Practice Management Q&As

March 4, 2005

Uninsured urgent care; dismissal letter; collections; informed consent

Uninsured patients and urgent careQ A man without health insurance who'd never been to our practice called to see if I could stitch up a two-inch gash in his finger. Our receptionist told the patient that I didn't have room in my schedule that day and he'd have to go to an emergency department or urgent care center, instead. Did she do the right thing? What if the patient had walked in? Could she still have turned him away without inviting liability?

A Because this patient didn't have an established relationship with your practice and his injury wasn't severe, it was appropriate for your receptionist to direct him elsewhere. But if a drop-in ever appears in your waiting room with a true emergency, treat him on the spot. And in the future, a clinical staffer should decide whether a patient's condition is an emergency or something that can wait.

When a patient dodges your dismissal letterQ I recently sent a registered dismissal letter to a noncompliant patient. He refused the letter, which the post office returned to me unopened. What should I do next?

In most jurisdictions, such actions will provide immunity against abandonment charges.

How much to spend on staff educationQ What do doctors typically spend on continuing education for employees?

A Less than 1 percent of collections-which is woefully shortsighted, according to our experts. It doesn't make sense, they say, to invest more in equipment maintenance contracts than in staff expertise. At the very least, budget enough to send each employee to one professional training seminar per year. Also try to cover fees for membership in professional organizations.

A script for collection callsQ I would like to give my employees a script to use when calling patients who have overdue accounts. Can you help?

A Try this: "Mrs. Nopay? This is Mrs. Green from Dr. Smith's office. We've been sending you statements of your account balance of $X and have not heard from you. Dr. Green has asked me to see if there's a problem."

If there is a legitimate problem, listen politely and try to help the patient solve it, if possible. If the patient offers excuses only, press on to the next question: "Mrs. Nopay, when may I expect your payment?" Don't be the one to suggest a payment plan. But if the patient proposes one that's reasonable, mark your calendar to follow up on each date.

If the patient won't commit to paying the bill, tell her, "Mrs. Nopay, I'll review our conversation with the doctor before proceeding to the next step."

Keep in mind that state law may dictate what your staff can say and do to collect on unpaid bills. So first, consult with your state's medical society.

What are your patient records worth?Q I'm planning to retire soon. A young doctor has asked to buy my charts. How much should I charge him?

A There's no simple formula. But a very rough rule of thumb for primary care doctors is about $10 a chart. This takes into account the material cost of the record as well as the potential for the chart to generate income. This approximate value applies only to the charts of active patients who are covered by health plans the buyer contracts with.