Practice Management

Should you let an employee trade cash for time off?

Q One of my staffers requested an extra two weeks' pay in lieu of using her vacation days. Is there any reason not to cut her a check?

A Yes. Even if she doesn't recognize it, your employee needs time off for rest and relaxation. Your practice also benefits when staffers return from vacations refreshed. Furthermore, when an employee won't take time off, it may be a sign that she's trying to hide something, like embezzlement.

However, if an assistant is entitled to a longer vacation—say, three or four weeks per year—you can bend the rules. Consider paying her extra for working one of those weeks.

When you're contemplating a cross-country trek

Q I've been working in an allergy practice in New Jersey for three years, but now I want to open a solo practice—either here or in California. What should I consider in the decision-making process?

A First, evaluate the success of other solo practices in each community you're looking at. Next, ask yourself whether the community can support another solo doctor in your specialty: Will you be able to attract enough patients within the next 12 months to break even? Will you be able to keep those patients and attract enough others to pay yourself a decent salary? Will you be able to afford the move—financially and emotionally? Will you be able to get a loan that covers start-up costs—office space, equipment, staff salaries, and supplies? Will you be able to negotiate as many contracts with health plans as you'll need for a sustainable patient base?

Finally, what is it about the community that you find attractive? Does it have the schools, cultural or recreational amenities, and/or professional opportunities that you're seeking?

Why bailing out of Medicare can cause you problems

Q When I opened my solo practice, I decided not to accept Medicare. Does this prohibit me from moonlighting in another facility where Medicare is accepted?

A If you opted out of the Medicare program and established private-pay contracts with patients, then you can't bill Medicare for patients you treat at another facility. The clinic where you moonlight must send bills directly to those patients or their commercial insurer, if any.

If, however, you're simply not a participating provider with Medicare, you may accept Medicare patients at any facility—but the reimbursement will be lower than if you were a participating provider, and you must submit claims on patients' behalf.

Making room for new patients

QHow many appointments a day should my partner and I leave open for new patients?

A Most practices leave four slots open a day. But you need to analyze your appointment books to determine what's best for your practice. No practice can afford to turn away new patients indefinitely. If the waiting period for new-patient appointments exceeds two weeks, start adding room in your schedule for more of these slots. And consider adding office hours.

Edited by Joan R. Rose,
Senior Editor

 

Joan Rose. Practice Management. Medical Economics 2001;3:125.