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Q
My group of physicians includes five internists and
one pediatrician. We have our own billing department. The
billing expenses are currently being divided equally among
all members. However, there are significant differences in
productivity and utilization of the billing department. Are
there any other common methods of allocating these expenses
more equitably?
A
You could run the billing office like an external billing
service and require physicians to pay for the level of service
required. One way to accomplish that is to charge for billing
services on a “per claim” basis: physicians submitting
more claims pay more. Similarly, you could split the costs
based on the percentage of relative value units (RVUs) generated
for the practice. If Dr. Jones generates 40 percent of the
RVUs, she pays 40 percent of the billing costs.
One other alternative:
everyone shares equally up to a point — say, 60 percent
of total costs — and the rest of the costs are then
divided based on productivity (RVUs).
The trouble is that you
need to communicate very clearly. You don’t want to
seem to be telling productive physicians to submit fewer claims.
Stress that, overall, they still make more by being more productive.
Also, be sure you don’t
divorce your plan for dividing billing costs from all your
other cost-sharing policies. You want to follow a consistent
strategy — a vision for how your physicians should expect
to work together.
Q
I am a solo practitioner, but I am expanding into
a second office and will be hiring a nurse practitioner (NP)
or physician assistant (PA). How do I turn over my established
patients to the new person? I have seen more than 10,000 people
over the last 23 years, and they have become accustomed to
seeing only me on their visits. I never had even a nurse in
the office.
A
Here are a couple of ways to introduce your new NP or PA:
Have the new hire accompany
you on several office visits so you can formally introduce
her to your established patients. Say something like, “Amy
here has stellar clinical skills and works under my guidance.
She’ll also be easier for you to get in to see, and
she will have more time than I usually do to chat. So I’d
like you to make your next follow-up appointment with her.
I’ll still see you at regular intervals, of course,
to make sure all is well.”
Encourage your scheduler
to direct patients, as appropriate, to your new employee.
Give the scheduler guidelines regarding who should be directed
where. You could also give the scheduler a script to help
guide her with these patient conversations. You may want her
to say, “Dr. Jones doesn’t have any openings for
three weeks, but he is overseeing a new nurse practitioner
who is just great. She is a graduate of XYZ University, has
been in practice for X number of years, and all her work is
supervised by Dr. Jones. Dr. Jones instructed me to tell all
of his established patients that they are welcome to make
appointments with her. She has an opening tomorrow. Why don’t
you see her for this visit?”
You also could invite
patients to an open house to meet your new NP or PA. Do so
by mailing postcards to your patient base with the new practitioner’s
photo and credentials. Explain when and where the practitioner
will start seeing patients, and invite your patients to meet
your new colleague informally at a reception.
Keep in mind that while
patients may not be used to an NP or PA in your practice,
they likely will have seen them in other offices.
Finally, make sure you’ve
thought through all the related billing and supervisory issues
that accompany bringing in a new practitioner. Review articles
addressing this topic at www.PhysiciansPractice.com
for further guidance.
Q
I’m thinking of giving staff a clothing allowance
for uniforms. How much is reasonable?
A
If you don’t want to hassle with
ordering uniforms for employees yourself, offer to reimburse
your staff anywhere from $150 to $250 per year for clothing.
This is a straight business expense for you, and it also allows
your staff some freedom of choice since they can spend the
money on the styles and colors they prefer.
Q After two and half years
of trying to do solo practice, I have had enough. This is
not for me. Ideally, I want to sell my practice. If I can’t
and I have to close it, what are the steps that I should take
to ensure a smooth closing?
A
To close the practice, you need to consider all the logistics
based on your practice situation. For example, what will you
do with your building? Do you rent, lease, or own? If you
rent, you need to notify your landlord about your intentions.
If you own, do you plan to sell? Find a real estate agent
and start your preparations.
Also, determine what you
need to do to move your equipment, files and furniture —
and where you will put them. If you lease your equipment,
notify your leaser. If you want to sell the equipment you
own, find a seller, have a yard sale, put your equipment up
for sale on eBay, or find another way to locate a buyer.
Give your staff adequate
notification. You’ll want to retain at least one staff
member for 30 to 60 days after the close to follow up on your
final outstanding accounts. Most physicians find a part-time
employee for 60 days to be adequate, but it depends on the
volume and how many of your accounts are still to be collected.
Remember that a physician
has an ethical obligation to notify her patients when she
moves or closes her practice to allow them to obtain copies
of their medical records or have their records transferred
to another practice. Ideally, a physician should notify each
patient by letter at least 60 days in advance of closing.
Often a physician supplements these written notices with a
published notice in her local newspaper scheduled to appear
on three or more occasions.
The American Medical Association’s
Ethics Opinion 7.03, Records of Physicians Upon Retirement
or Departure From a Group, states in part: “A patient’s
records may be necessary to the patient in the future not
only for medical care but also for employment, insurance,
litigation or other reasons. When a physician retires or dies,
patients should be notified and urged to find a new physician
and should be informed that upon authorization, records will
be sent to the new physician. Records that may be of value
to a patient and are not forwarded to a new physician should
be retained, either by the treating physician, another physician,
or such other person lawfully permitted to act as a custodian
of the records.”
Finally, if you have privileges
at a hospital — and especially if you take emergency
calls — you’ll want to give that hospital at least
90 days notice, if not more.
Q
How often should I hold staff meetings?
A
In my experience, the majority of practices
hold meetings once a month. It might be more effective to
hold shorter meetings every two weeks or even weekly. The
goals are to avoid letting issues fester and to keep the meeting
tight and relevant. Monthly meetings can tend to drag and
stray on to topics that aren’t crucial.
Q
I need to train a new medical records
clerk. Where can she find courses?
A
Medical records technician courses are
available through adult education services, Regional Occupation
Programs (ROP) and private colleges and schools. Try the DeVry/Phoenix
Universities and so on in your area.
There also are online
opportunities. Try http://allied.brightoncollege.edu/.
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