Practice Management Q&As

When longtime patients take advantage

Q: I have several longtime patients with chronic conditions who refuse to comply with my instructions. They don't keep scheduled appointments, they request medication over the phone, and they don't monitor their protimes or blood sugar. My partner tells me I should dismiss them from the practice, but I don't feel right about that. Is there any way I can get them to comply?

A: A noncompliant patient is a disaster waiting to happen. If anything goes wrong, you will probably be blamed, not the patient who failed to follow your instructions. Have a final heart-to-heart talk with each patient. Explain that you want to provide the best care, but you can't do your job if they won't cooperate. Let them know that, unless they comply, you'll have to discharge them. If they "get the message," give them another chance with the understanding, in writing, that one more failure to comply will result in termination-no exceptions.

A time-off policy for a solo office

Q: As a solo practitioner, what kind of time-off policy should I offer my staff?

A: Our experts recommend that you offer four types of paid time off:

Vacation: After six months of employment, staffers are eligible for two weeks off; then three weeks after five years; and four weeks after 10. Staff vacations should be scheduled to coincide with yours, and you should require employees to use all their vacation days by year's end.

Sick time: After three months of employment, give six days per year to be used when either the employee or a family member is ill. Allow your staff to accrue a maximum of 60 unused days for major illnesses or parental leave after childbirth or adoption.

Personal days: Give one or two per year. Some offices give employees a day off on their birthday; others let them choose the day.

Holidays: At a minimum, give all employees time off on New Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving, and Christmas.

Consult a practice management consultant or attorney to make sure your time-off policy complies with state and federal laws.

Aging receivables:What's the norm?

Q: What is a reasonable level of accounts receivable?

A: According to our experts, a good A/R aging profile is:

If an account is more than 120 days old, it's unlikely that you'll ever recover amounts under $100. Write them off. If the patient has a long history of payment problems and refuses to set up a payment schedule, perhaps you should consider dismissing him from your practice.

Sue over damage to your credit rating?

Q: I just found out that my office manager never paid the bills. Now I'm three months behind, my beeper has been turned off for nonpayment, and creditors are calling me at home to collect. I fired the manager, of course. But I want to know if I can take her to court to force her to compensate me for my ruined credit rating.