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Uncollected accounts receivables can eventually pile up and lead to bankruptcy for medical practitioners. Doctors are advised to keep tabs on their practice's financial reports which can be easily managed with the use of software packages such as Medical Manager or Medic. Proactive steps such as review of monthly financial summaries, tracking adjustments to gross income, assessment of overdue unpaid bills, and utilizing collection agency reports are also recommended., A few simple reports can keep you in the know about your accounts receivable. Insist on seeing them. At many groups, a gnawing uncertainty lurks in the backs of most [...]

Unhappy physicians are turning to labor unions to reclaim their profession. But first they must confront employers, antagonistic laws, federal investigators, and their own biases. Like millions of other workers, [...]

Midlevel providers (MLPs) such as physician assistants, nurse practitioners and nurse midwives can be used by group medical practices to improve their productivity, enhance patient satisfaction and reduce expenses. MLPs can be relied on to take care of routine health problems and may even deliver babies in the case of nurse midwives and physician assistants. The only problem seen is that the patients who are easy to treat are taken away from the doctors., Physician assistants, nurse practitioners, and nurse midwives can boost productivity, improve patient satisfaction, and even save you money. The parents thought their fussing 10-month-old girl had an earache, but pediatric [...]

The Internet provides several practical benefits for medical practitioners. Physicians who have their own Web sites can educate their Netsurfer patients on health-care informations by posting health-related articles and answering patients' E-mail queries. They can also become efficient in related trends such as having access with electronic medical records and telemedicine. Moreover, Web sites can also help them retain current patients and attract new ones with their improved services., Your own site on the World Wide Web can help you attract new patients, retain current ones, and increase office efficiency. And it doesn't cost a fortune. An ad in [...]

The Physicians Aid Association and Physicians' Home provide financial assistance to doctors and their families. These groups are funded by donations from other physicians. Physicians Aid spent $95,000 in financial support for applicants in 1996, while Physicians' Home spent $335,000 to help about 60 families. Applicants range from widows to recovering addicts., Careless retirement planning, bad investments, failing health, or a bout with drug addiction can wipe out a physician's finances. These organizations lend a hand. If you liken wealth to health, [...]

Proper design of a medical facility is dependent on the selection of an experienced architect. They are more likely to consider issues such as positioning of nurses' stations and avoiding recirculation of contaminated air. Collaboration between architects and physicians also prevents design flaws that may prevent safe, efficient patient service., Stick to the pros, ask the right questions, and avoid easy solutions. After all, you're going to work there for a long time. How's this for a new surgeon general's [...]

Business meetings held within group medical practice are part of each partner's legitimate work. It can be productive and significant if proper strategies are applied before, during and after the meetings. Meetings must have the proper agenda and specific objectives to avoid confusion and waste of time. The length of time for the meeting must be strictly followed to prevent unnecessary delays. Objections and approvals to a specific topic must be noted to avoid unnecessary and repetitive discussion., Which would you prefer: root-canal work, or sitting through another meeting? If you chose the root canal, read on. These tips can make your meetings shorter and more productive. Monday, [...]

Financial management of group medical practice can be improved by applying strategies acceptable to all associates. Drawbacks related to extreme frugality and austerity must be emphasized and explained as counter-productive factors in the practice. Performance of cost-benefit analysis and presenting it as an effective way to improve the practice can lead the way for the acquisition of much-needed equipment and hiring of the best qualified staff. Persuading a senior associate on the benefits of intelligent business spending is an additional advantage., Too few phone lines? Not enough staff? Penny-pinching management? Here's how to make the case for fiscal sanity. It's bad enough that HMOs cut costs to the point of degrading [...]

Time management serves an important function in helping physicians meet the requirements of their jobs. With the increasing focus on managed care, physicians need to budget their time properly for their personal and professional activities. Time management begins by identifying top priorities which should be translated into an organized daily plan. This will help physicians be constantly reminded of the things that requires immediate attention., In this age of too many things to do, time-management gurus teach not only how to be more efficient, but how to focus your energy on the truly important. Seven [...]

