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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.

Q I have a side job as the medical supervisor of a college health clinic. I spend three hours a week on site seeing patients, and I supervise three nurse practitioners. Each sees 15 to 20 patients a day. What do you think is fair compensation for this work?

A There are several ways to look at your compensation:

1. Base it on the relative value units (RVUs) you produce. You’d take a baseline salary, and then you’d pick up a bonus if you exceeded a certain productivity benchmark each quarter.
   
   
2. Calculate what your full-time salary would be at your other positions, and extrapolate a percentage from there.
   
   
3. Given that supervising the nurse practitioners (NPs) takes away from your ability to devote time to patient care and your own productivity, it’s worth arguing that you need some compensation for that, too. You can name a price based on an hourly rate (figured by taking what you get paid per hour for clinical work and then charging some percentage of that for your supervisory work). You could also set a flat fee (determined by what you feel makes the work worth it to you, basically). Or you can base your fee on a percentage of the revenue the NPs generate. The last is the least risky for the employer, since if you can make the NPs more productive, you all win.

Q I need help structuring a production bonus for my nurse practitioner (NP). Is it possible to bonus out a percent of collections above cost? I am a solo practitioner, and cash flow is a priority.

A Sure. The structure you describe is known as a profit-sharing program. Each quarter, or year-end, your NP would get a bonus, in addition to a base salary. The bonus is a set percent of profit or net revenue, bottom line, or however you define it. Note that if your NP helps generate more revenue, the profit will increase accordingly. You’ll want to be quite clear on when he or she would get this bonus: Will it be once collections are complete for patients seen in the first quarter? Will it be based on where you are at the end of the month? Or something else?

You’ll also want to run some numbers to see whether this works for you, bottom line-wise. If you’d enacted it two years ago, where would you be now?

The only trouble with a profit-sharing plan is that your NP will not have full control over all things related to profitability. What if you are a habitual under-coder or you decide to hire a nurse? Circumstances such as these would cause a negative impact on your NP’s earnings. He or she will either want to have more say in policy decisions or simply be quietly (or not so quietly) annoyed — which could affect his or her job performance.

An alternative scenario is to give your NP a salary as well as a bonus based on his or her productivity. Typically, his or her earnings would derive from the RVUs he or she produces. Check out your practice management software — it should have such a report. If your NP exceeds a certain baseline — set by, say, 100 percent of past performance or an industry benchmark — then he or she gets some agreed-upon additional dollar amount. If he or she exceeds it by more than 20 percent, he or she gets that much more. You might want to exclude RVUs for some lab work — I’ve been hearing lately that such reimbursements can be so low that practices end up paying their NPs for work on which the practice already lost money. Again, you’ll want to run some financial reports to make sure that the extra cash you promise will actually be available.

One last thought: Ask your NP how he or she would like to see the plan structured — that’s a sure way to get his or her backing.

Q I work for a billing company and am trying to select an Electronic Medical Record (EMR) for one of my physician clients. The practice is surgical. Any assistance that you can give to aid the selection process will be appreciated.

A First, I suggest that you encourage the physicians and staff to take the lead on this project, leaving you to act as project manager. They are the ones who have to use the product.

The surgeons, especially, will immediately see if a product doesn't have the clinical aspects they need.

I recommend starting with products approved by the Certification Commission for Healthcare Information Technology. You can visit www.cchit.org for more information.

I'd also do a comprehensive review of the needs of the practice: Do you also need to upgrade the management system? Is the goal just to find charts? What other management problems are you hoping to solve with an EMR? How will you handle work flow in an electronic world versus a paper world?

Create a list of the functions you need before going shopping.

When you've narrowed your search down to two or three vendors, ask them to run through actual clinical examples from your practice, not just any old practice. Call all of their references and visit one of their customers that is similar to yours. You need to visualize how it will work.

There are many steps. It's a little hard to summarize.

For more information, try searching www.PhysiciansPractice.com for EMR.