Health Law Pointers - Volume XIII, No. 2
Most professional practices have in place office protocols, policies and procedures that govern office operations and reduce the risk of liability exposure. However, in our experience, both longstanding and newer practices can benefit from a frank risk management appraisal. Such an examination not only can result in a more efficiently-run and safer office, but may reduce the possibility of patient complaints and payor audits.
Noted below are a few recommendations in the areas of office staff and patient relations that are commonly employed today.
- Performance and document reference checks, primary license verification, criminal background checks and searches for any disciplinary actions upon commencement of employment and annually thereafter.
- Require all staff to wear identification badges, with their name and title, at all times during office hours.
- Assign unique electronic signatures to all staff members.
- Make sure that the practice is named as a certificate holder for all mid-level practitioner malpractice insurance policies.
- Adopt a formal written policy identifying which staff member is authorized to accept legal papers and/or media inquiries.
- Develop a formal written policy on periodic staff education and training on the proper use of equipment and document such training and education in the employee’s personnel file.
- Develop educational programs for staff about confidentiality and HIPAA, documentation and medical records release.
- Have a formal written procedure for the proper identification of patients.
- Adopt a formal written procedure for patient reminders of upcoming appointments.
- Develop a formal written procedure for notification of the patient and (when applicable) the referring physician if the patient misses the initial appointment, or develops a pattern of non-compliance.
- Implement a formal written procedure for the follow-up of missed appointments.
- Have patients complete a medication reconciliation form prior to being seen by a provider at the initial visit and at each succeeding visit.
- Consider adoption of a chaperone policy.
Interviewing for a Professional Position
Frequently we are asked to assist new practitioners who are entering the job market in evaluating a contract offer. While it is essential for professionals to consult with a competent health care attorney before entering into a written employment agreement, it is equally important for the practitioner to conduct an effective due diligence inquiry of the prospective employer and the health care environment in the new community.
The job interview is a critical element of the interview process and should be handled with care. The following subjects are appropriate areas of inquiry for a candidate, and all professional practices should be prepared to respond to such questions if a good match is to result from the interview process:
- Is there a low turnover rate for physician and mid-level providers?
- Are you required to see a minimum number of patients each day?
- What are the scheduled office hours?
- Are the call/coverage arrangements fairly apportioned?
- Is the medical recordkeeping and documentation sound?
- Does the practice encourage the use of paid leave?
- Is the practice growing?
- Is overhead an increasing or decreasing percentage of revenues?
- Is there a stable work force?
- Is there a professional management team in place?
- When will the candidate be eligible for an ownership interest?
- Is there a buy-in cost?
- Will the candidate be eligible to acquire an ownership interest in the real estate holding company or other ancillary lines of business?
Quality of Care
- Have you had an opportunity to review the clinical policies important to your practice?
- Will you have a voice in determining these policies?
- How does the practice measure quality of care?
Office Sharing Arrangements
The high cost of establishing and maintaining a private medical office is causing many solo practitioners to consider (i) an office sharing arrangement with other health professionals or (ii) subleasing space from an existing practice. Properly structured, such arrangements help to keep overhead down and should not pose any material legal concerns. However, practitioners eager to conserve their limited financial resources too often make a hasty and ill-advised decision, when a little advance planning in structuring the relationship may make a huge difference in avoiding unnecessary conflict and heartache.
If you are considering such an arrangement, please keep in mind the following principles:
Will you fit in?
You should look to be personally and professionally compatible with your future office mates. Consider a day visit before making a final commitment to make sure that you will get along well with the others and are comfortable with the office environment.
Will your practice benefit from the mix of professionals?
Ideally, the various practices should complement, not compete with, each other, making it easier for your patients to access recommended care.
Be clear on the shared services or office systems afforded.
What costs are included, and what costs remain your exclusive responsibility? Generally, you should be responsible for your own supplies, appointment schedules, billing and collecting.
Can the space accommodate the hoped for growth in your practice?
Your arrangements should allow for expansion in the use of the actual premises and (when applicable) the times available for use. If not, you should be able to extricate yourself from the arrangement on 30 days advance notice.
Get your “deal” reduced to writing!
Not only is this desirable for compliance purposes; it will also establish your financial, working and legal relationship.
At some point in the career of most health professionals, you will be invited to become an owner of a professional practice. An invitation to acquire an ownership interest in the practice in which you have been associated is usually a welcomed event and serves to recognize all the hard work and contributions you may have made during your period of association with the practice. Many competent and hardworking physicians, however, historically have paid less attention to the business aspects of the practice of medicine and are less familiar with evaluating the health of the practice which has extended the offer of equity ownership.
Your personal checklist should include a candid evaluation of the practice personalities and environment to make sure that you will get along well with your prospective new partners. This due diligence investigation is critically important when you have not had a prior association with the practice as an employee, independent contractor, or resident. You should check references and make inquiries with those who are in a position to give a candid evaluation, such as hospital administrators, vendors and other friends of the practice. You should also request and then carefully examine with the help of an experienced health care lawyer the practice’s governing documents (shareholder or partnership agreement) to determine if the documents are fairly written and don’t contain unwanted surprises. Finally, you should get a copy of the practice’s recent financial statements, including their income and expense statements and balance sheet, and examine the statements with your advisors to gain an understanding of the financial picture and prospects for the future.
A guarded response, or refusal to share the requested documents, effectively serves as a warning and may be sufficient to dampen your interest in joining the group.
Next Issue: How is governance and decision making handled? What are the compensation plan and overhead arrangements? What key clinical issues should be investigated - are there any hidden compliance or other risk management concerns?