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Fam Pract Manag. 2003 Jul-Aug;10(7):74.

Vacation coverage

Q

I’m planning a week-long vacation from my cash-based solo practice. Am I obligated to arrange for call coverage, or can I simply consult with my patients by telephone while I’m away?

The safest approach is to arrange for call coverage during your absence. If that is not possible, you should create a message instructing patients who call you or your office to go directly to the emergency room in case of an emergency. If you do this, be sure to verify that your state’s medical practice law permits it and that it won’t affect your malpractice coverage in the event you’re sued.

Even though you do not have third-party-payer contracts or other contractual obligations to meet, there are still risk-management issues to consider when consulting with patients over the phone. For example, it may be difficult to evaluate patients well enough to determine whether their conditions require immediate attention, and even directing them to the emergency room is no guarantee against a malpractice suit for patient abandonment. For these reasons, whether you secure call coverage or not, it is always important to notify patients of your impending absence far enough in advance for them to make alternate arrangements for care if they choose to do so.

Disability insurance

Q

I am a solo physician with a personal service corporation that reimburses me at the end of the year for various out-of-pocket personal expenses I’ve paid (e.g., car expenses, professional liability/malpractice insurance, health insurance, books and journals, dues, licensure expenses). I pay for disability insurance personally. Jeffrey Sansweet wrote [“Benefits trends,” Ask FPM, May 2002, page 74] that a physician’s practice or personal corporation can deduct any disability insurance premiums it pays on its tax return but that any insurance proceeds collected are subject to federal income tax. He explained that if a physician pays for his or her own disability insurance, the premiums are not tax deductible but any insurance proceeds received are tax-free.

If I am not injured or disabled during the year and therefore would not be filing any disability claims, could my personal service corporation reimburse me for the disability insurance and deduct those premiums on its tax return?

Technically, yes. However, there is a risk that if you become disabled, the IRS could argue that the proceeds should be taxable since there has been a pattern of reimbursement at the end of the year. The safest way to preserve the income-tax-free status of the insurance proceeds is to pay the premiums personally without reimbursement.

Discouraging no-shows

Q

Our practice’s no-show rate is high even though we have a very strict policy that includes a warning letter after two no-shows and dismissal from the practice after the third. We give patients appointment cards and call to remind them of their appointments the day before. What is a good no-show rate for a practice, and how can we improve ours?

Acceptable no-show rates vary for many reasons, such as whether a practice serves a disadvantaged community (since patients could have problems with transportation or covering the cost of the visit) or whether a practice is in an area that experiences severe weather (since patients may be anxious about going out). Generally, though, two or fewer no-shows per day per family physician is a good no-show rate.

The patient-discipline approach you describe for keeping your no-show rate down seems appropriate and not too strict. It is usually a limited number of patients who create the majority of no-shows. Once these patients are dismissed, no-show rates decrease and appointments open up for other patients. Make sure that you share the policy with your patients up front (e.g., through a practice brochure or your Web page) and emphasize the reason for it (i.e., explain that when patients don’t show up for appointments they deny other patients the opportunity to be seen).

Another approach you might consider is to anticipate a certain number of no-shows in your practice and accept a similar number of same-day visits for sick patients without an appointment. Some practices charge for no-shows, but I discourage this practice because it focuses on money rather than patient compliance, it makes no-shows appear acceptable for a low price, and fees for no-shows are generally not collectable by collection agencies and small-claims courts.


* Denotes member of FP Assist, the AAFP’s online clearinghouse for consultants and attorneys.


 

Copyright © 2003 by the American Academy of Family Physicians.
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