Practice Management Q&As

June 2, 2006

Helping a partner catch up on paperwork

Q. The partner who founded our group practice 20 years ago is our busiest and most productive physician. However, he also has the worst backlog of dictations, lab reviews, and forms that need to be completed. We don't know how to discipline him because our practice never developed a formal policy for dealing with physicians who don't keep up with paperwork. How should we handle this situation?

A. No matter what you do, it's unlikely he'll change his ways. Be grateful that he's so productive, and find someone to help him get his work done. Maybe a staff nurse can sort through the labs, review dictation, or complete forms for his signature. Or see if you can delegate some of his purely clerical tasks to a part-time assistant. If so, hire one and charge the costs back to him.

No shoes, no paycheck

Q. Our human resources department has advised us that physicians and their staff may not wear open-toed shoes in the office. Many of us wear sandals and feel there's little risk of injuring our feet in an office setting. Do we have any basis to challenge this rule?

A. No. It's a safety issue, likely covered under OSHA. In a healthcare workplace, where objects may fall or be dropped, the foot is better protected in closed shoes. Sharps on the floor are an additional hazard. Your HR department's rule is meant to protect rather than control.

A legal way to save on employee health insurance?

Q. Can we legally stop offering health insurance to employees who have other coverage through their spouses?

A. Perhaps. The key is to avoid discriminating against anyone who is a member of a protected class because of race, national origin, sex, age, religion, or disability. Under federal law, providing health insurance only to those employees who are not covered by their spouse's plan is not discrimination, so you'd be okay.

However, state law may be another matter. Many states prohibit discrimination based on marital status, in which case your policy could violate state law. Some states exempt health insurance from their marital discrimination laws, but others do not. Have your attorney check your state requirements to find out what's permissible.

Should you stop accepting new patients?

Q. It currently takes four weeks for a new patient to get an appointment with me. Is it time for me to stop accepting new patients?

A. Think twice before you turn them away. You probably have more time for new patients than you realize. For example, can you reclaim more slots for new-patient visits by making efforts to cut down on no-shows and cancellations? Or can you free up more time for yourself by delegating tasks that don't require your expertise? Clear up whatever hinders your productivity. Then, if there's still more demand than you can handle, consider adding a mid-level provider.

Waving a red flag at CMS

Q. One of the doctors in our five-doctor practice consistently codes higher than the rest of us. He has excellent documentation, but he does a complete physical exam and review of systems for such complaints as a groin rash or sore throat. He codes about 80 percent of his visits at level 4, and only about 5 percent at level 2. Is he putting us at risk of an audit by being such an outlier?

A. Yes. His profile will greatly increase his chance of being audited, and that may result in massive repayments. Most doctors' charges for established patient visits follow a bell curve with most visits coded 99213, and about as many level 4s as level 2s.