Leveling the income playing field between a group's doctors, When your admitting privileges are in jeopardy, When you need to roll back benefits, How many exam rooms does each doctor need? A stickler who works at a snail's pace, Weeding potentially harmful OTCs from a patient's drug regimen, Should you take back a deadbeat? When family members want to do business with your group, Financial guidance for a freshly minted doctor
Q I'm puzzled by your consultants' insistence that groups split productivity pay based on collections rather than billings. Doesn't this formula favor the physicians whose patients pay the highest fees?
A It could. But in a typical practice, all partners belong to the same health plans and, therefore, have a similar payer mix. If there is disparity in collections among partners, then address how patients are assigned to particular physicians.
QMy hospital's quality assurance committee is reviewing all my charts. I'm afraid I may lose my privileges. If that happens, what should I do about patients who are later admitted to the ER?
A You'll have no obligation to patients with new illnesses, other than to make their records available to the physician who takes on their hospital care. For patients with ongoing problems, arrange for a colleague to assume their inpatient care.
If you lose your privileges, notify all patients that you're no longer on that hospital's staff. If you still have privileges at another facility, tell your patients you'll treat them there.
QOur four-doctor group has always covered the full cost of health insurance for our employees and their dependents. But premiums have skyrocketed to the point where we're thinking about asking staffers to pay a portion. How should we make this change?
A You should try to avoid it, our consultants say, or you may end up hurting office morale. No matter how you spin this, asking employees to pay some of their premiums amounts to a pay decrease. And if you trim employee benefits one month and show up in an expensive new car the next, your employees will resent you.
Before you do anything, make sure that what you currently offer in wages and benefits holds up against your competitors. Next, shop around for health insurance. Your office manager or a broker may be able to find you a better deal. Finally, determine whether the practice can cut costs elsewhere.
If you must make changes, choose the path that will have the least impact on your staff. For instance, you may be able to hold the line on premiums by asking employees to pay slightly higher deductibles or copayments. Or you could continue to offer 100 percent coverage for employees, while asking them to pay the additional premium for their dependents. If, in the end, you decide to ask employees to kick in for their health insurance, limit their contribution to no more than 20 percent of the premium.
When presenting the changes to the staff, explain the costs and value of all of their benefits, including paid leave; retirement plan contributions; reimbursement for education; and disability, life, and health insurance.
QOur newly formed multispecialty group is looking for office space. We're comprised of four primary care physicians and three specialists. How many examining, procedure, and consulting rooms should we figure on? Ideally, we'd all like to be working in the office at once.
A The rule of thumb is three exam rooms for each primary care doctor and two each for the specialists. You should also have one extra exam room to handle "spillover." You'll need one procedure room for the primary care doctors to share and one for the specialists to share. Plus, each of you will need a private office that can double as a consulting room. If space permits, add one larger consultation room that can also serve as a conference room. Since you all plan to see patients in the office at the same time, you'll need a big waiting room, too.
You may want to consult a practice management expert to analyze your individual practice patterns and determine the most efficient office set-up before you sign a lease.
QOur billing clerk of two months is a perfectionist, and she works at a snail's pace. Our nurse occasionally has to stay after hours to help her catch up. What should I do?
A Ask your billing clerk what you can do to help her work faster. It may be an easily solvable problem. If it's not, get her to commit in writing to working at a speed you both agree on. If after a specified period her performance doesn't improve, you have it documented and you can dismiss her.
QOccasionally, patients suffer side effects while taking over-the-counter drugs concurrently with medications I've prescribed. No one's been seriously harmed yet, but I'd like some tips to head off problems. What do your experts suggest?
A A lot of patients don't consider things they buy over-the-counter to be drugs. Get into the habit of asking patients at each visit, "Are you taking anything regularly, including vitamins, laxatives, aspirin, salt substitutes, or cold pills?" If you doubt the answer you get, ask the patient or his caregiver to bring all "pill bottles" to your office. Tell him which medications he shouldn't be taking.
If you prescribe drugs, such as MAO inhibitors, that have significant interactions with common OTCs, always make this danger clear to the patient.
QA patient with unpaid bills asked us to transfer her records to another practice, which we did. Now she wants an appointment with us again. Are we obligated to see her? May we require her to pay up before we take her back?
A By requesting a transfer of records, the patient ended her relationship with you, so you don't have to see her again. You can ask her to settle her account, but once you book an appointment for her, you're obligated to treat her whether she pays or not.
However, one attorney warns that if this patient claims it's an emergency, and you don't see her, she might assert she was harmed and sue you for abandonment.
QA colleague and I are starting a new practice. His wife wants to set up a business that would lease equipment to our practice. My colleague hasn't decided whether he would be a partner in his wife's business. What do your consultants think of this proposal?
A They say walk away. For starters, leasing ends up costing more in the long run than buying. Secondly, your buddy will end up profiting from your debt. This is a bad recipe for a partnership.
QWhat is the average start-up cost for a new FP who wants to go into solo practice?
A Estimates range widelyfrom $50,000 to $150,000. Variables include geographic region, malpractice premiums, how much you plan to pay yourself and your staff, and whether you plan to buy or lease space and equipment.
Your bank or a practice management consultant can help you draw up a business plan to determine the appropriate amount.
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 firstname.lastname@example.org (please include your regular postal address). Sorry, but we're not able to answer readers individually.
Kristie Perry. Practice Management.