Practice Management Q&As

Professional courtesy: where to draw the line

Q:For years, my partner and I have offered professional courtesy to colleagues and their immediate family. But these gratis services have started to eat into our bottom line. How should we determine which physicians' relatives we'll offer free services to?

A: In order to avoid even the appearance that you're playing favorites (and to avoid getting tangled up in antikickback laws and Medicare rules forbidding the waiver of copayments), offer professional courtesy to no one.

Convincing insurers to raise your fees

Q: Our group has decided it's time to raise our fees. But so much of our revenue comes from health plans that dictate what they'll pay us. How can we convince these insurers to pay us more?

A: It depends on your contract with the plans. If you contract through an IPA or PHO, your best bet is to ask those organizations to try to secure higher fees for all members.

But if you contract privately with the health plans, you probably don't have much bargaining power, unless your practice is highly in demand.

Can a messy desk get you sued?

Q: Our office manager—who is married to the practice's owner—insists on filing all test results and consults herself. But she's always so far behind that, often, I must ask her to fish out updated medical information at the time of a patient's visit. The clinic staff and I fear that these piled-up reports are a lawsuit waiting to happen. Should I notify our malpractice carrier about this problem?

A: No. You need to discuss the situation with the practice's owner. The malpractice carrier will only tell you what you already know: that you have a problem and need to fix it.

Tell your employer—in writing—that having to look for paperwork at the time of a patient's visit not only wastes money, but also leads to malpractice liabilities. Ask him to speak to his wife about the problem or to give you authority to have other staffers tackle the backlog when the office manager falls behind.

From full-time practice to volunteer service

Q: Where should I look for information on how retired physicians can practice as volunteers? What should I know about malpractice insurance?

A: Church groups and state and county medical societies can direct you to volunteer programs. Some programs will pay for your malpractice coverage. In some states, volunteers are immune from liability claims.

A gift for a staffer's employment anniversary

Q: I'd like to give my part-time receptionist/secretary a token of appreciation for 10 years of excellent service. What would be appropriate? Would I be establishing a precedent? How often should I do this?

A: A gift certificate to a restaurant or boutique makes a nice service award. Personalize it with a handwritten letter thanking your receptionist for a job well done. You will be setting a precedent, so be careful not to forget anyone. A better interval for service-recognition gifts is five years, not 10.

When to turn to a collection agency

Q: How many times should we contact a patient before we assign an overdue account to a collection agency?

A: At most, 10 times within a six-month period. Mail one reminder a month in the two months following the payment-due date. Call the patient every 15 days after that. In each communication, reassure him that you're willing to design a payment schedule that works for both of you. If the patient hasn't paid after six months, and his outstanding balance is big enough to make it worthwhile, notify him by mail that you've turned over his account to a collection agency. (For liability purposes, a physician must sign off on every patient whose account is turned over.)

If you follow this strict protocol, you should seldom need a collection agency, which typically charges a 50 percent commission on everything it collects.

Employment contracts tie your hands

Q: Should my practice require staffers to sign employment contracts?

A: No. Such agreements limit your right to hire and fire at will. In fact, your office policy manual should specify that employees are "at will," meaning that either party has the right to terminate the employee-employer relationship at any time.

If your lab coat frightens children

Q: My white lab coat seems to reassure the adults in my family practice, but frighten the children. What can I wear that will appeal to all patients?

A: Some doctors wear a suit or good sports jacket, and some dress less formally. If the adults like to see you in a lab coat, though, why not wear one, and simply remove it when you enter the exam room to see a child? And always remember, it's not your clothes so much as your manner that puts patients at ease.

When to call in a headhunter

Q: Should our four-doctor internal medicine practice hire a recruiter to help us find a replacement for a retiring partner?

A: If you have the time and tenacity, and you're located in a city or suburb, your group should have no trouble finding good candidates without hiring a headhunter. Your state medical society, local residency program, and your hospital's physician liaison office are good sources for leads. If, however, you're located in a rural area, where recruiting is notoriously difficult, you'll be better off using an agency.

Why saving paper can break the law

Q: To cut expenses and paper waste, our office manager has asked our staff to reuse paper whenever possible. But faxes and photocopies are being made on the backs of patient reports, statements, or old progress notes. Won't this cause patient confidentiality problems and violate HIPAA regulations?

A: Yes. Paper is cheap; litigation is not. So instruct your office manager to send all documents that contain identifying patient information to the shredder before recycling.

Selling equipment that's showing its age

Q: Now that our founding partner has retired, the rest of us want to upgrade our medical equipment. How should we go about selling our somewhat outdated inventory?

A: By placing an ad in a medical journal, on the bulletin board at a local residency program, or auctioning the equipment on an appropriate Web site, such as eBay (www.ebay.com ). You could also use word of mouth—contacts at local medical society meetings or conversations in the hospital cafeteria—to get the word out to academic colleagues who have residents who are graduating. If none of this pans out, consider donating the equipment to a nonprofit agency and taking a tax deduction.

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. 10, 2003;80:119.