Physicians Practice's
Ask the Experts
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.

Q When patients ask for a copy of their exam notes and/or their records when checking out, what is the best way to handle this? Do we need to photocopy them immediately? One of my doctors would rather type up a summary than give out copies of medical records.

A If this happens a lot, it’s another great reason to get an Electronic Medical Record (EMR) that lets you print a summary report right from the record.

The answer also depends on what the patients want it for. Billing? Their own records?

If it’s the former, they might need the whole thing.

Health Insurance Portability and Accountability Act (HIPAA) simply states that patients need to be allowed access to their records. How you do so is somewhat discretionary. HIPAA allows you to require all patients to send you a written request for their records before you release them. And it states that you may offer patients a summary or their full records, according to their preference.

Otherwise, this is a work flow issue. Physicians who feel strongly about the summary approach should commit to sending a summary of the visit via e-mail to the patient on the next business day.

If the patient won’t agree to do that, then just copy the most recent note and hand it over. Postponing such work only serves to make it more time consuming.

Q I am in my third year as a salaried employee in a three-physician practice and am looking into partnership. However, the practice situation is a little complex.

According to the business manager, the financial outlook for the practice is healthy, but I wouldn’t know since I am only employed and am not privy to the information. The accounting seems a little confused.

I am currently receiving $150,000, and my partner keeps telling me it’s a very competitive salary. I don’t know whether it’s true. If I am to negotiate my situation, then who is the best person to represent and advocate for me? A mediator or a lawyer?

A You should definitely encourage the practice to clean up its accounting and show you the data as soon as possible. You have now invested three years in this practice with the goal of becoming a partner, but you don’t have any idea of what sort of business you’re proposing to join. If the other physicians potentially want you on board as a partner, they should start training you now on being a part of the business side as well, and it’s only fair to you to understand what is going on. The assurances of the manager are not sufficient — what else is she going to say?

It would no doubt be worthwhile to have a consultant clean up the systems and reporting and educate everyone on what to review monthly. The accounting really should be transparent.

Becoming a partner is a business decision. You are buying into a business, not playing a game of flattered egos and academic-style approval seeking. You should also lay down the law contractually about what your job is — hours, doing paperwork for colleagues, call schedule, productivity expectations, etc. — so you don’t get railroaded later and so they know what to insist on.

As for the second part of your question, go ahead and ask salaried physicians in other practices like yours what they make. Why not? They want to know what you make, too. And this is not price fixing.

According to the Medical Group Management Association, physicians in your specialty make a median compensation of $187,138.

Speaking very broadly, lawyers are best at reading contracts. Have one review the terms of any contract or partnership agreement. You might be able to find an attorney who can both review documents and negotiate on your behalf. If not, you might consider retaining two lawyers: one for document review, the other for negotiating.

Also, arm yourself. You need to know good financial performance when you see it, how to judge salaries and overhead, how to read reports from the practice’s management system, what reports to ask for, what a typical buy-in looks like, how your productivity compares with that of your potential partners, and so on.

Q We have several employees who are also patients. Is there any way that we can provide better confidentiality to our employees so that their medical histories are not viewed by other employees at transcription, checkout, filing, and so on?

A I actually don't think you should change your work flow to accommodate employee-patients. I think you should stop seeing them. Their confidentiality is at greater risk than that of an average patient. They may want to withhold medical information you need because of their dual role, and it gets icky when you ask them to pay. I think you should refer these patients to physicians you trust.

If you do keep them, the only way to protect them from the usual work flow is to handle all of the business-related issues yourself or to delegate it to your manager.