Practice Management Q&As

When a patient gets another's lab results

Q:A patient just informed my office that she received the test results of another patient with a similar name. What should I do?

A: Thank the patient for informing you of the mix-up and ask her to return the misdirected medical information to your office (reimburse her mailing costs). Gently remind her that the information she saw is confidential. Put systems in place that will prevent this from happening in the future.

Guidelines for maternity leave

Q:What's an appropriate maternity leave policy for a practice's full-time physicians? Must we offer doctors and staff the same benefits?

A: Not if you have fewer than 50 employees—unless state law indicates otherwise. Practices typically allow up to six weeks of unpaid leave for staffers and eight weeks for partners. Regardless, you must treat a pregnant employee as you would any other worker with a medical disability.

If your practice employs 50 or more people, the federal Family and Medical Leave Act requires you to provide workers with as much as 12 weeks of unpaid leave in any year to take care of a newborn or adopted child. You may count paid vacation and sick days toward this benefit.

A timetable for paying bonuses

Q:When should we determine how much to distribute in employee bonuses—at the beginning of the year, based on budget allocations, or at the end of the year, based on surplus earnings?

A: If you regularly give bonuses, you might as well budget for them. But the incentive value is diluted because employees come to expect the bonus as part of their regular pay. If you reward workers occasionally for a job well done, pay out of surplus. Whichever you decide on, be consistent from year to year.

Do workers' comp lawyers get free charts?

Q:A patient's workers' compensation attorney said that, by law, I must provide medical records to him without charge. Is this true? If so, how should I cover my costs?

A: This varies by state, so check with your state's department of labor or bar association. If you're allowed to charge a copying fee, ask the lawyer to prepay it. But don't waste too much time quibbling over the amount, since medical records can be subpoenaed anyway.

When a new hire is a slow learner

Q:The billing clerk we recently hired assured us she would be a quick study when it came to learning our software programs. But now she's asking us to send her to expensive training classes. Should we indulge her request or look for a replacement?

A: If the billing clerk has proven to be a bright and capable worker in other areas, it's wiser—and less expensive in the long run—to invest in her computer training than it is to replace her. Plus, her request may be a sign that her supervisor or your software instruction materials are lacking.

How to keep your office ticking on weekends

Q:My partners and I have decided to open our practice on Saturdays and Sundays. Should we ask our employees to staff the office on those days, or should we hire part-timers?

A: Definitely encourage your current employees to assume weekend hours. Your patients will be happier seeing familiar faces, and your office will run more smoothly.

To reduce the need for overtime, shorten these workers' hours accordingly during the Monday-to-Friday workweek. Fill in the gaps during the week with part-time employees.

An added benefit: Your staffers may appreciate the opportunity to work shorter days—it may allow them to spend more time with family or go back to school.

Finding out a job applicant's age

Q:Is there any reason my practice shouldn't ask job applicants to provide their birth date and high school graduation date?

A: Yes. Such questions could lead to charges of age-discrimination, and they're outlawed by the Age Discrimination in Employment Act. Keep in mind, too, that there isn't necessarily any correlation between age and experience, skills, knowledge, chemistry, or motivation.

Is a patient survey worth the effort?

Q:Our office manager is badgering us to do a patient satisfaction survey. It seems like a lot of work. Is it worthwhile? If Yes, what should we ask?

A: Feedback from patients is essential. It gives you information on ways to improve your practice—assuming you're willing to act on the information. Here are some questions to include:

• How long did you have to wait to get an appointment?

• Were you able to see the physician at the scheduled time? If not, how long did you wait?

• Was the reception area comfortable? Is there anything you would change?

• Was the exam room comfortable?

• Was the staff helpful, knowledgeable, and friendly?

• Were you able to communicate effectively with the physician?

• Is there anything else you'd like to tell us?

Turning down fund-raising appeals

Q:A handful of patients regularly ask me to contribute to their favorite charities. How can I make it clear that, while I care deeply about a variety of issues, I'm not a money machine?

A: Establish a quarterly charity budget for both yourself and your practice. Allocate part of both for ad hoc requests. When the quarter's funds are exhausted, tell patients you're sorry, but you'll have to defer their requests.

Hiring: Go on gut feelings?

Q:After our group interviewed three finalists for a billing manager position, we unanimously agreed on one candidate because she seemed such a good fit with the rest of our staff. But she has less experience than the other two. Is it okay to base our hiring decision on such a subjective feeling?

A: Sure—as long as she has the basic skills and experience to fulfill her responsibilities.

When Stark rules don't apply

Q:The husband of one of our nurses recently joined a physical therapy group we sometimes refer patients to. Do Stark rules prohibit us from making any future referrals to this group?

A: No. Stark rules address situations where a practice refers to a physician's spouse or family member.

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 Q&As. Medical Economics Aug. 8, 2003;80:92.