Fam Pract Manag. 2007 Apr;14(4):52.

Be ready to accommodate caregivers

As the elderly population grows, more caregivers and family members are attending doctor's visits. To facilitate communication with both the patient and the caregiver in the exam room, include at least one extra chair and position it so that you can have eye contact with the person sitting in it. Position computers so they don't cause an obstruction between you, the patient and the caregiver. Make sure you communicate clearly with the caregiver as well as the patient, answering all their questions and ensuring that both understand your instructions.

Source: Klamar AE. On the other side of the exam table: focusing on the patient. Group Pract J. February 2007:50-53.


Ask patients for feedback

Find time each week to listen to what your patients have to say about your practice. If changing the focus of your conversation in the exam room feels unnatural, try to catch patients before or after their exams.

Ask if they had trouble scheduling their appointment or how long they sat in the waiting room. Or simply ask whether they have any suggestions or comments about their experience with the practice. Connecting with your patients will serve as a reminder of the bigger picture of patient care, and it could alert you to kinks in operational processes.

Source: Institute for Healthcare Improvement. Producer customer interface: listen to customers. Available at


Providing services as a professional courtesy


Professional courtesy has diminished over the last 20 years. Is it now fraudulent to waive charges for services for other physicians or individuals? Can we still give free care to those with little or no income?


In the current environment, professional courtesy is problematic, but permissible. Because professional courtesy could be used as a way to encourage referrals or reward individuals for providing the practice with business, physicians must take care to avoid running afoul of the Stark II law. According to the regulations, several conditions must be met when providing professional courtesy to a physician or a physician's immediate family or office staff:

  • Professional courtesy is offered to all physicians on the entity's medical staff or in the local community without regard to volume or value of referrals or other business generated.

  • The services provided are routinely offered by the entity.

  • The professional courtesy is set out in writing and approved in advance by the entity's governing body.

  • The professional courtesy is not offered to a physician or family member who is a beneficiary of a federal health care program without a good faith showing of financial need.

  • If the professional courtesy involves the whole or partial reduction of a coinsurance obligation, the insurer is informed in writing.

  • The arrangement does not violate the anti-kickback statute or any federal or state law or regulation governing claims and billing.

According to the AMA Code of Ethics, physicians should waive co-payments for indigent patients if financial hardship is keeping such patients from needed care.1 The anti-kickback statute does allow physicians to waive co-payments and deductibles for indigent Medicare patients, as long as they are based on a good faith determination of the patient's financial need, not based on the amount of the charges and not offered as part of an advertisement or solicitation. Regulations for Medicaid vary; contact the appropriate regulatory agency in your state. Private payers often prohibit waivers of co-payments and deductibles, so consult those you contract with before deciding to offer a waiver.


1. American Medical Association. Code of ethics: E-6.12. Forgiveness or waiver of insurance co-payments. Available at: Accessed March 7, 2007.


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Copyright © 2007 by the American Academy of Family Physicians.
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