Practice Management Q&As

Q. As a solo practitioner, must I employ an answering service to take calls when the office is closed? Would an answering machine that directs calls to my pager or cell phone be sufficient?

A. The important thing is to provide reliable access for patients who need care. Most doctors have elected to eliminate their answering service and adopt voice mail and pagers. However, if you decide to go with an answering machine, be prepared for more interruptions of your time without a service to screen incoming calls.

Q. My office manager has been on disability for 3 months. During that time, my other four employees have taken over her tasks, and we're doing quite well without her. Can I eliminate her position?

You also might be obliged to hold her position open for her if your state has a law similar to the federal Americans with Disabilities Act. The ADA applies to businesses with at least 15 employees, but some states have enacted laws that apply to smaller employers.

Likewise, although your practice is too small to be covered by the federal Family and Medical Leave Act, your state may have a similar law that may apply to you. The FMLA requires businesses with at least 50 employees to give a worker with a qualified serious health condition 12 weeks of unpaid leave per year, with the right of reinstatement to the job.

Q. I've been offered my dream job in another state. The salary looks good to me, but I know that real estate prices and general living costs are considerably higher there. How do I figure out whether I can afford to take the job?

A. Start by having your accountant prepare a personal income tax projection based on your new gross salary, with estimates of real estate taxes and mortgage interest. This will give you an idea of your income tax obligations and will allow you to figure what your future monthly net take-home pay will be.

Next, you'll need to estimate your future expenses. So tally your current monthly expenses, starting with the big items, like payments on your mortgage, car, and education loans. Add what you now spend each month on food, clothing, utilities, entertainment, etc.-but add an additional 10% to 25%, or whatever is appropriate based on figures at your disposal, to account for your new state's higher cost of living.

Comparing the estimates of your future take-home pay and expenses should give you an idea of whether you can afford to take the new job.

Q. Our small group practice plans to rent office space to a physiatrist. If we refer Medicare patients to him, will we violate federal anti-kickback statutes?

A. Not necessarily. You can fit this rental into a "safe harbor" (where the anti-kickback rules don't apply) if your arrangement is in writing, if the term of the lease is for at least 1 year, if the lease rate is equal to fair market value, and if the rent the physiatrist is scheduled to pay isn't affected by the number of patients you refer to him.

Editor's note: This article originally appeared in Urology Times' sister publication, Medical Economics ( http://www.memag.com/).