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Your Top Questions Answered
Marketing Tips; After-Hours Calls; HIPAA Compliance; Reimbursing Supervision
TARGETED MARKETING
QUESTION: I have been in practice for 16 years and will be bringing in a new doctor (or two) this summer. How does an established physician generate more patients for the practice? I lecture to other doctors and the community. I have been on radio and cable television shows. I have written articles for the local paper. I go to medical staff meetings, talk to doctors at lunch, play tennis with other docs. I send out letters to referring doctors after seeing their patients.
Despite all of these efforts, a competing group gets the bulk of the referrals at one of the hospitals. I would like to get some of that business. What should I do?
ANSWER: Try getting a little more specific. Here are some ideas:
- Market your new physicians. Hold an open house to introduce them to the community. Invite press, patients, your "high referrers," and people at the hospital who make referrals.
- Court referring physicians who send only a few patients - why not more? Court the hospital people - what can you do that will make you indispensable to them and help you win some of their business? Schedule a business meeting with them to discuss how you can assist them. What are their needs? This is different from playing tennis or chatting in the waiting room.
- Find a niche to distinguish yourself from others in your community. Is there a special clinical area of interest you have or a population you serve that others don't? Hepatitis C? Pediatrics? Busy executives needing timely service?
- Make use of your office manager. She can meet with the staff members who set up referrals to find ways to better meet their needs.
MANAGING AFTER-HOURS CALLS
QUESTION: We are having problems with patient calls after hours. Currently, patients who call during lunch or before or after clinic hours on the weekdays hear a message that tells them to call 911 if they are having an emergency, and to call the hospital operator to page the physician for nonemergency issues. However, physicians are getting paged for very unnecessary items that could wait until the office reopens. Some physicians in our group want the hospital phone number removed totally, but others feel that this sets us up for legal problems. What are our options?
ANSWER: Here are some choices:
- Rather than having physicians paged at the hospital, direct patients to call a line that connects them to a triage nurse, physician assistant, or nurse practitioner. They take "first calls" and can respond to patient questions, schedule appointments, or page the physician as appropriate per written protocols worked out by the physicians. You may have to pay these folks for their time, but it's worth it to stop interrupting your physicians for silly things while providing patients prompt attention and avoiding phone tag.
- Schedule physicians so one of them is available to triage these calls for everyone. They'd rotate, of course.
- Enlist a hospitalist so no one needs to be paged at the hospital.
- Direct your calls to a call service that notes the nature of the inquiry in a text message or e-mail to the physicians. You'll have to replace their pagers with BlackBerrys or cellphones, but those devices are more multifunctional, anyway. Then, instead of rushing to a phone, physicians can assess for themselves whether a patient needs a call right away or can wait 15 minutes.
- Some practices don't allow patients to call physicians during lunch hours on weekdays. The message just directs patients to call 911 or call back after 1 p.m. This is slightly obnoxious, but it is an option.
- Collaborate with other practices in your specialty to hire a triage nurse who can perform a first-call function for everyone. The nurse sends notes on every call to the relevant physician, but if she handles a simple patient question by herself, the doctor doesn't need to do anything further.
MAKING RELEASES HIPAA-COMPLIANT
QUESTION: Where can I find exactly what needs to be included on a "Release for Medical Information" form to be HIPAA-compliant?
ANSWER: You can find a sample form in the Tools section at www.PhysiciansPractice.com. Look for "HIPAA: Authorization for Use of Protected Health Information." Note that you don't need such a release to exchange information with other physicians about patient treatment.
DEFINING "FAMILY"
QUESTION: What are the rules for a physician who sees a member of her own family? I know immediate family members cannot be charged, but what does "immediate family" consist of?
ANSWER: According to the Medicare Carriers Manual, Section 2332, Medicare will not pay for services provided by immediate family members of Medicare beneficiaries. That exclusion applies even if your nurse or technician provides the service "incident to."
Medicare defines an immediate relative as your:
- Spouse;
- Natural or adoptive parent, child, or sibling;
- Stepparent, stepchild, stepbrother, or stepsister;
- Father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or sister-in-law;
- Grandparent or grandchild; and
- Spouse of your grandparent or grandchild.
SUPERVISION REIMBURSEMENT
QUESTION: 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?
ANSWER: 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. You don't say whether the PAs and 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 in which you are just the one lucky enough to supervise.
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.
This article first appeared in the September 2006 issue of Physicians Practice.
Copyright © 2006 Physicians Practice Inc. www.PhysiciansPractice.com All rights reserved.
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