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Q Our orthopedic practice is considering hiring a physician assistant (PA) to perform various tasks. How much money does the PA bring into the office, considering that surgeons are freed to spend more time in surgery and less time on other clinical aspects of the practice?

A We've seen some normative data, but the best idea is to run the numbers for your office, hypothetically, since, in reality, there are great differences in how practices use a PA.

So, estimate the PA's salary and benefits.

Then look at patient visits for a month. Estimate which visits, presumably most follow-up visits, would be handled by the PA. Make sure that number would actually fit in a PA schedule.

Then draw up a new hypothetical schedule for your MDs. Schedule then an extra surgery or whatever in the time now open, capture your average reimbursement for surgeries and services, and see what the increase revenue is.

You'll want to make sure the MDs would actually do that extra work versus taking time off, taking more time with patients, or hovering over the PA's shoulder.

You'll also need to decide if the PA will be billing incident-to (working only when a physician is on the premises and only doing follow-up work already set by the physician) or billing under his/her own number and getting 85 percent of the physician fee schedule, in general. Incident-to is a Medicare-only concept and requires the PA to follow a course of treatment set by the physician. The physician also must be on the premises. It generally can't be used for call or hospital rounds.

You'll also want to look at each of your commercial payers' policies on PA billing.

Q We are a small mental health practice. Our computers crashed, and we lost almost all of our electronic patient records. What can we do about that?

A Were you doing any kind of backup? Clearly, you could start again from your last backup, but I sense from your message you were not taking that precaution.

If you weren't doing any backup, you can call both the electronic medical record (EMR) vendor and data recovery services to see if they can pull out anything for you.

To find a data recovery firm, conduct an Internet search for recovery companies in your city (or the nearest big city).

Even with expert help, you may fail to find the missing data, but at least you'll have tried everything.

Q What are the legal obligations for physicians treating illegal immigrants? Must they see patients who have no documentation at all? What if patients present themselves at the physicians' offices with no documents, speaking limited English, and without the ability to pay for the services? What if the doctor saw such a patient for an initial appointment and does not wish to conduct subsequent appointments?

A First of all, there are state laws. You'll need to know what applies in your state. However, here are general guidelines provided anonymously by an attorney:

There is no specific requirement to treat or not treat someone based on immigration status. One thing to note is that a physician cannot, in most circumstances, report someone to the federal government or any other authority without violating patient confidentiality.

Physicians are not obligated to see all patients who present themselves. However, "documentation" and the ability (or inability) to speak English are non-issues. Physicians are not obligated to provide uncompensated care in their offices. The federal Emergency Medical Treatment and Active Labor Act imposes different obligations if the patient is seen through a hospital emergency department.

There are no hard rules about discontinuing service to a patient. Common practice is to adopt the American Medical Association guidelines, which suggest that patients be notified of the termination of the physician-client relationship and given 30 days to find another physician. During that period of time, the initial physician should provide required ongoing care and any emergency care that is related to the same illness or condition that initially brought the patient to the physician.

Again, the obligations are different when dealing with patients seen through the emergency department. The Emergency Medical Treatment and Active Labor Act has been interpreted by some to require physicians to provide necessary follow up care.