Problems arise in the division of overhead costs within multispecialty organizations when some specialists usually receive fewer expenses than primary-care physicians while grossing much more. Several suggestions to divide overhead properly for the benefit of all are presented, such as, the use of single-specialty practices which utilize the simplest expense and income arrangements due to physicians' similar practice patterns, and the introduction of cost accounting as a method to increase the category of direct expenses to include as much overhead as possible., The 23-doctor San Luis Valley Medical Clinics in Alamosa, Colo., has sliced the overhead pie almost every way imaginable. And fingers have been nicked in the process. In the late [...]

The Hopedale Medical Complex in Illinois boasts of a family of doctors dedicated to serving people and bringing 21st-century health care within the reach of the rural community. Anesthesiologist Lawrence Rossi Sr. was responsible for the medical center's establishment in 1955. His children carried on his legacy, with most of them rendering their services at the medical center. Training became an important tool for the Rossi children in pursuing their medical careers and serving their rural community., The scene was a bilateral renal artery bypass, but it resembled a family reunion. Actually, it was just business as usual for the Rossi clan of tiny Hopedale, Ill. Anesthesiologist [...]

Group practice has its downsides as seen from the experience of Generations Health Care, a group of Ob/Gyns in St. Louis, MO. The group was formed to improve the doctors' prospects of increasing their revenues. However, it failed to realize its financial objectives, thus resulting in an exodus of doctors to seek better opportunities elsewhere. Ex-members consider mismanagement as a major reason why they decided to leave group practice. With operations now in the hands of HealthLine Management Inc, the group aims to improve its growth potentials., Generations Health Care, a group of St. Louis Ob/Gyns once 30 strong, was barely a year old in April 1996 when five doctors exited as if fleeing from a burning [...]

Giant automobile manufacturer General Motors Corp. (GM) is emerging as one of the leaders in educating physicians on quality data and health care costs. Physicians are divided over their reaction to the innovative move by the company whose revenues reached $164 billion for 1996. Some physicians have accepted GM's efforts to help them provide quality care at minimal costs while some accuse GM of trying to reduce its employees' health care expenses which totaled $4.8 billion in 1996., The carmarker hopes to apply to medicine the lessons it so painfully learned from its Japanese competitors. There's a giant organization aiming to lower the cost of health care while [...]

Learning from their predecessors' missteps, these IPA s are determined to avoid dominance by hospitals and specialists. They're making primary care their top priority - and beating insurers at their [...]

The issue of informed consent takes on a new perspective based on the lawsuit filed by patient Donna Johnson against neurosurgeon Richard Kokemoor for the latter's failure to properly disclose his aneurysm surgery experience's complication rate, which caused serious damages to the patient. Furthermore, it was revealed that Kokemoor's previous aneurysm surgeries entail lower risks compared to what was required for Johnson. Since he did not consider the risks involved and should have instead referred the patient to a more experienced surgeon, his liability was further strengthened., That will happen if this important verdict sets a precedent. The case also has implications for referrals and physician training. Donna Johnson was in a preoperative room at Sacred Heart [...]

A research done on medical malpractice emphasizes that honesty and admitting a mistake are still the most effective way of avoiding malpractice litigation. Other cases have proven that hiding a blunder or not telling the truth to patients often encourages them to sue in order to know what really happened. Laying out the facts and explaining in detail what really occurred would increase the probability for patients to understand while still preserving the solidness of the physician-patient relationship., Clamming up only increases the odds a patient will sue. But there are good ways and bad ways to say you're sorry. You're a good doctor. But you're also human. [...]

Physicians sometimes find themselves in hostile situations where their managed-care patients accuse them of holding back required care for financial gains. To avoid such occurrences, doctors should learn how to empathize with their patients and develop a trusting relationship right from the first meeting. They should also uphold their professional values, spend time to educate their patients and listen carefully. These guidelines result in a friendlier atmosphere in the age of managed-care., He thinks you're withholding necessary care for financial reasons. How do you tell him the truth? Here's a lot of good suggestions. It was a fairly routine case, Seattle FP [...]

