Practice Management

When an insurer reneges on its word

QAn out-of-state patient, who's in town on business for a few months, came to me for treatment of hypertension and anemia stemming from chronic renal failure. His health plan—which isn't offered in my state—assured me I'd be reimbursed for any bills I submitted. Weeks later, the insurer denied payment because I hadn't secured a referral from the patient's primary care physician. What should I do now?

A Bill the patient. Since you don't have a contract with his insurer, you're not prohibited from doing this.

If you want to go the extra mile, give the patient copies of all correspondence between you and his insurer, and urge him to turn over the letters to his employer. At the very least, the company will be alerted to the insurer's disingenuous tactics. At most, the company may be able to intervene on behalf of you and the patient.

Fair pay for a colleague's management tasks

QThe physician who became the de facto "CEO" of our group after four doctors merged two practices now wants to be paid for the time he spends on management responsibilities. He says he wants to cut back on clinical work so he can devote time to leadership and administrative tasks during regular office hours. How should we compensate him for this?

A Most groups pay physicians an hourly wage for time spent on managerial tasks. The amount needn't be as much as he'd earn seeing patients, but it should be close to make it worth his while.

Handling a patient who shows up drunk

QWhat should I do if a patient arrives at my office intoxicated and then intends to drive home, putting himself and other drivers at risk?

A Laws vary by state, so check with an attorney or your state's medical society to be sure.

In general, you can protect yourself from liability by urging the patient not to drive and noting in his chart that you've done so. Ask the patient to let your office manager call a relative, friend, or cab to pick him up, and offer him an out-of-the-way space to wait for his ride. If he becomes violent or you see him get into his car, call the police.

Is there a way around this no-solicitation clause?

QI've been working for an urgent care center while saving to start my own practice. The center's owners just informed me of their plan to convert the practice from episodic care to primary care—something I've been providing to many patients all along.

I'm ready to leave, but I'm bound by an agreement not to solicit any of the clinic's patients for two years. How can I tell my patients about my new practice without the clinic accusing me of soliciting them? If I don't inform them, and simply leave, can I be held liable for abandonment?

A You won't abandon anyone by leaving an urgent care center; the owners will provide a replacement for you.

Regarding solicitations: Merely telling people you plan to go into private practice generally doesn't amount to improper solicitations. To be safe, though, have your attorney review the language of any announcement you plan to make about your solo practice.

Edited by Kristie Perry,
Contributing Writer

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

2002;16:92.