Fam Pract Manag. 2001 Jul-Aug;8(7):52.
Choosing a consultant
A practice management consultant recently presented us with a $10,000 proposal to improve our practice. How do we know whether the consultant is reputable? Should we get proposals from other consultants as well? If so, where can we find other consultants?
There are several different things you can do to find out whether a consultant is reputable:
Look at the consultant’s resume and biographical sketch. What has he or she accomplished? How long has he or she been consulting? What professional organizations does he or she belong to?
Ask the consultant for names of past clients who had needs similar to yours. Call those clients and ask them what they thought of the consultant’s work. Were their projects completed to their satisfaction in a timely manner? Did the consultant relate well to both physicians and staff? Would they hire the consultant again?
Take a critical look at the proposal. Examine the project objectives and work plan to see if they sufficiently cover your needs and what you hope to gain from the project. Depending on the work plan and expected result, $10,000 could be a reasonable fee for your practice.
However, if you’d like to check out some other consultants, contact professional organizations such as the Society of Medical-Dental Management Consultants at www.smdmc.org and the AAFP’s FP Assist at www.aafp.org/fpassist.
The lone overcoder
In my group of four family physicians, we suspect one partner of overcoding. Are we liable as a group? Should we have a written policy stating that if one physician is improperly coding, only that physician is responsible?
If your practice has reason to believe that any one of your physicians is overcoding or is engaged in any other improper billing practices, you are obligated to do something about it. Ignoring the situation is not only ethically wrong, but it also places the entire practice at risk in a way that cannot be remedied by a written policy.
Your group should meet with the physician and explain that fraudulent billing could create criminal and civil liability for everyone. If the questionable activity doesn’t stop, or if it becomes clear that the billing is indeed fraudulent, the prudent course would be to sever your relationship with the physician.
What is EMTALA? Does it apply to on-call emergency physicians?
As an on-call emergency physician, you should be familiar with the Emergency Medical Treatment and Active Labor Act (EMTALA). Hospitals and physicians who violate EMTALA requirements may face civil fines of up to $50,000 per violation, and physicians may also face exclusion from participation in federal health care programs such as Medicare.
Also known as the Patient Anti-Dumping Statute, EMTALA is intended to ensure that all patients who go to a hospital emergency department receive care, regardless of their insurance or ability to pay. The act imposes three fundamental requirements on the hospitals that participate in the Medicare program and on the physicians who work in them:
The hospital must conduct an appropriate exam on any patient who requests emergency care to determine if an emergency medical condition exists. As an on-call physician, you must come to the hospital to examine the patient when a request is made for your services. However, if your office is located in a hospital-owned facility on adjacent land or on the hospital campus, you may see the patient in your office.
If an emergency medical condition exists, the hospital must either provide the treatment necessary to stabilize the condition or comply with the law’s requirements for the proper transfer of a patient with an unstabilized condition. If a patient refuses the hospital’s treatment or refuses to consent to a transfer after having been informed of the risks and benefits, this requirement is considered to have been met.
A hospital may transfer a patient with an unstabilized condition in only two situations: 1) the patient or his or her representative has requested the transfer in writing after being informed of the risks of transfer and of the transferring hospital’s obligation to provide additional examination or treatment, and 2) a physician has signed a certification showing that the medical benefits reasonably expected from the transfer outweigh the increased risks (if a qualified medical person signs the certification in the physician’s absence, the physician must later countersign the certification).
For more information about EMTALA and how it applies to you, consult Title 42 of the U.S. Code, section 1395dd (which is accessible online at uscode.house.gov/usc.htm), and review your hospital’s medical staff bylaws or policies and procedures.
* Denotes member of FP Assist, the AAFP’s online clearinghouse for consultants and attorneys.
Copyright © 2001 by the American Academy of Family Physicians.
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