Advanced planning can keep your income, and your practice, afloat

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Larger groups may be able to work around one missing physician. Not only could the remaining physicians take over part of the patient panel, a larger practice is more likely to have midlevel providers who can relieve some of the burden.

Even when more physicians are present, the structure may work against ease of patient distribution. “Our problem when a physician was disabled is that we are very specialized,” said Lorin Easly, COPM, administrator for Central Oregon ENT in Bend. “You really can’t take a neurotologist’s patient, hand them off to a rhinologist, and hope it works. In our case, we coordinated with the university for patient care.”

After the patients have settled in with their new physicians, physician compensation must be sorted out. For smaller practices, a plan for compensation should be included in agreements about covering for one another. Usually, the money follows the patient, with business insurance making up shortages. “Our group has a production-based model of physician payment,” said Long. “If you don’t produce, you don’t get paid more than a base salary. For those doctors and midlevel providers who had to work harder, they saw the benefits.”

Dividing up call is often one of the more contentious issues to address. Few providers volunteer to take call, and working out these issues in advance of a need can be important in keeping the partners, at the least, not unhappy. “We are the only ENTs in our area, so we had to adjust call,” said Easly. “If all of my providers did not cooperate, it could have gotten ugly.”

Permanent Disability

Permanent disability, another facet of the coverage agreement for single or small groups, has to be addressed. For larger practices, buy/sell agreements that are already likely in place should be reviewed to make sure they define the moment when a disability becomes permanent and triggers the provision. “An agreement defining when the buy/sell parts of the partnership or corporation structure come into play [is] important to have in place ahead of time,” said Dr. Bryant. “This ensures all members agree [how to handle] the situation should it arise.”

Although most of the focus is on the physicians, office staff plays an important role that shouldn’t be underestimated. The staff needs to be kept abreast of what is happening, which can be as stressful for them as the providers. Unaddressed staffing concerns only add to the problems already being tackled by management.