When a patient disappears with his insurance settlement, Why signing dictated notes can cut your liability, Can an employer's actions invalidate a restrictive covenant? Carrots for keeping doctors on board, A dangerous way to cut down on phone time
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Q I can't locate a patient who owes me $5,000 for treating his auto accident injuries. The patient's insurer paid a $70,000 settlement directly to his lawyer, who split the money with him. The lawyer won't return my calls. I can't file a lien without a court orderand what good would it do me, since the patient has vanished? What should I do?
A Sue the patient and the insurance company. Depending on your state, the insurer may be held liable for the entire amount owed to you if the patient doesn't reappear.
Q Our hospital requires that doctors sign their dictated hospital notes. Would it be a good idea to institute the same policy in our office? I brought it up at a staff meeting recently, and my partners claimed they were too busy to do this.
A If your partners are too busy to sign their own dictated chart notes, then your group needs to hire another practitioner. In order to deliver the highest quality patient careand counter malpractice risksall doctors should have plenty of time to review dictated chart notes for accuracy.
Q The board of my large multispecialty group is considering some changes that could significantly decrease my income. If they're adopted and I leave the group, could its restrictive covenant be enforced?
A Normally, a restrictive covenant would be upheld if it's reasonable in regard to the length of time you've been employed by the group, the size of the area covered, and its effect on patients' access to care.
Even if the restrictions are reasonable, you may be able to get out of the covenant by proving that the executive committee breached the terms of your employment agreement. Have your personal attorney go over the agreement.
Q My partner and I own several urgent care clinics. Although we pay our associates a generous hourly wage, we think our turnover rate is too high. Because our business has expanded so much in the last year, we need to find ways to get physicians to make a long-term commitment to us. What's the best way to do this?
A First, confirm that you're paying your associates a competitive wage. You can do this by checking with colleagues, a local hospital, or your state's medical or specialty society.
Next, evaluate your hiring process. Are you asking the right questions? You need to screen out applicants who view urgent care facilities as a "stop-over" job until something "better" comes along.
Q Instead of having to stop what we're doing to take phone calls, our three-doctor group wants to install speaker phones in our consulting and exam rooms so we can talk while we're working. (Of course, we'd continue to take calls from patients and doctors privately to protect confidentiality.) Is this a good idea?
A No. You'll anger patients by not giving them complete privacy and your undivided attention. Worse, if you make a mistake that ends up in a lawsuit, and the patient testifies that you were talking on a speakerphone in the middle of an office visit, you wouldn't stand a chance in court. It's more productive to return calls at specified times, in your own office.
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 email@example.com (please include your regular postal address). Sorry, but we're not able to answer readers individually.
Kristie Perry. Practice Management. Medical Economics 2002;18:82.