Compensating an NP who works part time, Don't be in a rush to advertise your practice sale, Ways to reward your managing partner for increased profits, How to placate patients you've kept waiting, Whether to keep riding a health plan's merry-go-round, Does underbilling Medicare cancel out its overpayments to you? When you suspect a colleague of doing unnecessary procedures, Whether women doctors attract more business, Providing a training ground for future employees, A doctor who doesn't see his fair share of walk-ins, How to accommodate staffers who've lost a loved one
QShould I pay my part-time nurse practitioner an hourly wage or a fixed salary plus productivity incentive that ignores days and hours worked?
A A part-time NP should be paid a competitive hourly wage, plus a productivity bonus. Paying by the hour gives you the flexibility to have the NP in the office only when you actually need her. The bonus will give her an incentive to work harder.
QShould I tell my patients that I've put my practice up for sale before or after I've found a buyer? I plan to leave as soon as the new doctor feels he has things under controlpresumably six months after he's come on board.
A Wait until you've found a buyer. If you don't, you'll lose patients, and the value of your practice will drop. Also, if you can, plan to stay with the practice up to 12 months after you've sold it. This will help ensure a smooth transition for both the buyer and your patients.
QWhat do you think about tying a managing partner's pay to the overall growth of a newly merged practice? Should such a performance bonus be calculated before or after physicians' salaries are paid?
A It might be better to pay him a specified hourly amount for the time he spends on administrative responsibilitiesone that is roughly equivalent to what he'd earn seeing patients. Paying a performance bonus has three major pitfalls: (1) achievement of some goals may not neatly translate to a balance sheet; (2) it's unfair to pay the managing partner nothing for his time if the group fails to boost profits over last year's levels; and (3) the managing partner may become too focused on the bottom line.
Nonetheless, if you choose the bonus route, pay the managing partner a percent of the revenue increase before calculating physicians' salaries.
QMy staff and I do everything possible to keep the practice running like a Swiss watch. But despite our efforts, patients sometimes end up waiting more than 30 minutes to be seen.
In an effort to mitigate patients' ire, my office manager suggested that we post a sign inviting people to ask a staffer for an explanation if they're kept waiting too long. Will this help defuse patients' irritability or just draw attention to the problem?
A It may help, but don't rely solely on the sign. Patients deserve the courtesy of being warned when they check in that there will be a long wait, as well as how long that wait will be.
Give your receptionist the authority to reschedule patients who can't fit the delay into their schedule.
QWhen I opened my practice a year ago, I applied for provider contracts with the three biggest managed care companies in the community. Two plans accepted me without batting an eye. The third lost my application. Then it lost the second application I submitted. After I submitted a third one, the plan rejected me without giving a reason. Should I pursue this further?
A No. The plan sounds incompetent. Do you really want to do business with it?
QA practice management consultant our group hired to conduct a coding and billing audit told us not to worry about reporting or refunding Medicare overpayments that he'd identified. He said the overpayments were more than offset by instances where we'd underbilled. Should we follow his advice?
A No. Your consultant is leaving you vulnerable to charges of fraud and their accompany- ing fines. Fire him.
QA new doctor on our hospital's staff is doing a certain procedure far more often than any of his colleagues. What should we do if we think he's performing unnecessary operations?
AReport him to your hospital's quality-assurance committee. If the committee finds this doctor is at fault, it will likely subject all his cases to second opinions, or curtail his surgical privileges.
QOur group has narrowed our search for a new associate to two candidates: one male, one female. Some of the partners have argued that a female physician will attract new patients more quickly than a male. Is there any merit to that theory?
A Not necessarily. It depends on your specialty, the gender distribution for your specialty in your community, and most important, the candidate's skills and bedside manner. Before you make your decision, though, be aware that it's illegal to hire based on sex. If you hire a woman just because she's a woman, you could face a sex discrimination suit from the man you decided not to hire.
QThe program director at a local community college has asked our family practice to "hire" two medical-assistant students as unpaid interns this summer. They'd work three days a week. All we have to do in return is submit two written evaluations of the students.
We're always scrambling to find temporary help when employees take vacation, so the offer is tempting. Should we accept? The students are covered under the school's liability policy.
A Take them on. With trained medical assistants in short supply, participating in the program is one way to cultivate future staffers. However, don't regard them as fully qualified temporary help. They're students, without a regular employee's experience.
Question the director about the students' level of competence, their appropriate role in your practice, and what exactly is required of you and your office staff in the way of training and supervising.
QOne of my partners likes to slip out for a quick run after he catches up on his appointments. Despite frequent requests, he doesn't bother to tell anyone he's leaving, or for how longwhich means a frantic search whenever the phone rings for him. It also means he doesn't see his share of walk-ins.
How can we keep him from taking offor at least get him to tell the receptionist he's step- ping out?
A If you don't already distribute income based on production, propose switching to this system. Make it clear that you're doing this because he's not around to handle his share of walk-ins.
QWe'd like to add a bereavement policy to our personnel manual. How many days off should we allow grieving employees? Should we allow more days if the person who died was an immediate family member?
A Most employers grant three to five days off for deaths within the immediate family and one or two days for other relatives. Your policy should specify who falls into each category. Also, allow staffers to use vacation or personal days when lengthy travel is necessary or when religious beliefs call for more time away from the office.
Make sure you and your employees are comfortable with your policy before committing it to writing. Once it's in effect, you'll have a hard time decreasing the benefit.
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. Medical Economics 2002;19:138.