Every Practice Needs These Two Policy Manuals

By Grandinetti, Deborah | Medical Economics, July 29, 1996 | Go to article overview

Every Practice Needs These Two Policy Manuals


Grandinetti, Deborah, Medical Economics


Together, they'll help you stay on the right side of the law and get top performance from your staff

our staff may work for you with the best will in the world. But if they don't know specifically what's expected of them, you won't get top performance. Your patients want that, and health plans certainly do. To communicate to your staff exactly what you expect, you need two separate sets of explicit rules: an office policyand-procedures manual and an employee handbook. The policy manual states your practice objectives and sets forth how you and your staff will further them. The staff handbook clarifies the legal relationships between the practice and its employees.

Both handbooks should be thorough and upto-date, so if you have them already but haven't reviewed them within the past year, it's time to do so. If you don't have either document, the sooner you create them, the better. You'll accomplish either task more quickly by focusing on the key areas highlighted below. Building a team:

the policy-and-procedures manual Introduce the manual by telling staffers what the practice is all about, where they fit in, and how the policies relate to them. Here's an example:

"The ultimate objective of all activity in this office is to help our patients. To do that, we must function as a team. As with any team, we need a set of operating policies and rules. However, every member of our staff must realize that helping patients is more important than the rules themselves. If a rule appears to interfere with good patient relations, question it. Perhaps an exception should be made; perhaps the rule should be changed. Discuss these issues with [the administrator] or me."

This brief introduction covers a lot of ground. It asserts that the staff must function as a team, explains why policies exist, and encourages employees to use their judgment to question the rules in situations where a policy may actually work against the practice's mission. The meat of the manual should cover clinical, business, and related miscellaneous procedures. Here are the key areas to examine: Patient relations. Determine how you want staff to handle the telephone, schedule patients, greet them in the office, and respond to their requests for records or to see their charts. Educate your staff about the importance of etiquette and a good first impression.

"I've seen a real attitude problem in some practices," says David Karp, a loss-prevention consultant in Cloverdale, Calif. "There are too many front-office people who think it's their job to keep patients out of the doctor's office, rather than encourage them to be there when they need help."

Also make it clear that you, the physician, are the only one who can dismiss patients from the practice, and specify the formal steps that must be taken to avoid charges of abandonment.

"I've seen some practices where the bookkeeper 'cancels' a patient if he hasn't paid his bill or responded to three pastdue letters. That's improper," says Karp. "Here in California, and in most other states as well, patients have to be given sufficient notice of the doctor's intention to withdraw. They must have a reasonable time to find another doctor, and their current physician must make their medical records available and inform the new doctor of any medications that must be continued, or medical problems that must be monitored. All of this needs to be done by certified mail with a return receipt."

Your policy book should also specify the patient-termination requirements of the managed-care plans you contract with. You may also want to include a special section on how to handle inquiries from individuals who are doctor-shopping because their new health plan requires them to choose a primary-care physician. State your policy-whether it's to encourage or discourage get-acquainted visits. And tell employees what to say and what not to say to these patients.

Compliance with government regulations.

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