The Practice Overhaul Contest

Kudos to FP Alan T. Falkoff, the winner of your Practice Overhaul Contest, for his philosophy on how to deliver quality medical care ["Turnaround help for income and expense woes," Dec. 21]. Dr. Falkoff rejected the recommendations of your consultants to bring in more income by substantially increasing the number of patient visits. There are different opinions on how many patients per day are reasonable, but at the end of the day, Dr. Falkoff pretty much has it right—the physicians at his practice see an average of 16 to 20 patients daily, typically allotting 20 minutes per visit.

But, unfortunately, if Dr. Falkoff and his two partners want to make more money, they may have to increase their productivity. I would suggest the following: (1) start a boutique practice to run parallel with the current practice, with each doc picking up 200 boutique clients; (2) have each partner train to offer services in a different specialty area (for example, a dermatology subspecialty, acupuncture, or a cosmetic enhancement procedure; (3) get a great EHR and downsize ancillary staff; or (4) see more patients!

Your Practice Overhaul consultants said that Dr. Falkoff's practice needed a full-time practice manager. I take issue with their recommendation that it should be Dr. Falkoff's wife, who runs the billing department. It's almost impossible to have a doctor's spouse in such a leadership position without it causing more harm than good. I was happy to see that Ms. Falkoff had the wisdom to recognize that and say no. I'm disappointed that the contest consultants were asleep at the switch on that piece of advice.

Joyce D. Everett
Practice Manager
Cleveland, TN

I was appalled by your Practice Overhaul consultants' advice to offer nerve conduction studies as an ancillary service to generate income. If they're suggesting that Dr. Falkoff and his partners consider bringing a portable NCV machine into their practice, it's a very slippery slope into liability exposure.

I would refer you to http://www.aanem.org/documents/ProperPerformance.pdf for the position paper of the American Association of Neuromuscular and Electrodiagnostic Medicine. It states that "Electrodiagnostic studies should be performed by physicians properly trained in electrodiagnostic medicine, that interpretation of NCS data alone absent face to face patient interaction and control over the process provides substandard care, and that the performance of NCSs without needle EMG has the potential of compromising patient care."

Moreover, Medicare does not consider these types of sham studies compensable, at least in the state of Washington, and many insurers do not reimburse for them either. The only income generated through nerve conduction studies might be by a plaintiffs' attorney.

Daniel A. Brzusek, DO
Bellevue, WA

Health courts and tort reform

The National Physicians Alliance (NPA) endorses the health court concept as a way of bringing efficiency, fairness, and predictability to the medical liability system ["From the Editor: Why health courts could pick up steam," Jan. 4].

The NPA's position on medical malpractice reform ( http://www.npalliance.org/content/pages/malpractice) closely resembles the health courts model, but would go one step further. It would take compensation for avoidable medical injuries out of the court system entirely. Through an administrative no-fault system, like the ones in New Zealand and other countries, more injured patients will be compensated, at no greater cost than our current tort-based system (and maybe even less).