Magazine article Medical Economics

Practice Management

Magazine article Medical Economics

Practice Management

Article excerpt

When very sick patients are insured by managed-care plans

Q: Our internal medicine group is seeing increasing numbers of capitated patients with severe chronic illnesses. Because we take some financial risk for specialty and hospital care, we're concerned that a run on services for these patients might badly dent our bottom line. How can we protect ourselves?

A: Ask to be paid fee-for-service, rather than capitation, for these very sick patients. Your fallback demand should be a substantial rate increase. Bolster your requests with facts and figures.

Also, reassess your stop-loss insurance with these plans, especially if you're losing money on any capitated patients. You can ask for a lower deductible; failing that, purchase more reinsurance yourself.

Keeping things amicable when a partner must go

Q: We eight internists are merging our practices. If one of us clearly can't fit in, how can we force him to leave without wrangling over the buyout price? Our lawyers can't agree on an answer.

A: Spell everything out in the merger agreement. First, decide whether a simple majority vote will suffice to force out a partner. Second, specify how the value of a departing physician's hard assets (including computer system) and accounts receivable will be calculated, and set a percentage by which the receivables will be discounted for write-offs. Finally, in lieu of good will, agree to a "parachute" of two or three months' salary and benefits.

The merger agreement must also state how the payment will be made, and where the funds will come from. …

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