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2007 Medical Economics Exclusive Survey
Exclusive Survey—Capitation: Still a factor for some
A sizeable minority of primary care physicians still have some prepaid business, and many of them are doing fine.
Exclusive Survey—Malpractice premiums: Starting to level off
Rates in many places may have stabilized or even dropped, but no one is celebrating just yet.
Exclusive Survey—Expenses: Rising costs hit all physicians
Our survey will help you gauge whether your practice expenses are right on target or need a trim.
2007 Survey Methodology
Exclusive Survey: Productivity: Sinking reimbursement, harder work
Many of your colleagues in primary care are working long hours to keep their incomes up.
Exclusive Survey: Earnings: Group practices pay better
Primary care soloists earn less than other doctors, but they're in no hurry to consolidate.
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Americans with Disabilities Act Q&As
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?
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Antitrust rules Q&As
Physician unionization
Can physicians who are employed by a hospital to cover the ED form a labor union?
Antitrust rules affect mergers
My three-doctor cardiology practice is considering a merger with one of the three other cardiology groups in our community. Would this violate antitrust rules?
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Business Law: Buy/Sell Agreements Q&As
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?
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Business Law: General
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.
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Clinical Laboratory Improvement Amendments (CLIA)
Adding Ancillaries: Waived lab services
This is the ninth in a series of articles on specific ancillary services that can boost your bottom line and keep you and your practice busy in a competitive market.
A Physician's Guide to CLIA rules
Here's what you need to know to keep your office lab functioning smoothly
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Coping with tough markets
Coping with tough markets: Doctors battle a health plan monopoly
In the Philadelphia area, physicians face the double whammy of high costs and rock-bottom reimbursements.
Coping with tough markets: Doctors struggle with staying independent
With hospitals in rural North Carolina heavily recruiting, physicians face the hard choice of whether or not to sell their practices.
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Debt Management
Debt Management: Get out from under
If managing your finances is still an uphill climb, read our tips—before it's too late.
Debt Management: Will your credit card zap you?
Choosing the wrong ones can drive up your borrowing costs. Here's what to watch out for.
Debt Management: The right way to shop for a mortgage
The wrong loan can burden you for years. Don't contact a lender until you read this guide.
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Doctors' Legal Forum
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.
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Employment Law: Contracts
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.
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Employment Law: Discrimination
Employed doctors: Know your rights
Group practices may unwittingly violate their employees' civil rights. Here's what you need to know to be treated fairly at work.
Harassment: When you're the victim
Thanks to laws that protect against abuse, there's no need to suffer in silence. Here's how to fight back.
A Physician's Guide to antidiscrimination law
Federal EEOC requirements—and their local equivalents—govern hiring, firing, and everything in between.
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Employment Law: General
Employed doctors: Know your rights
Group practices may unwittingly violate their employees' civil rights. Here's what you need to know to be treated fairly at work.
Personnel files: Documentation is key
Whether your practice is large or small, you should follow certain steps to avoid potential trouble.
Do doctors need employment practices liability insurance (EPLI)?
Does our four-doctor group need employment practices liability insurance to protect us against employment and workplace claims, such as sexual harassment suits?
Practice Pointers: What goes into an employee handbook
By clearly outlining benefits, duties, and responsibilities, it can improve your staffers' performance and prevent lawsuits.
A Physician's Guide to wage-and-hour law
Exempt and nonexempt employment status has little to do with job titles, and a great deal to do with workers' level of responsibility.
Practice Pointers: Should you give references?
Letters of recommendation about former employees can put you in legal hot water—unless you follow these guidelines.
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Employment Law: Hiring / firing
Practice Pointers: Checking out job applicants
Here's how to conduct a thorough background investigation before hiring a new staffer.
Clip and Copy: Doing a reference check
When you phone a job applicant's former employer, here's what to ask.
Practice Pointers: Should you give references?
Letters of recommendation about former employees can put you in legal hot water—unless you follow these guidelines.
Practice Pointers: When it's time to give an employee the boot
Employees who break the rules, won't learn, or spread dissension don't belong in your practice. Here's how to cut them loose.
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Health Information Technology: Computers
Is this "free" technology worth it?
Video programs and "webpads"—with targeted messages—are being placed in thousands of physicians' waiting rooms. Should yours be next?
Keeping mobile computers mobile
Tech Talk
Computer Security: The war against viruses and other malware has no end
Malicious software code that infiltrates your computer is the number-one worry of IT security managers--again. It's a geeks' arms race out there, with authors of malware devising new ways to penetrate the latest cyber defense.
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.
Mobile Computers: The case for solid-state drives, continued
Mobile computers in your office don't need a ton of storage space. That fact makes it easier to justify buying a machine with a solid-state drive.
Get off the phone with health plans, Minnesota tells doctors
Minnesota doctors won’t be able to ask insurers about patient eligibility and benefits over the phone starting Jan. 15, 2009. New state regulations will require them to make these inquiries electronically.
Hospital patients don't mind rounding robots, study says
Imagine you're recovering from surgery. A robot whose head is a computer monitor rolls into your room to let you experience a videoconference with your surgeon, whose face is on the screen. Sound appalling? Patients in a real-life study didn't think so.
Who makes the most dependable laptops and desktops?
Apple and Lenovo laptops received the highest marks for reliability in a readership survey conducted by PC World magazine. Apple led the pack in the desktop category, too.
Here come solid-state drives for mobile computers
If you worry to death about dropping a laptop or tablet computer and wrecking its hard drive, you may want to pay more for a sturdier machine—one with a solid-state drive.
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Health Information Technology: E-Prescribing
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.
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Health Information Technology: E-mail/secure messaging
Why you should e-mail your patients
Trading e-mails with patients is easier than playing phone tag, and you may even get paid for it.
Online Communications: Secure messaging could reduce your malpractice premium
Think communicating with patients online is risky? One risk-minded malpractice carrier will lower your bill if you do.
Clinical Messaging: Imagine your hospital zapping you lab results every day
Some efforts by hospitals and doctors to share clinical data electronically on a regional basis have floundered. Not in Indiana.
Electronic nagging is good for preventive care
Women who read online reminders to get a mammogram are 68 percent more likely to do so than women who ignore them, according to a study conducted by the parent company of insurer UnitedHealthcare.
Aetna and Cigna want to pay you for online visits
You normally can't charge insurers for phone care. However, if you belong to the Cigna and Aetna networks, there's a good chance you can now bill these insurers for treating their patients via the web.
Doctors don't meet patient demand for e-mail communication
Poll after poll shows that patients want an online relationship with doctors, but that doctors aren't obliging. The latest one from Harris Interactive is no exception.
Online "visits": Insurers pay but docs don't play
Insurers are finally reimbursing for e-mails with patients, but physicians are worried about losing office visits.
Technology Consult
Choking on spam? Here's help
Expanding clinical connections: Referrals
E-mail presents challenges, but it will get easier as piecemeal solutions give way to local health data networks.
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