Physician groups that want to raise capital but do not savor the idea of giving up control to hospitals through physician-hospital partnerships should consider a direct public offering (DPO). This practice is a financial tool that enables a company to issue stock without incurring costs usually attached to going public. Doctor groups that intend to make a DPO should actively market the stock because failure to do so may makes the initiative unsuccessful., Using a Wall Street firm to issue stock will cost your group a bundle. Here's an economical alternative. While some doctors have successfully raised money from their hospital without giving [...]

Carle Clinic Assn. in Urbana, IL, has drastically reduced the volume of telephone inquiries received by its 300 member-doctors through its Patient Advisory Nurse Service. Under this system, doctors take only about 5% of patients' calls while the rest is handled by telephone-triage nurses. These nurses serve callers by referring them to the right doctors, sending to the urgent-care center when necessary, suggesting home remedies or making clinic appointments. The nurses do not make medical diagnoses, write prescriptions or interpret test results. The system gives doctors more free time., A time-tested triage system at this Illinois clinic relieves the physicians of dealing with thousands of inquiries. "I've had this headache and sore throat for a week." Joel McCrary (not [...]

A new breed of patients is showing up in doctors' offices, elbowing aside those who quote from medical books and magazine articles. These new set of patients claim to have been educated on the Internet through health-care sites offering a wealth of medical information. Patients with Internet access can easily get hold of peer-reviewed articles that doctors read in medical journals or medical knowledge from sites of health-care groups such as the National Cancer Institute and the American Academy of Child and Adolescent Psychiatry. This information revolution allows patients to take responsibility for their well-being and reduces the burden on physicians., The Internet has put a wealth of medical information at patients' fingertips. That's both good and bad. When Tom Ferguson was a medical student at Yale in the mid-1970s, he [...]

Physicians may consider hiring professional business brokers once they have decided to sell off their practice. These brokers may help identify the right hospital, insurer and practice management company to buy the medical practice. Moreover, they can provide many other services that doctors may find useful in selling their businesses. However, these physicians should be careful in choosing a broker because business brokerage is largely unregulated and attracts incompetent people., Possibly, but seller beware. Business brokerage is largely an unregulated field, and the big money attracts new people who aren't necessarily competent. Meet A.T. "Fred" Zirkle, a business broker in [...]

Call schedules in a medical group practice need to be managed well to avoid giving doctors additional stress. Participating doctors should be apportioned an equitable share of patient calls to ensure fair financial opportunities. With salaried doctors, this problem has been partly solved. Scheduling, nevertheless, should be flexible so as not to unduly burden doctors who may be unfortunate to be assigned midnight calls., Call duty can impose a heavy, unequal burden. These groups use flexible scheduling and other ways to make it more palatable. One of the lures of group practice is being [...]

The poor market performance of Coastal Physician Group Inc. (CPG) should serve as a warning to physicians who are planning to sell their medical practice to practice management companies. CPG's stable earnings and benefits have attracted physicians but the $47 million loss of CPG in 1995 forced the company to discontinue the service contracts of its physicians. Medical practitioners should evaluate the financial history, philosophy and future of practice management companies before selling their medical practice., Tempted to sell out to a practice management outfit? That's what these physicians did, and then the company started bleeding red ink. When Curtis J. Eshelman and his partner sold [...]

Doctors will make more house calls when paid higher fees. Capitation and integrated delivery systems could make home care more financially rewarding. The advent of telemedicine allows medical examination of patients at a distance by means of interactive technology. Medicare is also contemplating an increase in home care fees. Reimbursements are being made to doctors who handle Medicare patients in hospices and private homes under a new CPT code., Home-care fees have risen 40 percent since 1991, and Medicare is considering proposals to raise them even more. And there's a new CPT code for house calls, too. Hippocrates made [...]

