| Physicians Practice
Pregunte a los expertos
es un foro de preguntas y respuestas que cuenta con expertos líderes en la administración de la práctica médica que pueden o no ser empleados de Physicians Practice. Physicians Practice recibe preguntas de médicos, gerentes y administradores de consultorios y otros. ¿Tiene alguna pregunta sobre la operación de su práctica médica? Visite www.PhysiciansPractice.com. Responderemos a su pregunta en el transcurso de los tres días hábiles.
P:
I’m a solo physician. I try to encourage my
staff to coordinate their vacations with mine, otherwise I
end up paying their salaries during my vacation, even though
there is no revenue coming in and they don’t even have
to report to work. Still, they usually take vacation whenever
they want. Is there anything I can do?
A
You really can’t do much in the way of forcing staff
to take vacation when you do. They need to respect the needs
of their families and their own schedules. One thing you can
do is ask your staff to report to work when you are gone.
They can work together on the sorts of tasks that usually
don’t get done when everyone is dealing with the day-to-day
patient flow. For example, they might put the medical records
in fresh, better-organized folders, repaint the staff room,
organize the supply closet or research technology purchases.
P:
I have a paperless office. My billing person tells
me that I must keep all my paper explanations of benefits
(EOBs) for several years. How many years do I have to keep
my EOBs from various insurance companies? I would really like
to shred them.
A
Many practices retain EOBs for up to seven years — a
nuisance, but they come in handy. Take a look at what legal
requirements your payer contracts do or do not specify on
this point.
There may be no reason
to keep the paper. A well-scanned version is just as legitimate
— and easier to find later on. Just scan and store them
by numerical assignment or whatever filing method works for
your biller.
P:
My husband joined a practice some years ago. The only
other partner’s wife serves as an office manager. My
husband wants me to work at the practice as well. My question
is how does one go about easing into the practice without
ruffling feathers? And should I?
A
I think the physician-and-spouse practice sounds lovely, but
often does not work well in reality. It’s impossible
to hold the spouse of the physician accountable like a regular
employee. I hear about spouses who abuse their power, but
who can’t be confronted because of their status.
In what other industry
would a million-dollar business hire an inexperienced manager
just because of a marriage?
This is not to say you
are not fully competent or would abuse your power; I just
mean to draw your attention to the hazards.
That said, it looks like
one wife already is entrenched and if you want to be involved
too, there are several options.
1. Respect the domain
already established by the other spouse and ask her what she’s
overwhelmed with; ask what you could do for her. Work as her
assistant. Disarm her with your respectful approach.
2. Lean on your experience.
Perhaps you have a degree in marketing or love to paint. Offer
to help in ways that suit your skills.
P:
In general, what is the
yearly “work RVU” target for an internal medicine
physician working in a five-provider clinic and earning a
salary of $180,000 per year?
A La Medical Group Management Association (MGMA) (Asociación de Administración de Grupos Médicos) realiza encuestas sobre las unidades relativas de valor del trabajo (RVUs) según la especialidad (entre otras cosas). According to its Physician Compensation and
Production Survey: 2003 Report Based on 2002 Data, internal
medicine FTE physicians generate a median of 3,856 work RVUs
per year. The size of a clinic should not impact productivity.
But the same publication states that the median compensation
for internal medicine single-specialty practices is $160,000
- so that’s 3,856 work RVUs for $160,000. You can get
more up-to-date data from MGMA at www.mgma.org.
P:
Does every note of every
visit transcribed necessarily have to be signed in some fashion
other than the transcriptionist’s indicator of the physician
dictating?
A
Yes. According to Amy D. Berret, an associate with Kean, Miller,
Hawthorne, D’Armond, McCowan & Jarman in Baton Rouge,
La., this is a federal Medicare/Medicaid requirement and not
just an insurance carrier or state stipulation. In general,
the health care provider must sign the progress note as well
as all reports of tests or test results. The purpose of the
requirement is to confirm that the services were actually
performed.
P:
Do we measure days in
accounts receivable (A/R) starting from the date of service
or the charge date? Also, should we demand information on
individual A/R from our billing service, or is group A/R enough?
A
The industry standard is to start counting days in A/R from
the date of service. You want to also work to eliminate any
delay in getting the claims out the door. I should think group
A/R is enough (you can divide by total number of physicians
if you wish). But your staff and the billing staff presumably
are not holding back one physician’s claims over another’s.
The physicians don’t really control the speed of payment.
