Fam Pract Manag. 2005 Oct;12(9):64-72.

Give your waiting area a makeover

You don’t have to spend a lot of money to make your office more welcoming for your patients and more productive for you and your staff.

  • Have your upholstery professionally cleaned every six months.

  • Get rid of dead plants.

  • Update your magazine subscriptions.

  • Remove clutter, for example, by having reception staff limit the number of personal items they keep in the front office.

  • Use table lamps instead of overhead lighting in waiting areas, and use wall sconces in hallways.

  • Offer a variety of seating options because one style of chair might not be comfortable for everyone.

  • If you can afford new flooring, consider carpet for the waiting area. It creates a homier atmosphere and cuts down on noise.

Source: Calandra R. Redesigning an office? Opt for simplicity and comfort. ACP Observer. July/August 2005:5,11.


Discounts for self-pay patients


Is it permissible to offer discounts to self-pay patients for paying at the time of service?


Medicare and other insurers recognize that what is actually collected will vary among patients based on their insurance. Collecting an amount less than the actual charge for uninsured patients is no different and would not be seen as fraud.

You should ensure that any discounts your practice offers are applied consistently according to an established policy. For example, your policy might stipulate that any payment waivers based on financial hardship must be based on a good-faith determination of the patient’s need. You could use a simple form for this purpose that asks about employment status, household income and expenses.

You should not routinely waive co-payments, co-insurance or deductible amounts. Managed care plans require that you make a good-faith effort to collect these, and Medicare considers routine waivers of this type to be a potential kickback to the patient for receipt of services.

Source: Kent J. Moore, AAFP, Leawood, Kan.


Eight tips for physician buy-in

Making the case for organizational change or for embarking on a new project is an essential skill, but it can be difficult, especially if you’re trying to get buy-in from other physicians over whom you have no real authority. These eight tips can help:

  1. Treat your physician colleagues as you would treat your patients: listen and empathize.

  2. Create opportunities for them to voice concerns and feel heard.

  3. Respect their time by scheduling meetings during times when they are most available.

  4. Quantify the information whenever possible.

  5. Help them see the relationship between what you’re proposing and improved performance and quality.

  6. Communicate frequently about the goals and the status of the project.

  7. Address skepticism directly.

  8. Reward and recognize their contributions.

Source: Blattner S, Wenneker M. Getting physician buy-in – even without direct authority. The Physician Executive. September/October 2005:14–18.


Make conflict productive

If your definition of a good meeting is one at which everyone agrees, you might be shrinking from conflict in the rush to achieve consensus. The result is often artificial consensus and unresolved conflict that breeds anxiety and frustration.

A more productive strategy would be to encourage people to challenge important issues. Then, don’t be afraid to throw yourself into the middle of disputes rather than glossing over them. The best path might be through the conflict rather than around it.

Source: Hanft A. The joy of conflict. Inc. Magazine. August 2005.


Secrets to effective physician-administrator partnerships

Trust is the key ingredient in successful physician-administrator collaboration. Here’s how one Mayo Clinic management team suggests building and maintaining strong, trusting partnerships:

  • Spend time together: Meet regularly, and be available for quick, informal conversations.

  • Share information freely and promptly.

  • Provide timely, constructive feedback.

  • Discuss each other’s strengths and weaknesses.

  • Recognize your personality differences.

  • Ask hard questions of one another, and listen carefully to the answers.

  • Take training courses together.

  • Support one another publicly.

  • Remember that the needs of the patient come first.

Source: Glenn SW, Ward C, Bartley G, Rider CT. Physician-administrator relations: what makes an effective partnership? Group Practice Journal. June 2005:16–19.


Liability and administrative surcharges


Is it ethical to charge patients an additional fee to help cover the costs associated with rising liability insurance and administrative services that health plans don’t cover?


The AMA’s Code of Ethics doesn’t include any guidelines specifically related to surcharges, but an AMA Board of Trustees Report presented at the AMA’s 2005 Annual Meeting advises that a surcharge should not be imposed “if it would constitute a barrier to needed care” and should be “reasonable and voluntary.” The report also stated that after legal issues and other barriers are taken into account, “physicians may find a relatively small number of patients remain eligible for a surcharge” and “should consider the fairness and practicality of charging a small portion of their total patient base a surcharge.” The report suggested the following implementation guidelines:

  • Medicare and Medicaid patients must be exempted from liability surcharges. Assessing an administrative fee would be permissible only if it didn’t charge the patient for services already reimbursed by the government.

  • Identify relevant restrictions in your state’s laws, as well as restrictions in your contracts with private payers.

  • Notify patients in advance of implementing the surcharge, and offer an opt-out or hardship waiver option. Your communication should be in writing and should explain why the surcharge is being levied. It should also make it clear that “the patient’s decision whether to pay the surcharge will have no effect on the physician-patient relationship or quality of care.”

Source: AMA Board of Trustees Report 27–A–05. Liability surcharges in physician offices. Available online at: Accessed Sept. 23, 2005.


Stay on top of third-party payers

To minimize payment delays and maximize reimbursement, your practice’s billing process needs to operate at optimum efficiency:

  • Use your billing software to create reports showing the average time between the date of service and the date of claim submission, and between the date of claim submission and the date you receive payment. The reports will help you to identify the source of recurring delays.

  • Create a grid that shows key characteristics of your major plans, such as co-pays, precertification requirements, participating laboratories and noncovered services. Post it by the phone for easy access.

  • Make sure your staff verifies patients’ demographic and insurance information when they arrive.

  • If your office has more than one biller, assign a couple of your payers to each of them and ask them to become “experts.”

  • Develop procedures for tracking payment denials and verifying payers’ adherence to their contracts. This will save you time and money, and identify payers who may not be playing by the rules.

Source: Cascardo DC. What insurance companies don’t want you to know: tips on maximizing reimbursement. Medscape Business of Medicine. August 2005. Available online at: Accessed Sept. 22, 2005.



Practice Pearls presents the best advice on effective, efficient practice operations and patient care drawn from the medical and business literature, along with tips developed from your experience. Send us your best pearl (250 words or less), and if we publish it, you’ll earn $25. We also welcome questions for our Q&A section. Send your pearls and your questions to us at


Practice Pearls presents readers' advice on practice operations and patient care, along with tips drawn from the literature. Send us your best pearl (250 words of less), and you'll earn $50 if we publish it. We also welcome questions for our Q&A section. Send pearls, questions, and comments to, or add your comments below.


Copyright © 2005 by the American Academy of Family Physicians.
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