Practice Management Q&As

September 16, 2005

Staff turnover; returning records; practice funding; flu test reimbursement

What's normal staff turnover?

Q. What's a typical turnover rate for front-office staff in a small primary care group?

A. It isn't unusual for the front-desk staff to turn over every nine to 16 months. This is a faster rate than for clinical positions because these employees are the ones who take the heat, while the clinical staff sees patients' nicer side. Moreover, the pay for front-office staff is usually the lowest in the office.

When a doctor won't send patient records

Q. Several patients who followed my former partner to his new practice are now returning to me. Although I've sent him requests, signed by the patients, to return their records to me, he refuses to hand them over. What should I do?

A. Ask your lawyer to write to your former partner's lawyer, pointing out his client's obligation to provide a copy of the charts to patients who request them.

Can out-of-state docs bankroll your practice?

Q. I want to start my own practice, but I can't get a loan from the bank because I have so much debt already. I have several private investors lined up, though-physicians licensed in another state-who would like to be shareholders in the professional corporation I'd set up. Is this legal?

A. Maybe. Although most states require doctor-shareholders to be licensed in the state where the practice is located, there are some exceptions, so consult a healthcare attorney.

You should also check whether "foreign" corporations (i.e., those incorporated in another state) are permitted to register and practice in your state. If so, you might incorporate in the state where your investors are, but practice in your home state.

There are also a variety of esoteric organization structures (like management companies) that may allow the out-of-state doctors to effectively own or control the practice without being the titular owners. But these approaches require careful examination to avoid anti-fee-splitting rules and other legal constraints.

Cost effective rapid flu tests

Q. Because rapid flu tests can indicate the presence of a flu virus in 10 minutes, I'd like to offer them. However, the reimbursement won't cover the $20 cost of the test, let alone the time and effort to administer it. How can I make such testing worth my while?

A. First, make sure you're not losing money through coding errors. If you provide separately identifiable services in addition to the rapid flu test (87804), you may code for an office visit (99212-99213; 99203-99204) as well.

To make the test more cost-effective, you may be able to save money by obtaining the test through a buying cooperative sponsored by your local medical society or hospital.

If you find you can't get reimbursed adequately for the test, don't offer it. Do a culture instead. It will take longer to get the results, but at least you won't be losing money.

In this issue, the answers to our readers' questions were provided by: Geoffrey T. Anders, JD, CPA, The Health Care Group, Plymouth Meeting, PA; Judy Bee, http://www.ppgconsulting.com, La Jolla, CA; Ellis I. Kahn, JD, Kahn Law Firm, Charleston, SC.

Do you have a practice management question that may be stumping other doctors, too? Write PMQA Editor, Medical Economics, 5 Paragon Drive, Montvale, NJ 07645-1742, or send an e-mail to mepractice@advanstar.com (please include your regular postal address). Sorry, but we're not able to answer readers individually.