P:
I have heard that staff
payroll should be between 18 percent and 22 percent of total
revenue. Does staff payroll include the office manager’s
salary, or are we talking about support staff only? Second,
does “revenue” refer to gross or net?
A
That range does include the office manager’s salary,
and the reference is to net revenue — what you actually
brought in the door, not what you billed out.
Of course, the exact percentage
would vary by specialty. The Medical Group Management Association
publishes survey data that breaks this down and gives details
for your specialty.
P:
In planning an office
for a family practitioner, what is the industry standard for
square footage, not including space for medical records?
A
The only industry standard I’m aware of is the median
published by MGMA in its annual costs survey. For family practices,
the median square footage per FTE physician among its respondents
is 1,900.
Presumably, most of the
practices surveyed do not have EMRs and need room for medical
records.
Clearly, your space needs
would change based on the number of physicians in your office,
whether you plan to offer ancillary services that require
a procedure room or large equipment, workflow, custom and
plans for growth. Is there a phlebotomist on staff? Would
he or she draw blood in her own room or go to the patient?
Do you have physician offices or have you done away with them
in favor of standing dictation/EMR pods and centrally located
hand-washing stations? Are you thinking of adding new clinical
staff?
Generally, expect exam
rooms to turn around every 15 minutes. The number of exam
rooms needed per physician will depend very much on their
personal productivity.
Physicians should share
exam rooms, and smaller rooms are better. You want everyone
taking as few steps as possible.
Try to avoid devoting
much, if any, space to nonproductive physician offices. Patient
consults can take place in small consult rooms or in exam
rooms. Dictation and quick phone calls can happen in small
stations near each set of exam rooms.
P:
What are the typical
duties of a receptionist/check-in staff member for a practice?
A
Here is a partial list, though requirements can vary quite
a bit from practice to practice.
For all patients:
- Welcome
patients
-
Collect copayments, deductibles, past amounts due, etc.
For
new patients:
- Get signatures
on Health Insurance Portability and Accountability Act (HIPAA)
and other forms
- Create
new charts
- Photocopy/scan
insurance cards
- Collect
and enter accurate and complete patient demographics for
billing
For
established patients:
- Schedule
follow-up appointments
- Handle
scheduling
- Make sure
charts are complete for the next day’s patients
Other
duties:
- Answer
the phone
- Manage
pharmaceutical reps
- Sort mail
P:
I am a family physician
currently negotiating a long-term contract at the end of my
first year with this practice. I am supervising two physician
assistants directly and assisting with the supervision of
two nurse practitioners. What is a customary and fair amount
to expect in return for two to three hours per week spent
supervising, answering clinical questions, reviewing charts,
handling patient complaints and covering some inpatient admits
for nonphysician providers?
A
There really is no “industry
standard” for supervision reimbursement; this is more
a matter of finding something you all can agree on than following
a standard.
I can share
some possible compensation designs that you could propose.
There are many
groups that simply assign all of the revenue — and the
expenses — to the supervising physician. It’s
not clear to me whether the physician assistants (PAs) and
nurse practitioners (NPs) in your practice bill incident —
to only under your physician ID, bill on their own or also
work “for” the other physicians in the group.
You could consider
an hourly rate. If it takes you 30 minutes a day to perform
supervisory duties and your time is worth $150 an hour (a
typical physician income), then start calculating this number
based on the days a week and weeks a year you spend supervising.
On the other hand, most physicians find that “supervision”
means a few minutes here and there, so it’s hard to
track the time you spend on these tasks each day. Still, you
could use your estimate of 2.5 hours a week and ask for $375
a week or so regardless of actual hours worked. That way,
no one has to keep track, and you can assume you’ll
do a bit more some weeks and bit less other weeks.
If all physicians
in the group share overhead and revenue from the nonphysician
providers evenly, you could suggest that, as the supervisor,
you take a slightly higher percentage than the others. This
is simple negotiation. I’d start by asking for 15 percent
more and see where it goes. The others can always offer to
rotate the supervision if they are interested in picking up
extra cash, too.
I like the
model of taking a percentage of what the PAs and NPs bill,
since this encourages you to teach them to be efficient and
productive. If they make more, so do you.
P:
Where can I find exactly
what needs to be included on a “Release for Medical
Information” form to be HIPAA-compliant?
A
You can find a sample form in the “Tools” section
of www.PhysiciansPractice.com.
Look for “HIPAA: Authorization for Use of Protected
Health Information.”
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