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| Accommodating disabled patients
| The second-floor office where I'd like to set up my internal medicine practice is not accessible to patients in wheelchairs. However, if I need to see any wheelchair-bound patients, another physician in the building has offered to let me use his office downstairs. Would this arrangement satisfy ADA regulations? Also, what changes will I have to make to the restrooms to accommodate handicapped patients? | | | When a deaf patient demands an interpreter
| | One of my deaf patients is capable of communicating with me in writing or by typing on a computer. However, she insists on having a sign-language interpreter present when she comes to the office. Does the Americans with Disabilities Act oblige me to provide one? | | | Can you fire a staffer on disability leave?
| | My office manager has been on disability for three months. During that time, my other four employees have taken over her tasks, and we're doing quite well without her. Can I eliminate her position? | |  MORE ARTICLES
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| When a medical group practice partner retires
| | A senior partner has announced his plan to retire from our single-specialty group practice. We have a buy-out in place and expect his departure will be amicable. However, we have no experience with managing the details of a doctor's departure. For example, when should he tell his patients and referring doctors that he's leaving? What else do we need to do? | | | A mediator or an attorney?
| | Both my partner-to-be and I agree that the buy-in agreement we signed years ago needs to be renegotiated. But we disagree on some issues. Should we hire a mediator to help us hammer out a new contract, or should we each hire our own attorney? | | | Nailing down the terms of a practice sale
| | I plan to recruit an associate who would buy my practice when I retire in a few years. I'd like to start cutting back my work schedule as soon as he's comfortable. When we draft the buy-sell agreement, what provisions should I include to protect my interests? | | | What happens if a partner dies
| | I'm forming a practice with two other doctors. If one of us dies, does his ownership interest pass to his estate? Should the remaining partners be required to buy his share? What should our contract say about transferring ownership in the event of death? | | | Could a contract clause spoil your retirement plan
| | My younger associate, whom I assumed would succeed me, told me that he intends to resign. He says our buy-sell agreement obligates me to purchase his shares. I plan to retire next year, and this will upset my plans. What should I do? | | | Time to rethink this buy-out agreement
| | According to our small group practice's buy-sell agreement, part of the payout upon termination is return of capital invested. How does the practice provide for the payout without hurting the remaining doctors? | | | Can out-of-state docs bankroll your practice?
| | I want to start my own practice, but I can't get a loan from the bank because I have so much debt already. I have several private investors lined up, though--physicians licensed in another state--who would like to be shareholders in the professional corporation I'd set up. Is this legal? | | | MORE ARTICLES
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| Collections
| | If a patient receives insurance checks directly, cashes them, and refuses to pay the physician, aside from sending that patient to collection, might criminal charges also apply, and on what grounds? | | | ER Compensation
| | My hospital has recently started paying certain specialists to take ER calls. Other specialists continue to be required to take ER calls as a condition of medical staff privileges. Is this legal to force some physicians to take uncompensated ER coverage while others are being paid by the hospital? | | | Charging no-shows a fee
| | I just read the article on no-shows by Dr. Eric Shore (June 6, 2008 issue). I share his concern regarding physicians’ liability when patients neither arrive for their appointment nor cancel. There is an added expense for physicians to follow up on these unreliable patients. What are the legalities of charging no-shows a fee, and what is Medicare’s stance on this? | | | Debt collection
| | Is it okay to set up an in-office collection process for past due patient balances using a form letter that looks similar to a collection agencies letter? I have seen other office send these out. The letter usually has a letterhead that indicates something like "The Collection Center," and goes on to advise the patients that they have X number of days to pay their balance or further collection measures will be taken. | | | S corp, C corp, LLC, LLP—which is best?
