Practice Management

Whether to turn away tardy patients

QI'm fed up with patients who arrive late for appointments. Would it be a good idea to teach them a lesson by refusing to see them that day and requiring them to make new appointments?

A It depends on whether they're chronically late. Don't be rough on a patient who's late for the first time; life sometimes gets in the way of doctors' appointments. Simply have your receptionist explain to him that he might have to wait a bit to see you.

But if the patient is always late, have your staff tell him he'll either have to reschedule or wait until all the other patients have been seen. There's no need to lecture the patient; just make it clear that your staff won't revamp the schedule to accommodate him.

Renegotiating pay when a group's founder cuts back

QAfter 32 years in practice, a medical disability has forced me to curb my hours. Although I still keep 9-to-5 office hours and come to work on the occasional Saturday morning, I no longer work evenings or weekends. My partners insist that they be compensated for the hours they've picked up to cover my absence. But I feel that because I founded the practice, my pay shouldn't be docked. What sort of compensation arrangement will address everyone's concerns?

A Normally, this contingency is spelled out in a buy-sell agreement when a new doctor becomes partner. Absent such a contract, ask your partners to buy out your share of the practice and continue to compensate you based strictly on productivity.

Put the brakes on an aggressive collection agency

QThe collection agency I use has advised me to sue a number of patients who've stopped paying on their overdue accounts. The agency says these people have the ability to settle their bills. If I proceed, the agency has asked for 50 percent of whatever I recover in small-claims court. Is this a legitimate request?

A Only if the agency handles the litigation. Otherwise, ask the agency to close the accounts and return to you the billing records of patients you intend to sue.

Are three-day weekends a boon or bane for your practice?

QI'd like to ask my staff to work four 10-hour days during the summer, so that we can close the office on Fridays and enjoy a three-day weekend. What do your consultants think of this idea?

A They think it's unwise. You're in the service business. With so many competitors open six or seven days a week, limiting your practice to four days would be risky. But if you want to provide a summertime perk for your employees, consider rotating a few staffers at a time to four-day schedules.

How much time to spend on recruiting

QOur founding partner has agreed to assume the responsibilities of recruiting two associates. He wants to cut back on patient visits while he focuses on the search. Is this really necessary?

A Yes. He'll need at least one hour a day for the first week to get organized—writing job descriptions, deciding where to advertise, and the like. But he should delegate the associated paperwork to your practice administrator. She should place the ads, process the resumes, and schedule the interviews.

Relieve the founding partner from weekend call and evening appointments so he'll be free to conduct interviews and show prospects around town at times that are convenient for them.

Making staff meetings more productive

QOur 10-doctor multispecialty group holds monthly practice-wide meetings. We've always required all physicians and employees to attend. But some have complained that the meetings are a waste of time. Should we loosen up on our policy?

A Yes. Your practice is large and diverse enough to warrant smaller, monthly department meetings. Smaller settings will go a long way toward reassuring employees that their voices don't fall on deaf ears.

Hold practice-wide meetings on a quarterly basis.

When employees walk off with office supplies

QOur new office manager wants guidance on how to handle staffers who use practice stationery for personal use or take home office and sample medical supplies. What do your consultants suggest?

A "Borrowing" supplies is common in all offices. Make sure your office manager isn't overreacting to a small problem.

However, if your manager offers evidence that employees are crossing the line, discipline or dismissal may be in order. Make sure your office policy manual covers theft. If a staffer is caught stealing, your office manager should warn the employee that the incident will be noted in the employee's record, and that a second offense will result in a written warning, and that subsequent stealing could result in termination.

Rid yourself of inactive charts when you take over a practice

QHow should I dispose of the dormant patient charts I inherited from the physician whose practice I just purchased?

A These charts are really the responsibility of the seller. But if he didn't assume responsibility, one option for you is to destroy the chart of any patient who hasn't been seen by the practice for long enough to be past the statute of limitations for malpractice claims. Keep in mind that in some cases, the statute of limitations doesn't begin to run until a patient discovers that a medical error has occurred.

Therefore, it would be better to hold on to records until you've attempted to notify patients of the practice sale and ask if they'd like you to retain their charts or transfer them to another physician. The letter may serve to lure some patients back to the practice.

Another option: Store the records off-site—as paper copies or microfiche.

Whatever your decision, make sure you know what the statute of limitations is in your state. Be especially careful with the charts of patients younger than 18. In many states, the statute of limitations doesn't even begin to run until the patient has reached the age of majority. Check with your state medical association or your malpractice carrier.

The best way to cut payroll costs

QWould a five-doctor multispecialty group with a support staff of 16 save money by farming out payroll tasks?

A No. Your computer, the right software, and a practice administrator familiar with income tax law are all you need to handle this job.

A group your size should already have these things in place. If it doesn't, any up-front investment in hardware, software, and staff training will pay for itself quickly in efficiency and savings over fees to a service bureau.

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;9:153.