Practice Management Q&As

November 5, 2004

Does this breach patient privacy? Vacation coverage for a solo doctor; Whom to consult before firing a staffer; How to set a buy-in price; Get paid for being on hold? Don't be short-staffed at the holidays; Where to store old records; Clamp down on overtime; Can your office fire deadbeats? Why you need an expert coding audit; When a patient returns to you; Two offices: two fee schedules?

Does this breach patient privacy?Q Sometimes my receptionist fields calls from people who ask whether a particular patient is in the office. Can we answer these questions truthfully without breaching patient confidentiality?

A Not unless the patient has given permission to the practice to release such information, and you've documented it in the chart. In all other cases, your receptionist should explain that she can't divulge such information over the phone without the patient's permission.

Vacation coverage for a solo doctorQ As a solo FP, what's the best way for me to deal with patient care when I take time off? Could I simply check in with my office while I'm vacationing? Or should I hire a locum tenens to cover for me?

Whom to consult before firing a stafferQ My partner and I have concluded that a billing clerk who's been with us for 18 months isn't working out. Should we get our lawyer's advice before we let her go?

A That shouldn't be necessary if you've routinely documented the clerk's performance problems, and if she's employed "at will"-meaning without a contract. But if you're worried the employee will file a claim for harassment or discrimination in response to the dismissal, or that she may steal, vandalize, or sabotage records, get your attorney's advice.

You're particularly vulnerable if the employee has ever filed a workers' compensation claim, taken time off under the Family and Medical Leave Act, or requested accommodation for a disability. She may claim that the dismissal is retaliation. An attorney will be able to help you verify that your decision was based solely on performance.

Other reasons you may want legal counsel: for help designing a severance package, arranging for COBRA coverage, or paying out pension or profit-sharing funds.

How to set a buy-in priceQ I want to hire an associate, with the understanding that she'll buy into my solo family practice after three years. Should I base the price on the practice's net earnings or on the value of its assets?

A You can use either method or a combination of the two-whichever prevails in your area. If you use net earnings, set the price at the five-year average. The combination formula sets the value of a practice by adding 15 to 30 percent of gross to the fair market value of hard assets, minus liabilities.

Keep the price low enough to be affordable. That's especially important if the associate is just out of residency and facing a lot of debt.

Get paid for being on hold?Q Can I charge health plans for the time I spend on the phone trying to get pre-authorization for prescribing certain drugs?

A Probably not. But check your provider contracts with the insurers.

Don't be short-staffed at the holidaysQ A few employees who have been with our practice for more than 10 years now qualify for four weeks of vacation. We're worried about having more than one person away from the office for an extended time. So we've thought about limiting the length of time an employee can be away to 10 consecutive days. Should we also put an end to vacation-day carry-overs? Should that include everyone, or only staffers who have earned four weeks of vacation?