| | Whether you're setting up a new practice or re-evaluating an existing one, here's help in sorting through your options. | | | MORE ARTICLES
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| When a patient refuses to take a test
| | I have a patient who's been prescribed Warfarin. She has been asked repeatedly to go for PT-INR testing but refuses. The last testing several months ago required us to change her dose and I'm sure it will need adjusting again, but there is no way of knowing until I get results from the refused tests. I would think that I'd be held liable if I refill the medication and it causes bleeding or if it's ineffective, but I would think that I could be held liable for not refilling the medication, too! What do I do? | | | U.S. Court in New Jersey Sides with Physician in Claims Case Against Insurer
| | The U.S. District Court for the District of New Jersey held August 8 that the plaintiff-physician?s payment claims against an insurer were not completely preempted under the Employee Retirement Income Security Act (ERISA) and thus remanded the case back to state court. | | | | Liability issues after dismissing a patient
| | I have a patient who has been noncompliant for several years and I have sent him a letter of dismissal. I still have not heard back regarding where he wants his medical records sent and he is on several medications that must be refilled soon. I'm sure he's going to try to request refills again after 30 days. One of his medications needs to be monitored closely and cannot be discontinued for any length of time if it is to remain effective. Can I be held liable in any way if I deny his request for refills after the 30 day period? | | | First Amendment Does Not Exempt Physicians from Prohibition on Sexual Orientation Discrimination
| | The Supreme Court of California held August 18 that the federal and state constitutional rights to free speech and freedom of religion do not exempt a physician from complying with the California Unruh Civil Rights Act's prohibition on sexual orientation discrimination. | | | Massachusetts High Court Recognizes "Loss Of Chance" Recoveries In Medical Malpractice Actions
| | The Massachusetts Supreme Judicial Court has held plaintiffs asserting medical malpractice in wrongful death actions could recover for "loss of chance" where defendant physicians' negligence reduced or eliminated their decedents? prospects for achieving a more favorable medical outcome. | | | CMS Issues Rule Aimed At Reducing "Never Events"
| | The Centers for Medicare and Medicaid Services has introduced new payment provisions to reduce so-called "never events" that occur in hospitals. | | | New National Scorecard Shows U.S. Health System Lagging
| | The overall performance of the U.S. health system continues to lose ground, despite investing more resources than any other industrialized nation, according to a new 2008 National Scorecard on U.S. Health System Performance issued by the Commonwealth Fund this week. | | | Increasing Price Transparency Could Reduce Healthcare Costs, House Panel Told
| | Increasing transparency in healthcare pricing could play an important role in reducing healthcare costs, Peter R. Orszag, Director, Congressional Budget Office (CBO), told the House Budget Committee. | | | Medicare Advantage organizations had lower spending, higher profits than initial projections
| | Medicare Advantage (MA) organizations saw profits of $1.14 billion above their initial projections in 2005 while, on average, spending less on medical expenses (85 percent of total revenue) than they anticipated (90.2 percent), the Government Accountability Office (GAO) found in a recent report. | | | MORE ARTICLES
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| Look out for employment contract snags
| | Be careful, because the terms of this agreement can have a profound impact on your career. | | | When a noncompete isn't ironclad
| | They're tough to break, but two Indiana doctors showed one way to do it. There are other ways that could work, too. | | | The end of restrictive covenants?
| | A state supreme court rules that "noncompete" clauses violate public policy by limiting patient access to medical care. | | | No contract? No good!
| | Leaving things to chance can spell disaster for your practice, the author says. | | | When a salary guarantee expires
| | This "base compensation" model provides built-in incentives for new physicians, and protects the group if they don't produce. | | Finding a Job
Step 4: Weighing offers
| | Before you sign an employment agreement, do your homework, talk with your advisers, then decide which offer you can't refuse. | | | A win-win alternative to noncompete clauses
| | For both groups and their employed doctors, there's now a fair and legal alternative to restrictive covenants. | | | 8 ways to escape your employer
| | Unhappy--and feeling fenced in by a noncompete clause? Chances are you can break free, with little or no penalty | | | Handshake partnerships: Tick...tick...tick...
| | This practice probably couldn&t have been saved, but the breakup could have been far less acrimonious. | | | MORE ARTICLES
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| Health care IT: Public support high for adding more IT to health care
| | Strong public support for the use of information technology in the nation's health industry stands in "stark contrast" to the industry's adoption of it, according to a national survey of 1,000 U.S. adults by the Commonwealth Fund, a health care advocacy nonprofit. | | | E-prescribing: Pharmacies use patients to persuade doctors to throw away Rx pads
| | Maybe you’ve seen the signs at your local pharmacy saying “E-prescriptions filled here” and “Give your prescription a head start” They’re part of a campaign to encourage patients to convert their doctors to electronic prescribing. | | | E-prescribing: Big business, labor, insurers lobby for mandatory e-prescribing bill
| | A bill in Congress that would require doctors to e-prescribe for Medicare patients or else take a pay cut has been endorsed by an impressive list of groups representing patients, employers, and insurers. But only one major physician organization has jumped on the bandwagon. | | | E-prescribing: Follow the money—and former government officials
| | Remember internist David Brailer, once the point man for EHRs in the Bush administration? He’s now the chairman of a private-equity firm that’s bankrolling a healthcare IT startup with its own cast of ex-public servants. | | | E-prescribing: Going electronic just got a little easier
| | The push for e-prescribing is heating up, with bills in the House and Senate that would penalize providers who don't abandon paper scripts for Medicare patients by 2011. | | | E-prescribing: This website can help you pitch your Rx pad
| | You're under growing pressure to e-prescribe, but how do you get started? An interactive website co-sponsored by organized medicine walks you through the steps. | | | The best programs for your handheld
| | When you practice medicine in the palm of your hand, you'll want a smartphone and cutting-edge programs. Here are the best. | | | Computerized Physician Order Entry: A Massachusetts insurer pressures hospitals to drop paper prescriptions
| | Starting in 2012, doctors in Massachusetts hospitals must order medications, tests, and procedures using computerized physician order entry (CPOE) if those hospitals want to earn quality-of-care bonuses from Blue Cross Blue Shield of Massachusetts. | | | Bill requires e-prescribing for Medicare, pay cuts for non-compliance
| | Identical Senate and House bills introduced last month would require you to electronically transmit prescriptions for Medicare patients to the pharmacy starting in 2011 or else take a pay cut. | | | MORE ARTICLES
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