Private Practice Pitfalls

By Jeff Bonner

If you are a physician in private practice – meaning you own the practice – and you have fewer than four full-time providers, you’re making mistakes that you aren’t aware of, and you’re not alone. It is nearly impossible to keep up with both medicine and business. And small practices generally cannot afford an experienced, qualified administrator. So you wing it and do the best you can. In the process, almost by definition, you break rules and laws you didn’t know existed, and/or you pay too much for services because you don’t have the time or expertise to shop them. Here are just a few of the common pitfalls I see in small practices:

Isolation. This one causes all the rest. You don’t have anyone going to meetings (MGMA, carrier sponsored meetings, continuing education on coding, legal, etc.). You can get some of the information you need virtually, but you often don’t know what you don’t know.
DOL/Wage & Hour violations. Most people tend to think that if you make someone salaried, you don’t have to pay then overtime. The rules here are more complicated than that, and the penalties are substantial.
Bad contracts. Sure, your lawyer could look over everything you sign, but who wants to pay for that? And, you sign a lot of contracts for things seemingly as innocuous as phone systems, copiers, waste removal, credit card process, and more. Many of these have long terms, and punitive auto-renewal clauses that lock you in for as long as five years at high rates.
Handbooks and training. Your employee handbook essentially tells the government or court (in any litigation or audit) what you have promised. If you deviate from it, you are liable. If you leave something out, you are liable. Keeping that manual, as well as your HIPPA and OSHA manuals and training up to date is a daunting task, one which most small practices don’t have the time or resources to accomplish.
This might be the most important –trust. You have a Martha or a Peggy who’s been with you forever and she knows everything. You trust her. She’s probably honest and doing what’s in your best interest. But if she leaves, all that knowledge and trust goes with her. You don’t know what was in her head. Cross-training and shared knowledge saves you a huge headache down the road, but small practices generally don’t have enough staff to effectively cross train.

So, you may feel that you’ve done alright so far. But please remember that nothing matters until it matters – and then it REALLY matters. Going 100mph on the interstate doesn’t matter until you crash or see the blue lights in your rearview mirror. As a physician, you need to attend to every detail, just in case. The business side of your practice needs the same attention. You can’t, and shouldn’t, have to do that. Find someone you can trust and hand off that piece. And focus on what you were trained for and love to do.