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    Practice Management Q&As


    A phone call that could save your hide

    Q. Your consultants have said that regulations about keeping patient records vary by state. I'd like to know when I can discard the charts of former patients of the deceased doctor whose practice I purchased. How can I find record-retention guidelines for a specific case like this?

    A. Contact your malpractice carrier's risk management director. Your carrier has a real interest in making sure you understand how long you need to hold on to certain records. If a patient files a suit and you've jettisoned the records before the statute of limitations runs out on the claim, the carrier won't be able to provide a proper defense. It may wind up having to pay any judgment awarded to the plaintiff.

    When an employment contract is too vague

    Q. I'm about to sign my first employment contract as a physician. In addition to a list of specific actions that could get me fired, the contract also says that "behavior that reflects negatively on the practice" is grounds for dismissal. Isn't this too vague? Should I object to this clause, or is it the norm in employment contracts?

    A. You should ask the employer to delete that clause. Such language is generally not used in employment contracts because it's so general an employer could interpret it however he pleases. The list of reasons for termination should be limited to such clear-cut specifics as loss of license, censure by an accreditation agency, or discharge from the hospital's medical staff.

    Telling your partners you're leaving

    Q. When a physician decides to leave a group practice, how far in advance should he give notice to his partners?

    A. The longer the better. Although many employment agreements require a minimum notice of 90 to 180 days, such short notice makes it difficult to recruit a replacement before the departing physician leaves. When it comes to retirement—which is usually planned well in advance—some groups require a minimum notice of eight to 12 months to make sure they have enough time to fill the void.

    If doctors want to give up call

    Q. I see a problem brewing down the road for our 18-physician practice. Already nine of the older physicians have dropped call, and, with that precedent set, it looks as if a few more soon will be looking to do same. How can we discourage our colleagues from dropping out of the call schedule prematurely?

    A. Establish a policy that makes it clear that dropping call is not an automatic rite of passage. It should state that dropping call is contingent upon there being enough remaining doctors to cover the call obligations. If that's not the case, the doctor who wants to drop call either must reduce his schedule to make room for a new doctor who will accept call, or agree to pay a financial penalty that goes to whichever doctors are willing to take up the slack. Many groups reduce the compensation of no-call docs 5 to 10 percent.

    Sending medical reports by fax

    Q. After I see a patient who's been referred to me, I fax my report back to the referring physician. Is there anything wrong with that?

    A. There's nothing illegal about faxing reports between physician's offices. But the law does require you to take appropriate precautions to safeguard protected health information. So call those offices to which you plan to fax reports on a regular basis to confirm that they have policies in place to protect patient confidentiality.


    Liz O'Brien
    Associate Editor

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