Practice Management

Does a practice purchase obligate you to all the seller's patients?

Q I've just purchased a family practice from a doctor who treated a large number of workers' comp patients. I told the seller that I don't plan to take over the care of these patients. What should I do with their charts?

A In theory, nothing. The seller should have alerted all of his patients of the impending practice sale, informed them that you had no plans to assume their care, and given them instructions on how to transfer their records to another physician who could take over their workers' comp cases. If he didn't, he could face charges of abandonment.

If the seller didn't take these steps, contact your attorney or liability insurer to find out what to do.

How to get complete information on new patients

Q Too many new patients submit incomplete medical-history forms. What can we do about this?

A Mail your questionnaire to a new patient a week or two before the scheduled appointment. Include a stamped return envelope and a copy of your patient-information brochure. When the patient arrives, have a medical assistant review the form. The assistant can then question the patient about any omissions and fill in the blanks before the exam.

Of course, some patients won't complete and mail in their history before their appointment. To cover your bases, your scheduler should ask new patients to arrive 10 minutes early to complete paperwork.

When a partner's indiscretion becomes your lawsuit

QCould I be held liable for patient privacy violations committed by one of my group's partners?

A Probably not personally liable. But, your group—as a business entity—would be liable. You should consider getting a separate insurance policy to cover the group's liability for the actions of an individual partner or employee.

Securing reimbursement for care provided by nurses

QMust my partners and I sign off on chart notes made by nurses who provide services "incident to" ours?

A Yes. But most states don't require this for services delivered by NPs or PAs.

A restrictive covenant may hamper your marketing plans

QIn accordance with the terms of my noncompete clause, I'm opening a practice more than 20 miles away from my previous employer. I plan to advertise my new practice through newspaper ads and bulk mailings that will reach people within the 20 mile limit. Is there anything wrong with this tactic?

A Probably not, say our consultants. To be safe, check with an attorney.

Time off as a reward for long-term service

QShould long-term employees be entitled to more generous vacation benefits?

A Yes. The typical scale is: 1 to 3 years—two weeks; 4 to 6 years—three weeks; 7+ years—four weeks.

Whether an expert witness should get paid up front

QIs it a good idea to request advance payment for any work I do to prepare for testifying as an expert witness in a malpractice case?

A If you've never worked with the attorney before, Yes. Ask for a retainer against which your hourly fees will be deducted. When it's depleted, ask for another.

Chart retention guidelines for a retiring physician

QI've just informed my patients that I'll be retiring at the end of the year. Naturally, I've offered to forward copies of their records to any subsequent treating physicians. How long do I need to retain the originals?

A Ask your malpractice carrier, since it will want original documents available for your defense if you are sued. The statute of limitations for filing a claim varies by state and the patient's age, so that will dictate how long you need to hold onto medical records. In some states, the statute starts running from the date of injury. In others, it starts when the injury is discovered. For children, the clock may not start ticking until the child reaches the age of maturity—usually 18.

Meager benefits might be costing you staff

QThe office manager for our three-doctor practice is concerned about our high employee turnover. She insists that our "meager" benefits package is to blame. How can we verify her claim?

A Ask colleagues and your local hospital what their benefits packages are. You could also check with your state medical or specialty society about what's typical for practices your size.

A warning: Our consultants were skeptical that benefits are the issue. They wondered if uneasy relations between doctors and staff is the real reason for high turnover.

A surefire way to get dropped by an insurance plan

QA colleague told me that his primary care group improved its bottom line by making it "inconvenient" for patients with low-paying insurance to make appointments. Is that legal?

A Yes, but it's certainly not ethical. And it's hard to believe that his strategy would bring about a significant increase in profits. Many insurers would cancel their contracts with your colleague if they got wind of his tactics. Don't follow in his footsteps.

Don't let a plaintiff's attorney pit you against co-defendants

QI've been named in a malpractice suit. The plaintiff's attorney wants me to testify as an expert witness against a co-defendant. Is this a good idea?

A No. Your testimony could undermine your credibility as a defendant and a witness. The jury may perceive your work for the plaintiff as an effort to get off the hook at the other doctors' expense. By letting the plaintiff's lawyer pit defendants against each other, you'll make his job a whole lot easier.

Securing a locum tenens for a partner's absence

QA senior partner notified us that he wants to take six months off to do charitable work overseas. How far in advance should we contact a locum agency in order to find a replacement?

A As soon as you know you'll need one. Ask the agency to give you the temporary doctor's name and background information 45 days before your partner plans to leave. And stay in touch with the agency until the locum arrives.

When a salaried employee requests overtime pay

QWhen my partner and I hired our office manager two years ago, we offered her a competitive salary and a bonus based on our practice's productivity. At the time, we thought she'd understood that she couldn't file for overtime. But she's asked us to pay her time-and-a-half for the extra hours she's worked covering for a billing clerk who's been out on maternity leave. Should we honor her request?

A Not as long as management activities still comprise 80 percent of her responsibilities. But lighten her workload by hiring a temp to cover for the billing clerk.

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.

Medical Economics

2002;22:100.