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    Practice Management

     

    Practice Management

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    How to get ready for an interview with a group practice

    Q I have job interviews scheduled with several group practices. What questions should I be prepared to answer? What questions should I ask each group?

    A In addition to standard interview questions about your goals, expectations, and salary requirements, be prepared to answer the following:

    • What are your clinical interests and proficiencies?
    • Are there any patients you won't work with?
    • What managed care experience do you have?
    • How many patients do you typically see per day?
    • How do you score on patient satisfaction surveys?

    You should ask the following:

    • What hours will I be expected to work?
    • What's the call schedule?
    • What's the timetable and formula for buying into the practice?
    • When do senior partners plan to retire?
    • What is the community need for physicians in my specialty?
    • What percentage of payers are managed care, fee-for-service, Medicare, and Medicaid?
    • How are income and expenses divided among physicians?
    • How will you help me build my patient base?
    • Are there bonus opportunities?
    • What is the benefits package?
    • How long have doctors and clinical and administrative personnel been with the practice?

     

    Q Should I include anything in a buy-in contract that addresses what happens to my practice's assets if I die before an associate's buy-in is complete?

    A Yes. The contract should include a provision making the associate's remaining buy-in portion payable to your estate, should you die before he has taken full ownership of the practice.

    Skirting caller ID when you're on call

    Q I've asked the phone company to block caller ID on outgoing calls from our home phone, to protect my family's privacy. Sometimes, when I'm on call, I must unblock my number to phone a patient whose phone system otherwise won't accept the call. Is there a way to return these calls without revealing my home phone number? If there isn't, can I simply ignore these patients?

    A Legally and ethically, you must respond to all patients while you're on call, so you can't ignore those with special phone features. Instead, have your answering service instruct patients to disable their call-blocking feature. Or ask the service to forward your call, so its number, not yours, shows up on the patient's caller ID box.

    Providing ample seating in your reception area

    Q How should my three-doctor internal medicine group determine how much seating we need in our waiting room?

    A Use the following formula as a rule of thumb: Multiply the number of doctors by the number of patients each sees per hour. Multiply the result by 2.5, then subtract the number of exam rooms. So if the three of you each sees four patients per hour, and you have six exam rooms, the calculation would be: (3 x 4 x 2.5) ­ 6 = 24. That's how many seats you need in your reception area.

    Of course, this calculation assumes that you see patients on time.

    Ways to reward employees for their hard work

    Q I'd like to pay my staff productivity bonuses. What's the best way to do this?

    A Our consultants advise against productivity bonuses, because it's difficult to create a system that doesn't end up demoralizing staff—or you. The common pitfalls are that: (1) you establish unreachable goals; (2) staffers learn to "game" the system, thereby earning a bonus without producing measurable gains for the practice; and (3) diligent workers wind up resenting colleagues who don't pull their weight. What's more, employees who start to rely on the extra cash will become disappointed if you have to end the program.

    The best way to reward workers, consultants say, is to pay them competitive wages and benefits with merit increases, maintain a pleasant office environment, and thank them for a job well done.

    Tips for creating your own physician report cards

    Q To respond to the increasing use of physician report cards, our group would like to do an internal comparison of each doctor's cost-effectiveness. But many experts say this data is meaningless unless the information reflects the differences in age, sex, and morbidity in each physician's patient panel. Is there software to handle this? If not, how should we do these calculations?

    A The software exists, but it's extremely expensive. You're better off turning to your patient charts and billing and coding records. Identify your practice's most common diagnoses, and look at the number of tests and referrals each doctor makes for each 100 patients with those diagnoses. Significant deviations are likely to surface, regardless of patients' age, sex, or morbidity. Any variation in utilization is worth discussing, and may help you establish preferred protocols for your practice.

    When walk-in patients threaten to overwhelm your practice

    Q Our four-doctor family practice leaves open four or five appointments per doctor per day to see urgent care patients. We find, however, that we're frequently overwhelmed by calls for urgent care, and these slots are sometimes filled before we've seen our first patient. What can we do to balance routine appointments, follow-up visits, and urgent care?

    A Instead of trying to "balance" appointments, adjust your schedule to reflect what's actually happening in your practice. You obviously need to create more openings for walk-ins. To figure out how many more openings, study your group's history of actual patient visits. Then add additional walk-in openings during flu season, on Mondays and Fridays, and before or after holidays.

    You also might consider designating one doctor each day to see walk-in patients, extending your hours, or hiring another physician.

    And for advice on converting to a same-day appointment system, see "Re-engineering your practice: You mean I can see the doctor today?" March 20, 2000.

    Must a doctor take all comers?

    Q A while back, my office stopped accepting patients covered only by Medicaid. But sometimes new patients covered by both Medicare and Medicaid come to us. Can I accept these patients while declining Medicaid-only patients?

    A As long as you're not discriminating on the basis of sex, race, religion, or against some other protected class, you're free to accept or decline any patients you'd like. But what constitutes discrimination varies by state, so check with your state Medicaid office.

    Edited by Kristie Perry,
    Senior Associate Editor

     

    Do you have a practice management question that may be stumping other doctors, too? Write PMQA Editor, Medical Economics magazine, 5 Paragon Drive, Montvale, NJ 07645-1742, or send an e-mail to mepractice@medec.com (please include your regular postal address). Sorry, but we're not able to answer readers individually.

     

    Kristie Perry. Practice Management. Medical Economics 2000;10:180.

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