Practice Management

When your office manager alienates staff

QThe office manager for our three-doctor group is incredibly knowledgeable and efficient. Our collections have grown exponentially under her watch. But since she joined the practice two years ago, three employees have left. In exit interviews, these people said that friction with the office manager was the main reason for their resignations. What should we do?

A First examine your group's historical turnover pattern. If turnover hasn't increased under your current manager's watch, case closed.

If turnover has increased, evaluate the performance of the employees who left. If it wasn't stellar, thank your office manager for running a tight ship.

But if you find you've lost good workers, review the notes from their exit interviews. Their comments should help you pinpoint the supervisory skills your office manager needs to improve. Review those with her, but be sure she understands that you value her knowledge and efficiency and the effects on collections her efforts have had. Stress that good employee relations are equally important, and let her know that you're sure she can accomplish both. If the situation seems drastic enough, or the office manager thinks she could use some help in this area, consider formal training in personal relations skills.

Keep chart notes free of "qualifying" diagnoses

QI've read that I should avoid using the terms "probable" and "possible" when making diagnostic notes in a patient's record. What's the danger here, if the findings aren't definite?

A The terms "possible" and "probable" imply a judgment as to likelihood. If you wrote that a diagnosis was "possible" or "probable" and then failed to follow through with the appropriate tests, a plaintiff's lawyer would have an easier time making you appear negligent in front of a jury than if you had merely written a list of diagnoses to "rule out."

How to bill for your care of nursing home patients

QDo commercial or government insurers limit the number of times a month a physician may see a patient who's in a nursing home?

A Medicare pays for all necessary treatment to nursing home patients. But accurate and complete documentation is vital in order for you to receive reimbursement. Payment from Medicaid depends on state law. Commercial carriers are all over the map, so check the rules of your patient's health plan.

Sharing call when doctors have uneven patient loads

QI share coverage with three other solo obstetricians. One doctor is so busy that it's not uncommon for the on-call physician to do three or four deliveries for that doctor on a weekend and none for any of the others. Is there a fairer arrangement?

A Are you complaining about the reimbursement arrangements or the workload? If each covering doctor simply charges his own delivery fee, payment will be fair. But if you and your two less-busy colleagues resent spending one hectic weekend a month treating this physician's patients, ask the fourth doctor to find another call group.

Will a restrictive covenant block your marketing plans?

QIn accordance with the terms of my non-compete clause, I'm opening a practice more than 20 miles away from my previous employer. I plan to advertise my new practice through newspaper ads and bulk mailings that will reach people within the 20 mile limit. Is there anything wrong with this tactic?

A Probably not, say our consultants. To be safe, check with an attorney.  

Edited by Kristie Perry,
Contributing Writer

Do you have a practice management question that may be stumping other doctors, too? Write: PMQA Editor, Medical Economics magazine, 5 Paragon Drive, Montvale, NJ 07645-1742, or send an e-mail to mepractice@medec.com (please include your regular postal address). Sorry, but we're not able to answer readers individually.

Kristie Perry. Practice Management.

Medical Economics

2002;14:70.