Medical management consultants have adopted different approaches in billing for telephone consultations. Los Olivos Women's Medical Group charged medical calls to deter persons who would call after office hours. The Fort Collins Youth Clinic uses the same approach to educate callers on important and unimportant calls. However, groups like Bristol Street Pediatrics and Rogers Medical Centers have abandoned the approach due to collection problems., Many consultants consider billing more trouble than it's worth, but that hasn't stopped some groups. Here's how they've fared. Few patients make 11 p.m. calls to the doctors at Los [...]

Wisconsin Independent Physicians Group is a 970-physician network that deals with the managed-care version of Medicaid. The network cares for 45,000 individuals under a full-risk contract with a local health plan. Reimbursements of doctors are comparable to those caring for commercial patients. However, the managed-care version of Medicaid leaves little margin for error financially because the program remains underfunded., This new brand of the program appears to be working for patients and doctors alike. But as these physician groups will tell you, it's not for the faint of heart. [...]

Physicians should remember certain factors when delivering bad news to patients. These include selecting a quiet and private place to inform patients about their illness. The patient's understanding of the situation must first be determined before breaking the news. Patients should be told about their illness using simple and direct words, and given a realistic prognosis to enable them to organize their affairs., Honesty doesn't necessarily translate into caring. Here are guidelines for one of your most difficult jobs. "Your biopsy for cancer was positive," said the young internist. The patient, an old [...]

The American Medical Assn. (AMA) and 15 other health-care organizations have condemned medical procedure patents on the grounds that they jeopardize patient care by discouraging the free flow of medical knowledge. The AMA has adjudged doctors who secure and enforce such patents as unethical. Supporters of procedure patents stress that these patents provide an incentive to break new scientific ground., It's not as farfetched as it sounds. A lot of tests and treatments in everyday use are patented, with the owners expecting payment for every use. Medicine's Hippocratic oath, as [...]

Many physicians will need strong business skills negotiating contracts or other business matters because of the rise of managed care. Career-boosting educational programs may be a good investment for physicians. They stand a chance to earn substantially more, their understanding of financial statements and transactions may mean savings or profits and they can deal better with hospital administrators., It's sure looking that way. Business-trained doctors are reaping more pay and more clout. Here's how to find a good program. Several years ago, St. Louis OBG specialist Carlton S. [...]

Doctors can earn millions out of their practice with the current industry trend to consolidate. One way is to sell one's practice to a physician practice management (PPM) company. Another way is by joining group practices where alliances are formed between investors and enterprising doctors. Ownership and management are given up by a doctor when selling to a PPM. However, he or she gains profitably when it goes public., Groups and their spinoffs are the darlings of venture capitalists, who come waving big bucks. What risk does the money carry, though? Get rich quick? In medicine? That's what happened [...]

Physicians and group doctor practices sometimes encounter abusive and noncompliant patients that strain doctor-patient relations and complicate the provision of fee-for-service medicine. Before dropping such patients, doctors should first check with the concerned managed care provider for their requirements in such cases to avoid legal problems. Health maintenance organizations and health insurance plans need to establish guidelines that define cases for such patients before they are discharged., He was every doctor's nightmare - the terminally ill patient whose desperate behavior drives people away. "He wanted to control his care, even when it came to lab tests," recalls [...]

Group medical practices have started to strictly evaluate their doctors' performance as they face increased competition from managed care plans and capitated payment systems. The emphasis on quality is designed to maintain group practices' competitiveness in an increasingly crowded medical market. However, doctors are divided on the effectiveness of performance evaluations in grading their work., How are you getting along with the office receptionist these days? At the Carle Clinic Association in Urbana, Ill., that question is one criterion for evaluating each of the group's [...]

Doctors participating in managed care plans are given salaries with performance incentives. This scheme is designed to encourage them to see more patients in less time. With some seeing as much as 70 patients a day, primary-care physicians understandly become irritable as they try to cope with their staggering workloads. To address the problem, some groups have started exploring ways by which doctors' workloads can be equitably distributed. Their efforts are discussed.

