Your responsibility for protecting patients against crime, Should appoint reminders double as health warnings? Pay for a part-time doctor who doesn't do hospital work, Getting deadbeats to honor their bills, Updating job descriptions for your growing staff, A policy for dealing with uncharted walk-ins, Could a patient's laziness lead to a malpractice suit? When it makes sense to demote an employee, Record-keeping for a cash-only practice
QMy practice is located in an area where a number of assaults and burglaries have been reported recently. Would I be liable if a patient were victimized in my parking lot?
A Only if it could be proved that you were aware that crimes had occurred in your parking lot and that you didn't take reasonable precautions to secure the area. To avoid trouble, make sure the area is well-lighted and easily navigable. Better still, move.
QTo emphasize the value of early detection, I'm thinking about including mortality statistics for breast, cervical, ovarian, and uterine cancer on the appointment reminders I send to women who need to come in for their annual pelvic exam. Is this an effective strategy for getting patients to come in?
A Probably not. People tend to ignore negative statistics, thinking, "It could never happen to me." Also, it might look as if you were using scare tactics to drum up business. Positive reminders, with a calmly worded paragraph or two describing the tests and their value, are aggressive enough.
QMy partner and I want to hire a part-time physician. We won't have this doctor take call or make hospital rounds. Under such circumstances, would it be better to bring her onboard as a salaried employee or should we treat her like an independent contractor who's paid by the hour?
A Make the part-timer a salaried associate. Otherwise, you'll have problems with the IRS and third-party payers.
The IRS sets stringent standards for determining whether a worker is an employee or an independent contractor. One of the first things the government looks at is how much supervision and control a business has over a worker's activities. Since you'd be setting the part-timer's schedule and determining which patients she'd see, the IRS would most likely consider you an employermaking you responsible for payroll taxes and the like.
Another consideration: Medicare and many commercial insurers prohibit you from billing for an independent contractor's services.
Plus, an employment arrangement allows you to offer a more attractive recruitment package. You can get away with paying a slightly lower hourly fee or collections percentage to an employee because you can supplement earnings with benefits such as health insurancewhich bring your practice tax breaks.
Finally, an employment contract would allow you to include a restrictive covenant, if permitted in your state.
QI give patients who have outstanding bills one year to pay off their balances. My office follows the standard collection routine: letters, phone calls, more letters, and more phone calls. After 12 months, I send overdue accounts to a collection agency.
Recently, though, collection agencies in my community stopped accepting individual bills under $200.
Although most of my unpaid accounts fall within that category, the sum total equals thousands of dollars. If I can't turn to a collection agency for help, what should I do to get these people to settle their accounts?
A Get tough with the collection agencies. Tell them that you'll yank your big accounts if they won't take your smaller ones. You're not obligated to stay local if the local agencies can't meet your needs.
You should also revamp your collections policy. A year is too long to wait to resolve bad debts. Let patients know that your practice is willing to work with them to clear up their balances. Let patients put their bills on a credit card, or allow them to set up a payment schedule. But as soon as the patient skips two payments, turn the account over for collection.
QAfter our four-doctor group added two front-office employees, our staff became confused over who's responsible for what. To clarify things, we've decided to revise job descriptions. How should we go about doing this?
A Ask each employee to submit a list of what she thinks are her responsibilities. Explain that once all the information is compiled, there may be some reorganization of duties.
Then sit down with your office manager or a practice management consultant to sort out the details and write the actual job descriptions. Let staffers read and comment on them before you make them final.
QShould I try to accommodate walk-in patients whom I've never treated?
A Yes, as long as the visit won't keep established patients waiting. That walk-in may become a life-long patient.
QI instructed a patient with a chronic health problem to arrange for regular blood tests at a lab covered by his insurer that takes walk-ins. But the patient isn't following our agreed upon schedule. Could I be held liable for the patient's failure to show?
A Probably not. But to protect yourself, notify the patient in writing that if he continues to ignore your directions, you'll withdraw as his physician. Tell him he has 30 days to either comply with your instructions or find a new physician. In the letter, include the names of three other doctors who are qualified to treat his condition. Send this information in a certified, return receipt requested letter.
QA staffer I elevated to office manager about a year ago isn't working out. She's having trouble disciplining and evaluating former co-workers. I'm thinking about reassigning her to her previous position, because we happen to have an opening. If I do this, should I also cut her pay?
A Yes, but her reduced pay should be at the top of the salary range for the job you reassign her to.
However, recognize that your action may embarrass the employee and harm staff morale. Your decision will fly only if your new manager acknowledges that she couldn't handle the new responsibilities that came with the promotion and that her failure wasn't a result of your lack of support.
When you recruit a new office manager, keep in mind that job proficiency in one area doesn't necessarily translate to skill in managing personnel.
QI'm fed up with the hassles of third-party payers. If I switch to a cash-only practice, can I develop my own system for coding, billing, and collections?
A Yes, but you're naive to think you could pull this off, our consultants say. If you don't contract with third-party payers, most patients will leave you for a physician who will accept their insurance.
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;17:120.