When a nonpatient wants you to take over for her care; What to include in your associate's buy-in contract;Do more phone lines require more staffers?; How to tell if a Medicaid patient no longer qualifies
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Q A woman who came to me for a second opinion asked me to take over her case. I'm not sure why, because I confirmed the first doctor's findings. Should I accept this patient, or send her back to the other physician?
A Patients are free to change physicians whenever they wish. But in a situation like this, it would be best to try to persuade the patient to return to the original doctor. Otherwise, you risk causing bad feelings and losing future referrals.
QMy partner and I have been together for 10 years. We'd like to offer a buy-in opportunity to the associate we hired two years ago. What sort of salary, benefits, and profit-sharing arrangement would be best?
A First, set the buy-in price, which should equal roughly one-third of the group's annual collections. That amount should cover the associate's share of the fair market value of the office space and equipment. The associate's salary should be set the same way as yours: Base it on productivity, profit-sharing, or a combination of the two.
Allow him or her to buy in through payroll deductions, and offer the same benefits you and your partner have.
Q After the phone company analyzed our group's phone use and caller volume, it recommended that we add two more lines. But our office manager balked. She's worried that the extra lines will result in unanswered calls or even longer on-hold time for patients, because there isn't enough front-office staff to handle the increased volume. Is this a valid concern? If Yes, should we skip the extra phone lines, or should we add staff?
A Add the phone lines, but investigate technological solutions that could eliminate the need for extra staff. Perhaps you could benefit from a voice mail system that kicks in when a patient's call isn't answered by the third or fourth ring. Or perhaps adding dedicated phone lines for prescription renewals and billing would ease the burden on the front-office staff. Check with your phone company: Nowadays, there's an abundance of affordable systems that could meet your needs.
If you still need to add staff, consider a part-timer who could work when the phones are busiest, such as Monday mornings and lunch hours.
Q A few of my Medicaid patients who are now working and have employer-provided health insurance still carry Medicaid coverage. Is this legal?
A Probably not. But since Medicaid policy varies by state, the best thing to do is contact your state's Medicaid office.
QOur group comprises three surgeons and three internists. How should we share income and expenses?
A There are dozens of reasonable methods, but one that several consultants recommend is to share 50 percent of operating costsrent, utilities, supplies, and staff expensesequally, and allocate the remainder based on use. Each physician should pay for his or her malpractice insurance, CME and other professional fees, and benefits.
Divvy up revenues the same way: 50 percent shared equally and 50 percent based on productivity.
Joan Rose. Practice Management. Medical Economics 2001;2:118.