Whether to redirect patients who show up at the ED, Should a manager's paycheck grow when your practice does? How many authorizations do you need to transfer records? When an office move upsets your employees, Your liability when patients omit allergy information
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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.
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.
QOver the past year, our internal medicine practice has added a physician and three employeesbringing 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 latterand she's making a difference to your group's bottom linethen she deserves a raise.
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 patientsand earning a higher salarysome 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.
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 suedunless 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, thoughfor you and the patientget into the habit of asking all patients about possible allergies before giving injections or prescribing medications.
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 firstname.lastname@example.org (please include your regular postal address). Sorry, but we're not able to answer readers individually.
Kristie Perry. Practice Management.