Practice Management Q&A

January 4, 2008

What to pay for management services

Our ten-physician multispecialty clinic is negotiating a contract with a new management company to oversee office functions, including billing and collections. Our previous management company charged 10 percent of net collections for such services. What's the going rate?

Management companies typically charge 10 to 20 percent of net collections, depending on the functions they perform. Billing using their system and personnel will cost an additional 7.5 to 9 percent. It may be more cost-effective to hire a good practice administrator and keep these functions in house.

Our community hospital recently opened some offices staffed by newly-recruited family physicians. Now, some of my patients who received care at the hospital's ED say that doctors there tried to refer them to these new physicians for follow-up care. Aren't there laws against poaching another doctor's patients?

No, it's perfectly legal for a doctor to suggest that a patient go to another physician. And if the hospital insists that the ED physicians refer within the hospital group, that's legal too.

However, such a policy isn't very smart if it alienates the attending staff whom the hospital depends on. If you have privileges there, you should definitely present your concerns about "patient poaching" to the hospital's medical staff executive committee. Press for a policy that requires the ED staff to ask whether the patient has a primary care physician; if not, they can suggest someone from the hospital group.

Can a contract bind you outside your job?

I plan to start my own strictly fee-for-service practice but continue to work part time for my present employer. In that position, I belong to several health plans. Does being on the panels of these plans obligate me to accept their members in my own practice?

It's possible. Some plans' contracts may require you to be a provider for their members both within and outside of the employment arrangement. If that's the case, ask the plan to release you from that part of the contract.

If the original agreement was between the plan and your employer-not between the plan and you as an employee of the practice-you could try to use that fact as the basis for your argument. But tread carefully, so you don't wind up at odds with your boss.

Preserving privacy with a black marker pen

A local hospital notifies us when they've admitted some of our patients by faxing a list of names (normally three or four names at a time) to our office. We make a copy of the page for each patient's chart and then use a marker to black out the other names on the list before filing it. Does this practice violate privacy rules?

No, not as long as you obliterate the other names. Otherwise, a patient who requested a copy of his record would receive information about other admitted patients as well, and that would be a breach of confidentiality.

In this issue, the answers to our readers' questions were provided by: Barry B. Cepelewicz, MD, JD, Meiselman, Denlea, Packman, Carton & Eberz, White Plains, NY; Margaret Davino, JD, Kaufman Borgeest & Ryan, New York City; Alice G. Gosfield, JD, Alice G. Gosfield and Associates, Philadelphia, PA; H. Christopher Zaenger, CHBC, Z Management Group, Barrington, IL.

Send your practice management questions to: PMQA Editor, Medical Economics, 123 Tice Blvd., Woodcliff Lake, NJ 07677-7664, or send an e-mail to mepractice@advanstar.com (please include your regular postal address).