the agreement, and where can we find examples of such a document?
A Sorry, but our consultants aren't keen on "simple guidelines." Absence of the right kind of formal agreement opens the door to violation of referral rules, wrangles with the IRS over payroll taxes, and increased malpractice liability.
Contact an attorney experienced with medical groups. The agreement that's drawn up should indicate which expenses are divided equally, and which are allocated based on consumption. How will you measure consumptionby gross charges, receipts, number of patient visits, or RVUs? Which practice is responsible for withholding and depositing payroll taxes? You also may want to consider incorporating or setting up a limited liability company to shield each of you from malpractice claims filed against the other doctors.
QWhen a patient switches to another physician, we often receive a request for "all" medical records. Is it appropriate to send everything in the patient's chartincluding communications and test results received from other specialists and hospitals?
A Yes, but be sure to get written authorization from the patient to send everything in her file. Get a separate release for records that contain references to treatment for STDs, drug or alcohol abuse, or psychiatric problems. And send copiesnot originals.
Q I'm planning to retire in two years and want to make sure my employees are well provided for after I leave. Many of them have been with me for 25 years, and I want to reward them for their loyalty by allowing them to buy my business and pick my successor. It seems to me that the law should permit me to do this, since it allows me to sell my practice to a corporation. Is this legal? If not, what can I do to ensure my staff will still have jobs after I'm gone?
A Most states prohibit individuals who are not physicians from owning a medical practice. However, you can make staff retention and compensation a condition of purchase when you negotiate with the buyer. Since your successor is after your patients, emphasize your patients' comfort with your staff. But keep in mind that such demands may hamper the success of your sale.
QWe've had some staff turnover recently, and now patients are complaining that they spend too much time in the reception area and exam room waiting for the doctor. Then, it takes them too long to check out. Before we can fix the problem, I need a benchmark for how much time it should take a primary care patient to sign in, get seen, and leave the office.
A Ideally, patients should wait no more than 10 minutes in the reception room, and no more than 15 minutes altogether, before being seen by a nurse or physician. Checkout should take no more than 10 minutes.
Joan Rose. Practice Management. Medical Economics 2001;4:151.