Managed care groups discipline physicians who have shown unsatisfactory performance by collecting fines, sending doctors to anger-management classes and giving letters of warning. Although a constructive approach may provide satisfactory results, some group practices have come to realize that there is less financial risk when the punitive approach is adopted. Such groups implement formal policies and procedures which hinge on drafting performance standards and constantly evaluating physicians., His weekend lasted a day too long - and that cost the surgeon $5,000." Dr. Bishop, as we'll call him, was one of three surgeons in a multispecialty group practice. [...]

Many are now advocating the use of arbitration, mediation and other forms of alternative dispute resolution (ADR) for settling medical malpractice disputes. Although ADR can be effective in avoiding the high costs associated with litigation, its track record over the past 20 years shows that ADR has been somewhat of a disappointment to both doctors and patients. A brief overview of ADR and how it has figured in malpractice suits is presented and discussed., Absolutely, but the various forms of ADR--alternative dispute resolution--are seldom more satisfying for an accused doctor. Health-care reformers like President Clinton want to do a favor for patients and doctors [...]

Organized medicine societies, such as the American Medical Assn, are reassessing their goals to encourage membership among independent physicians. Previously, independent physicians favored joining specialized societies because of economic and social considerations. Organized societies may gain new members as physicians seek more aid under the Clinton Administration's healthcare reforms and diminishing fee-for-service care., St. Louis cardiologist Joseph H. Bodet, 37, is a very selective joiner. "Back in college, I never belonged to a fraternity," he says. As a young doctor, he has never [...]

Medical society presidents face lost income and heavy demands on their time. They must deal with society members, politicians, the media and the public, while attending to family and medical-practice duties. North Carolina Medical Society Exec VP George E. Moore said that the society's president usually spends over 25 hours per week on the job., "In the old days, being president of the medical society was an honorary job," says Louisiana radiologist Daniel H. Johnson Jr. "But now, it's very little accolade and a great [...]

Physicians should realize that hospital although ethics committees offer advice they cannot decide cases. Their proponents believe ethics committees can influence hospital policies, manage conflicts between physicians and patients and help physicians behave in an ethical manner. Opponents believe the committees undermine doctors' ability to care for patients and to approve cost-reduction measures. The conflict over the role of ethics committees has not been resolved., These hospital groups provide advice, not verdicts. Here's how to make the best of what they have to offer. The attending physician felt at a loss. His elderly patient needed [...]

It happens. The guiding light of a large practice dies. Is your group structured so it can bounce back after such a calamity? Alton Multispecialists in Alton, Ill. seemed to [...]

Thousands of doctors threaten to have their contracts sold to a hospital that does not allow physicians to govern themselves, with the plan of MedPartners to leave the physician practice management (PPM) business. The Birmingham, AL, company is the latest in a long line of PPM companies which have either abandoned the field, downsized or reorganized themselves amid the woes faced by the entire industry. Hospitals, health plans and physicians themselves are the expected buyers of group practices. Doctors are advised to get out of their PPM contracts either through negotiation or litigation., MedPartners' plan to leave the jinxed field of physician practice management will put thousands of doctors on the auction block. That could make the outlook even grimmer for physicians who [...]

Venture capitalists invest in new companies which banks consider very risky, thus, they demand high returns for their investments - about 25-35% annually. The venture capital's life span is also a determinant of a good or a bad venture capitalist. The normal life span is seven to 10 years. Doctors should assess if their interests are compatible with the venture capitalist's., Venture capitalists are a ready source of cash or doctor groups with growth on their mind. These investors put money into new companies considered too risky by banks and other [...]

Doctors contemplating on selling their practice to venture capitalists should take precautions before forging contracts. One must check the buyer's assets and make sure he has a stable source of capital. One should also determine the quality of the principals. The management experience of a practice management company should also be determined., Everyone, it seems, wants to manage your practice, from industry leaders such as Coastal Physician Group to the one-person, mail-drop companies that sprang up yesterday. Unfortunately, the magic of desktop [...]