Could a professional favor cause liability risks? Tracking down patients when a partner leaves; Should employees forfeit unused vacation days? Ask about a patient's ability to pay? An exit agreement between new partners
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Q: Sometimes colleagues refer high-risk OB patients to me who have no insurance coverage. I can't afford to work for free, but I do want these patients to have the care they need.
Is it ethical for me to ask referring physicians about insurance before accepting their patients? May I divert those without insurance to a clinic for low-income patients?
A: You can turn away any nonemergency patient you want as long as you're not basing your decision on race, religion, gender, national origin, or sexual orientation. If you haven't accepted the patient in the first place, you have no doctor-patient relationship.
Q:After one of our cardiologists resigned to start his own practice, we sent a letter to his current patients notifying them of his departure and explaining that our group could continue caring for them. We also gave any patient who asked for it our former partner's new contact information. Must we notify his "dormant" patients of the change, too?
A: No. That's the exiting doctor's responsibility. However, if a so-called dormant patient eventually calls your office to schedule an appointment with the long-gone physician, offer to take over that patient's care. If he declines, help him get in touch with his former doctor.
Q:Our group allows employees to carry unused vacation days into the following March. They forfeit what they haven't used by the end of the month. But with expenses rising, we're thinking about implementing a "use-it-or-lose-it" policy at the beginning of next year. What do you think?
A: Don't do it. If you're trying to cut costs, look for ways that won't erode the goodwill you get from the rollover allowance. Besides, "use it or lose it" is illegal in some states, so check with your state labor department before you make changes.
Q:Is there a malpractice risk in approving prescription refills for a partner's patients?
A: Not if you've consulted the patient's chart and determined that he isn't abusing the drug, asked about adverse reactions and changes in condition, and remembered to document that you've written a refill. You and your partner should establish a written protocol to guide how you'll approve refills for each other's patients.
Q:My partner and I are talking about incorporating. We disagree about how much notice we should provide if one of us wants to leave the practice. I say three months is plenty. My partner says we need to make it a year because it takes that long to recruit a new physician. Who's right?
A: Our consultants recommend six to 12 months' notice. For every month less than 12, the exiting physician should forfeit 1/12 of his buyout.
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 Q&As. Medical Economics Apr. 25, 2003;80:96.