Practice Management

Following up with someone who ignores appointment reminders

QA patient with a chronic illness, who typically shows up for all of his visits, called to cancel an appointment. My scheduler has left three messages at his home to reschedule. At what point is my office off the hook for following up with this patient?

A You're off the hook after you send the patient a letter (by certified mail, return receipt requested) stating that you've tried to reach him three times (specify the dates). Tell the patient that if you don't hear from him within 30 days, you'll assume he has found another doctor. If the patient doesn't respond within a month, send another certified, return-receipt-requested letter formally discharging him from your care.

Can you go into business with a nonphysician?

QAnother doctor and I would like to establish a partnership with a business manager. We'd like this arrangement to free us up to focus solely on medical care, and leave administrative details to the manager.

Can we do this? If Yes, how should we compensate our business manager?

A Many states prohibit this type of arrangement. Check with a health care attorney, your state medical society, or your state's department of business affairs to see whether your proposal is legal in your state.

If it isn't, you can reward the business manager like a partner by giving her a generous compensation package or paying her a productivity bonus.

Shed administrative burdens, not fiscal oversight

QI've handled the check-writing responsibilities of my solo practice for 20 years. Recently, I questioned a few colleagues about their bill-paying policies and discovered that most of them have passed on the task to their office managers. Is this really the way to go?

A Yes. Hand off all check-writing—but not check-signing—tasks to your office manager.

You'll still need to act as an informal auditor for your practice. So before you sign any check, make sure to match it with its invoice.

Whether to let employees help you select new staff

QShould my partner and I ask our staffers to conduct their own informal interviews with applicants we've identified as finalists for administrative or clinical support positions?

A Yes. It gives you a chance to see if the applicant would get along with your staffers. In addition, your employees may be able to ferret out attitudes, skills, or deficiencies the applicant didn't reveal to you. And letting the prospective employee talk to your staff will give the applicant a better perspective on the realities and specifics of the position.

If you include your staff in the hiring process, make sure they know that the final decision rests with you.

When hospital committee work increases your liability risk

QI've been nominated to my hospital's quality assurance committee. If I accept the post, should I buy more professional liability insurance? I'm worried about an antitrust or defamation suit.

A Your hospital should defend you and your committee members against any such lawsuits. Get this promise in writing. If the hospital won't pay for the insurance, it's unlikely you can get the coverage on your own. Most malpractice and umbrella policies exclude coverage for antitrust or defamation suits.

How to use the local press to market your practice

QWe suspect the open house we held last month was a flop because the newspapers didn't print our announcement. But we're not giving up on this marketing method. What can we do to improve publicity for our next one?

A Try a theme for the event (such as lowering blood pressure or cholesterol), and offer free health screenings. Another idea: Tie-in your open house to a health-related charity drive. In return, you could make the charity's literature available at your open house.

Find out who your newspaper's health care and science editors are, and send them a press release and invitation to the open house. Try to meet one for lunch a few weeks before the event so you can promote it in person. Also, mail invitations to patients and referral sources, and ask your hospital's public relations department for help.

There's another alternative: Buy advertising space to announce the open house.

A dress code for your back-office staff

QShould our three-doctor suburban internal medicine group place restrictions on what our administrative staff can wear to work?

A Yes. Your office policy manual should state that jeans, shorts, very short skirts, tank tops, low-cut blouses, open-toed shoes, very high heels, and sneakers are unacceptable. To create an appearance of unity between front and back office, you may also want to give administrative personnel pastel lab coats or tunics to wear over their street clothes.

Squeezing the air out of staff meetings

QOur 12-doctor group's monthly staff meetings sometimes run as long as three hours. Our practice administrator suggested we shorten meetings by using an egg timer—when it goes off, the speaker must stop and give someone else the floor. Is this a good idea?

A Only as a last resort. It would be better to create written agendas, listing topics by priority and specifying a time limit for discussing each item. If necessary, hold shorter meetings more frequently.

When does an employee deserve a more prestigious title?

QThe office manager for our six-physician practice has asked that we change her title to Business Manager. She has an associate's degree in business administration and has been with our urban practice for eight years. Should we agree to her request, and, if so, are we obligated to a pay raise, too?

A If you feel she's demonstrated that her education, experience, and skills warrant a title change, allow her to order new business cards. Your recognition will certainly foster loyalty and morale. As for the pay increase: You're not obligated to provide one, but realize that the new title will certainly give her bargaining power the next time you discuss her salary.

How to get patients to settle their accounts

QMy year-old solo practice sees several patients with outstanding balances of $200 or more. What's the best way to collect on these 4- to 6-month-old bills without alienating patients?

A Your office manager should tell these patients that you'd be happy to continue treating them, but that it will be on a cash-only basis until they settle their bills. Your manager should get commitments in writing from these patients that they will pay a specific amount every month on their outstanding balances. Remind patients that they may pay by credit card.

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;10:87.