Practice Management

January 24, 2000

Practice Management Q & A

Practice Management

Preventing callers from hanging up on your practice

Q. How long is a reasonable amount of time to leave a calleron hold?

A. No more than 30 seconds. Someone should call thepatient back if prompt assistance isn't possible. Train staffto call patients back within the time frame promised. Many patientswill wait by the phone for the call.

Protect yourself from liability when you release a surgicalpatient

Q. I'd like to develop a form letter to give surgical patientswhen I release them from my care. What elements should I include?What should the letter say if my involvement is limited to a consultationfor an elective procedure?

A. A surgical release form should contain the following:

(1) postsurgery instructions concerning medication, time off from work, and care of the affected area; (2) a description of what symptoms should be reported to the primary care physician or to you; and (3) a statement that clearly discharges the patient from your practice and refers him back to his regular doctor.

For consultations, give the patient a copy of the letter you'llsend to his doctor. The letter should state that you advised thepatient to return to his primary care physician within a certaintime frame.

Office expenses for physicians who go it alone

Q. What's the typical overhead for a solo family practice?

A. According to the latest Medical EconomicsContinuing Survey, most physicians spend more than one-third oftheir gross revenue on practice expenses. The median for solodoctors in all of the specialties we surveyed is 41.5 percent.Family physicians in groups of all sizes reported spending a medianof 39.8 percent.

Regardless of practice size or specialty, the biggest chunkof money is spent on staff salaries, followed by office space,malpractice insurance, and business supplies.

What to do when a health plan plays doctor

Q. A patient's insurer recently sent her a month's supplyof an over-the-counter drug, with the suggestion that she tryit. I normally prescribe a different drug for her condition. Isit legal for a health plan to do this? How should I handle thesituation?

A. Some states are beginning to challenge this practice.Tell your state medical society about your experience, so it canstart to address the problem.

Until your state's laws change, you'll need to ask the healthplan to stop sending drugs to patients. Also, send a letter toyour patients telling them to contact you before they try a differentmedicine. Explain that you need to monitor them for appropriatedosage and possible adverse drug interactions.

Delegating duties to clinical staff when the doctor stepsout

Q. Sometimes a patient arrives for an appointment whilehis doctor is finishing rounds at the hospital across the street.In these cases, is it okay for my group's nursing staff to performphysician-ordered procedures—such as therapeutic ultrasound,ECGs, drawing blood, and administering injections—while the patient'sdoctor is still off the premises?

A. This decision should be made on a case-by-case basisby the patient's physician. If the doctor gives the go-ahead fora procedure, at least one of the group's other physicians shouldbe on the premises to supervise.

When a patient's former physician won't forward records

Q. A patient with a chronic illness recently asked me toassume her care. She signed a standard release form asking herprevious physician to forward her chart. He refused to do so untilthe patient settles an outstanding balance. What's my responsibility?

A. None, except to explain to the patient why her recordsweren't forwarded. The other doctor's action is unethical and,in some states, illegal. You could report him to his state medicalsociety. One phone call from the society might convince him toforward the records and use more acceptable ways to collect hisdebt. If that doesn't work, consider reporting him to his state'sethics board.

Can a specialist forgo hospital practice?

Q. I hate dealing with hospitals' case managers and administrators.Is it possible to run a strictly office-based pulmonary practice?

A. Not really. You may lose patients to competitorswho provide the full range of services. Plus, you'd need to makeup for lost revenue by expanding the in-house diagnostic proceduresand primary care services you offer.

You'd be better off working with fewer hospitals and headingoff potential conflicts with case managers and administratorsby supplying cost and outcomes data that proves you provide high-quality,cost-effective care. Alternatively, consider group practice. Manylarge groups assign hospital care to specific members, leavingothers to focus solely on outpatient care.

How to calculate vacation leave for a part-time employee whogoes full time

Q. I recently converted a part-time employee who's beenwith us 10 years to a full-time schedule. I think it would beunfair not to consider her years of service in determining howmuch paid time off she's now entitled to. But I'm afraid thismay upset employees who've worked full time for years. What shouldI do?

A. Convert her part-time service into full-time years.If she's been working 20 hours a week for 10 years, for instance,she has five years of full-time service to apply toward paid vacationleave.

The pros and cons of communicating with patients via e-mail

Q. I'd like to start using e-mail to notify patients ofnormal test results, because I think it will save my staff timeand money. What do your consultants think?

A. They like the idea. E-mailing test results to computer-savvypatients may save time and money, and even generate patient loyalty.But take a step-by-step approach. First, get the patient's consentto communicate electronically, and explain the confidentialityrisks. If you don't use encryption software already, considerdoing so. This will protect the information while it's in transit.But encryption can't protect the confidentiality of an e-mailonce it arrives at its destination. This could be a concern fora patient who might use an office e-mail account that's sharedor monitored.

Don't forget to print a hard copy of your message to put inthe patient's file, so you have a record of your communication.You should also ask the patient to confirm that he's receivedthe information.

When to show your cards in the recruiting process

Q. My partner and I are adding an associate. At what pointin the recruiting process should we reveal what salary and benefitswe'll offer?

Let potential associates know right at the beginning, in ageneral way. Tell them what type of compensation is available,including salary range, productivity bonus, benefits, and thetimeline and price tag for buying in. That way, you won't wasteyour time and energy interviewing candidates who are looking formore. But you don't have to be specific until you make the offer.

Edited by Kristie Perry, Senior Associate Editor

Do you have a practice management question that may be stumpingother doctors, too? Write PMQA Editor, Medical Economics magazine,5 Paragon Drive, Montvale, NJ 07645-1742, or send an e-mail tomepractice@medec.com (pleaseinclude your regular postal address). Sorry, but we're not ableto answer readers individually.



Kristie Perry. Practice Management.

Medical Economics

2000;2:200.

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