Practice Management Q&As

When patients need nursing home info

Q: What should I tell patients who ask me for help in choosing a nursing home?

A: Refer them to "Nursing Home Compare," available at www.medicare.gov/nursing/overview.asp, an interactive tool that will allow them to search a database of more than 17,000 Medicare- and Medicaid-certified nursing homes nationwide. It covers such characteristics as number of beds, type of ownership, nursing personnel qualifications, and it summarizes the most recent state inspection results. Patients can also download a detailed checklist for rating nursing homes based on various criteria, as well as a 64-page "Guide to Choosing a Nursing Home." In addition, they'll find links to other useful Web sites, including the American Association of Homes and Services for the Aging (www.aahsa.org), the American Health Care Association/ National Center for Assisted Living (www.longtermcareliving.com), and the National Citizens' Coalition for Nursing Home Reform ( www.nursinghomeaction.org).

Replace COLAs with merit raises

Q: Our six-doctor group wants to eliminate annual cost-of-living raises. Instead, we'd award pay hikes based on productivity for our administrators, billing clerks, and lab personnel. Is this a good idea? If Yes, how should we calculate the raise?

A: Productivity pay programs often cause more problems than they're worth. For starters, it's difficult to establish goals that all employees can have an impact on or achieve. If you try to get around this by establishing different criteria for your clinical and administrative departments, you may end up with an accounting nightmare. Finally, workers who go the extra mile to earn the bonus may end up resenting those who don't and cause the staff to fall short of the overall goals. It's best to stick with cost-of-living and individual merit raises.

When test results go to the wrong patient

Q:As our practice has grown, so has the number of like-named patients. What can we do to avoid sending test results and other confidential information to the wrong person?

A: Set up a filing system that requires multiple layers of identifying information—not only the patient's name, but also Social Security number and insurer identification number. In addition, flag the charts of patients with similar names. And consider placing patients' photos in their charts. This could be as simple as making a copy of their driver's license.

Finally, impress upon your staff how important it is—from malpractice, privacy, and efficiency standpoints—to avoid such errors.

Fire a staffer who doesn't heed warnings?

Q: One of our billing assistants lets difficult or aging collectibles sit untouched. We've warned her three times over the past two years that she needs to improve, and we've documented the discussions in her file. Each time we spoke to her, productivity would improve for a few weeks, but then she'd slide back into her old habits. Is it time to fire this employee?

A: Yes, as long as you've made sure that the problem is really with the employee and not with office policies that may hinder her performance. And as long as the warnings you gave her in the past were accompanied by specific deadlines for improvement.

Edited by Kristie Perry,
Contributing Writer

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 mepractice@medec.com (please include your regular postal address). Sorry, but we're not able to answer readers individually.

Kristie Perry. Practice Management Q&As.

Medical Economics

Oct. 24, 2003;80:72.