PMQA Layout for 11/20/00, page 129
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QA hospital opted not to renew its contract with our primary care practice. We're now grappling with whether we should stay together or go our separate ways. Can you explain the pros and cons of expense-sharing, incorporating, and going solo?
A There are few benefits to going solo. Although you'd have autonomy, you'd probably have trouble getting health plan contracts and would end up working long hours.
The benefits of staying together are numerous: Contract negotiations with health plans would be more successful; economies of scale would yield greater cost savings; and patients would be more likely to stick with you, because they could continue to see familiar doctors in a familiar setting.
An expense-sharing arrangement would allow each of you to maintain your own independent practices, but because you'd be in the same office suite, you'd save money by splitting the cost of rent, utilities, equipment, and, perhaps staff.
Forming a true group would require you to be comfortable with one another's practice styles, and to agree on a way to pool revenues and expenses, and to govern the group. A true group would also allow you to earn revenues from ancillary services without running afoul of anti-kickback rules. But group practice would bring administrative and management responsibilities that are absent from solo practice.
If you decide to form a group, make sure to incorporate the practice or establish it as a limited-liability structure. These setups shield individuals from personal liability for the professional conduct of others in the group.
QA nurse practitioner will soon join my staff. Do I bill for her services the same way I bill for mine?
A It depends on who's paying, although in all cases, you'd use the same CPT and ICD-9 codes to report the NP's services as you would to report your own.
If you're billing Medicare, use the NP's own PIN number for services she performs independently. Medicare will reimburse these services at 85 percent of the allowable physician fee schedule. When the NP is simply assisting you, and her services are performed under your direct supervision, bill for them under your PIN number.
If the patient is covered by a commercial carrier or managed care plan, you must follow that insurer's specific billing rules for an NP's services. And check with your local medical society to learn about any state requirements.
Q I'm the only one in my three-doctor primary care group who still accepts new patients. At this point, it takes six weeks for a new patient to get an appointment with me, even though I leave four slots a day open for them. Is it time for me to stop accepting new patients, too?
A No. But it is time to hire a new associate, nurse practitioner, or physician assistant. If your group continues to turn away new patients, you run the risk of stagnating and losing managed care contracts.
Practice Management. Medical Economics 2000;22:129.