Fam Pract Manag. 1999 Oct;6(9):48.
What are my responsibilities when one of my patients requests leave from his or her job under the Family Medical Leave Act (FMLA)?
FMLA allows employees to take leave for their own serious health condition, to care for a family member with a serious health condition or for certain events such as the birth or adoption of a child. For an employee to receive leave for any of these reasons, certification is required, and the Department of Labor offers a Certification Form that can be used to obtain it.
The employer should provide this form, or another form containing the same information, to the employee for the employee's physician to complete. If the employer provides the form directly to the physician, the employee's signed consent for disclosure of the medical information should be included with the request. It's important to remember that no additional information is necessary; the information required on the form relates only to the condition for which leave is needed.
FMLA specifically defines “serious health condition.” To learn more about the definition and other important details of the FMLA law, or for a copy of the Department of Labor's Certification Form, visit the Department of Labor's Web site at www.dol.gov/dol/esa/fmla.htm, call the FMLA help line at 800-959- FMLA (800-959-3652), or call the AAFP at 800-274-2237 ext. 4148.
I work at a satellite clinic as a salaried physician for a regional hospital system. Our clinic accepts private insurance, but we also provide indigent care. The indigent care makes up roughly 30 percent of our patient visits. The compensation formula for physicians throughout our system is productivity-based. I'd like to find a formula that fairly compensates the physicians in our clinic as well as our peers who don't accept the same patient distribution. Any suggestions?
You need to know who made the decision to accept indigent-care patients into the clinic. If the decision was made by the doctors at your clinic, you should all be compensated based on the existing production-based incentive program. This way, each doctor's pay is impacted by his or her own commitment to indigent care.
However, if the decision to accept indigent-care patients was made by the regional hospital system, compensation for the physicians in your clinic should be adjusted so that you are not penalized because you treat indigent-care patients. The following formula can be used to adjust an individual physician's collection amount so that it's comparable to that of other physicians' in your system who don't provide indigent care:
Amount collected in one year ÷ (1 - (Number of indigent patient encounters that year ÷ Number of total patient encounters that year))
Here is an example:
Amount of money collected for patients seen in 1998: $175,000
Number of indigent patient encounters in 1998: 1,800
Number of patient encounters in 1998: 6,000
In this example, the adjusted collection amount would be:
$175,000 ÷ (1 - (1,800 ÷ 6,000)) = $250,000
If this physician's compensation were based on 50 percent of collections, he or she would earn $125,000.
We recently discharged a patient from our practice who had been abusing her medication and calling in her own prescriptions. Her new physician has now requested her medical records from us. Should I explain to the physician that the patient is a drug abuser, or does that put me into a legal situation?
It's not advisable to call the other physician to warn him or her that the patient is a “drug abuser.” If the patient found out, it's possible that a slander or libel claim could be filed, because the term could be construed as a subjective assessment with damaging personal consequences. It's important for the physician and staff to document noncompliant patient behavior in the medical record without using subjective labels. Instead, place in quotations exactly what the patient said; for example: “7/11/99 — Patient stated her 'dog chewed up the prescription' and she needed another Rx for Vicodin. Informed patient that doctor denied an additional prescription. Patient advised of risks of overuse of pain medication.”
If you have documented previous behavior in the chart as described above, included factual evidence from the pharmacist that shows the patient tried to call in her own prescription, and if there's a copy of the letter of withdrawal in the patient's record that clearly states the reason for discharging her from your practice, the new physician should be able to easily discern the patient's behavior. This physician can then decide whether to accept and treat the patient. Factual rather than subjective chart documentation is more defensible in the event of a liability claim.
*Denotes member of FP Assist, the AAFP's online clearinghouse for consultants and attorneys.
Copyright © 1999 by the American Academy of Family Physicians.
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