Can you be sued for losing a chart? How to implement a drug-testing policy; A financial trade-off for skipping call; When a patient doesn't show up; A dress code for the 21st century; Gifts of good cheer for the holiday season; Should patients pay more for weekend visits? When to tell patients you're retiring; Judging readiness for management tasks; Fire an employee for indiscretion? Join a group others spurned? The cost of hiring an accountant
Q: My partner likes to review patient charts at home. Occasionally, he misplaces one. Could he be sued for malpractice for losing a chart? Should our office manager make copies of all charts as a backup?
A: By itself, losing a chart isn't an act of malpractice. But if your partner were ever sued for malpractice, a jury might conclude that the loss was either intentional or negligent and below the usual standard of care.
Copying all your charts is too expensive. Your partner can copy individual charts if he wants to work on them at home. But you should have a policy that no original charts can leave the office. Also, ask your practice's attorney to talk to your partner about the legal risks of losing charts.
Q: What do I need to know about testing employees for illegal drug use?
A: First, you'll need to establish a written policy to guide the program. The policy should explain that your practice will require new applicants to be tested before a hiring decision is made; that current employees must submit to random testing; and that all staffers could be subject to "for-cause" testing.
Before implementing the policy, consult a labor lawyer to find out whether any state laws govern drug testing. You also need to make sure that your policy doesn't appear to single out employees based on race, religion, gender, age, disability, or sexual orientation.
Once you've finalized this new policy's language, give your current staff adequate notice before implementing the testing program.
Q: The 10-member orthopedic group I work for wants to make me its first physiatrist-partner. Because I can't participate in regular call, the practice is going to "charge" me $1,500 a month. Is this reasonable?
A: It depends on the group's overall compensation plan. If you share revenues equally, your $1,500 deduction is a bargain. If you're paid based on productivity, you may be losing out.
Q: Could I be liable for a patient referred to me by the ED who fails to make an appointment?
A: No. But go the extra mile to protect yourself by alerting the ED that the patient didn't show, and note it in the patient's chart. If the ED sends you the patient's test results and they show something significant, send them back to the ED, explainingin writingthat the patient never contacted you.
Q: Our office manager has reported grumbling from the staff about our group's dress code. For years we've provided employeesboth clinical and administrativea small stipend to purchase scrubs or other apparel within prescribed guidelines. Do we need to give our staffers more leeway? If so, how much?
A: Consider allowing your employees to vote on some of the detailscolor or pattern, for instanceof office attire that fall within your group's general guidelines for professional appearance and demeanor. Also, make sure your stipend is enough to buy at least two uniforms per year.
Q: I asked my staff to suggest uncomplicated, nonsectarian ways for my office to celebrate the upcoming holidays. My receptionist suggested we offer patients bite-sized chocolates at the front desk. Would this offend anyone?
A: Probably not. But given the health implications of chocolate, it might be better to offer magnets or pocket calendars that feature your practice's name, address, phone, and office hours. If you still want to offer candy, just make sure you provide sugar-free and low-fat alternatives.
Q: Can I charge more for Saturday and Sunday appointments?
A: Not for Medicare patients; the fee schedule doesn't take into account when services are provided. And it's unlikely that many states permit extra charges for Medicaid patients. Although you can raise fees for other patients, most private insurers won't pay the higher fees. That means you'd have to explain your new fee policy to patientsthey're paying for added serviceand let them know that they're responsible for the extra charge themselves. The explanation should be given to each patient every time he or she wants to make a weekend appointment.
Q: I'm preparing to retire. Should I tell my patients now or after I've finalized the sale of my practice?
A: Tell them now, but assure them that the buyer will assume their care. Encourage them to stay with the new doctor, but make it easy for them to transfer their records if they choose someone new.
Q: Should my partner and I ask our associatewho's been with us for a yearto conduct performance reviews?
A: Not by himselfhe's too new. Instead, ask him to review the evaluation forms you completed and to sit in on your meetings with employees.
Q: The accounting manager for our large multispecialty group has complained to various physicians and staffers that she thinks our practice administrator's salary is too high. This strikes me as inappropriate. Is it grounds for dismissal?
A: It's unprofessional, but not immediate grounds for dismissal. First determine if her gripe is a backhanded way of saying, "I'm not paid enough." Ask around to see how much other groups pay their administrators and accounting managers, or check a source like the Medical Group Management Association (www.mgma.com ). If it turns out that her salary isn't competitive, perhaps you need to raise it. But if you're satisfied that you're paying her appropriately, warn her to stop airing her grievances publicly. If she continues after this warning, let her go.
Q: A multispecialty group wants to buy my solo family practice. They've offered a fair contract, but other local FPs have rejected similar offers from the group within the past year. Should I reject the offer, too?
A: You won't know unless you ask the other FPs. So contact them before you go any further in contract negotiations.
Q: How much should my practice be spending on accounting services?
A: The typical charge should be 1 to 2 percent of gross receipts.
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 Q&As. Medical Economics Nov. 7, 2003;80:104.