Practice Management

Whether to redirect certain patients who show up at the ED

Q Our pediatric practice is open every night until 10 pm. If an ED physician calls us to evaluate one of our established patients for a nonemergent condition before our office is closed, is there any harm in asking to have the patient sent to our office?

A No. Just make sure that you and the ED agree that the patient's condition isn't an emergency.

How many authorizations do you need to transfer records?

Q After I announced that I was leaving my group to join another, I asked patients who chose to follow me to sign a form authorizing me to transfer their charts. But before my new partners will accept these patients, they want them to sign a new records-transfer consent form. Is this necessary?

A Our consultants say No, as long as you're transferring copies, not originals.

But your former and current employer might have concerns about privacy, malpractice, or noncompete issues. It's probably easiest to go along with the new group's request.

Should a manager's paycheck grow when your practice does?

QOver the past year, our internal medicine practice has added a physician and three employees—bringing the number of doctors to four and the number of staffers to twelve. In response, our office manager has asked for a raise because of her increased supervisory responsibilities. Should we grant her request?

A It depends. If your manager can still fulfill her responsibilities within the standard workday, tell her that you'll address her request at her next performance review. If she's putting in extra hours, determine whether that's because she needs to delegate more tasks or because her workload has truly increased. If it's the latter—and she's making a difference to your group's bottom line—then she deserves a raise.

When an office move upsets your employees

QI'm merging my practice with another physician whose office is located across town. Although I've tried to convince my staff that there is potential for attracting more patients—and earning a higher salary—some are unhappy about the change because of the longer commute. A few might quit. Should I offer them incentives to stay?

A You could offer a one-time bonus to any who agree to join you. But that may cause hard feelings among the other doctor's employees. And then you'll have two offices that are unhappy. Since the inconvenienced workers are likely to quit anyway, focus your energies on hashing out a compensation package for your newly combined staff that rewards everyone fairly.

Your liability when patients omit allergy information

QWe ask new patients to specify drug allergies on their intake form. For people who leave this section blank or write "None," are we protected from liability for adverse reactions?

A If the patient writes "None" and signs it, you'll have a strong defense if sued—unless you have information to the contrary from another source.

If the patient leaves the section blank, ask for the information when you first see him. Record his answer on the form, and have the patient date and initial it.

As added protection, though—for you and the patient—get into the habit of asking all patients about possible allergies before giving injections or prescribing medications.

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;20:68.