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is a question-and-answer forum featuring leading practice management experts who may or may not be employed by Physicians Practice. Physicians Practice receives questions from physicians, office managers, office administrators and others. Have a question about the operation of your practice? Visit www.PhysiciansPractice.com. Your question will be answered within three business days. For more practice management resources and tools, visit www.yourpractice-online.com. Q I know a single family physician who sees at least 100 patients a day and has at times seen 145 patients per day. How many patients are too many?
A That’s a great question. We are constantly encouraging physicians to see more and more patients, but there may be a breaking point. We have seen some physicians literally maxed out at 20 patients, while there are others who easily sail through 60 patients a day — yet their patients are typically the most satisfied! Some of it has to do with maximizing the time with the patient; the physician is simply more efficient.
Practices with low phone triage tend to have higher productivity as well because they are seeing those “easy” visits in person instead of handling them on the phones. The risk the physician takes is making a mistake because he’s going too fast and ending up with a malpractice case. Q I am a physician employed in a small family practice. I was told some time ago that I would have the opportunity to become a partner and was wondering what the buy-in process usually entails. Do I have to borrow the money to buy in, or does the clinic usually take a percentage of my production per year until the buy-in is complete?
A Usually buy-ins are structured so that the practice pulls money from your pay during the employment period, which is normally one to four years. The terms of the buy-in, as well as the period of time, totally depend on the contract. You should request a copy of the agreement in writing as soon as possible. This need not imply the practice is asking you to partner right now, but it does give you a sense of what to expect. If other physicians have become partners in the practice, there must be a buy-in in place, even if it has never been written down. Your ideal would be to have an agreement in which the buy-in money is taken from your collections, not straight cash, with as little negative financial impact to you as possible.
Q We’d like to develop a coding system in which one code automatically populates all associated CPT codes for that service. For example, if a charge-entry person enters one code for a flu shot, the code for administration of the shot would also be automatically posted to the patient account. What do you think?
A Shortcuts are fine as long as they don’t create a compliance issue. A similar example is for the ICD-9 code for the patient’s last visit to print on the current encounter form. Practices have generally stopped doing this, recognizing that the current visit may not be for the same purpose as the last, and the fact that many physicians would likely defer erroneously to the pre-printed diagnosis in the interest of time. In short, by all means, set up shortcuts, but make sure you also abide by the rules and regulations of coding and documentation. Training and periodic audits would be wise.
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