Accounting

As a recurrent theme during this session, panelists stressed the importance of having checks and balances by having 2 individuals responsible for the daily closing of the books. Doing so not only minimizes the chances for temptation of theft but also reduces the chances that any one individual will feel a sense of entitlement and hold an office hostage by his or her unique role. On a larger scale, monthly reconciliation can be performed in-house, but then the accounts can be ultimately sent to an independent accountant for review and tax submission. Understanding the difference between accrual- and cash-based accounting can provide a more insightful view on true monthly profitability and net cash flow, respectively.

Credit card processing

There was a consensus that deliberate and constant monitoring and renegotiation of rates were important to minimize excessive rate charges.

Some questions that one should ask are as follows:

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  Are you charged daily, weekly, or monthly?

  
  
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  What is your transaction fee per item, percentage by type of card, and chargeback fees for disputed claims?

Credit card processing

There was a consensus that deliberate and constant monitoring and renegotiation of rates were important to minimize excessive rate charges.

Some questions that one should ask are as follows:

• •
  

  Are you charged daily, weekly, or monthly?

  
  
• •
  

  What is your transaction fee per item, percentage by type of card, and chargeback fees for disputed claims?

Purchasing for office, controlling expenses, and reducing overhead

Like credit card processing, there are varying rates charged for purchases, which fluctuate from time to time and also based on order size.

Questions should be posed as follows:

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  Is shipping included or is it extra?

  
  
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  Are there discounts for early payment?

  
  
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  Do you have free extended financing terms?

  
  
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  What are the minimum purchases required to eliminate a surcharge for small orders?

  
  
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  Do you maintain par levels?

  
  
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  Are you sitting on stale or expired merchandise?

  
  
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  Do you return near-expiring drugs for credit (guaranteed returns)?

Investigating various group purchase orders that offer negotiated discount rates should be performed on a regular basis.

A suggestion to initiate a system of logging all expenses and costs was offered. Companies increase fees without notifying the office. If there is no system in place, the office will never know about the increase. A company can install a computer program that lists all frequent orders and their prices. One employee should be responsible for ordering. Looking for generic products for office purchases can also be an alternative method to save purchase costs. Budgeting and keeping a close control on inventory are important.

Checks and balances for practice and staff well-being

To avoid theft and entitlement, no one person in the office should be in charge of performing only one role that does not have built-in redundancy. The office manager can be the individual who is in charge of the employees in the office, regarding questions, advice, conflicts, and so forth, but the surgeon ultimately maintains the highest position in the chain of command. Teamwork should be emphasized to minimize conflicts and individual competition. However, annual reviews and quarterly interviews along with establishing periodic individual goals can help define personal performance and stimulate personal growth.

Some questions posed include the following:

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  Who is the internal risk manager to ensure safety in your workplace for the patient and the staff?

  
  
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  Do you replace any or all defective equipment?

  
  
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  Do you have a routine maintenance program to eliminate potential dangers in the workplace?

  
  
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  Do you have a routine inspection list for temperature control, fire safety, equipment safety, and other such parameters?

Financing

Independent of the current economic turmoil, the consensus was that financing/loan programs expanded the pool of potential customers and was worth having in the practice. An interesting point mentioned was that when patients paid with CareCredit or any such service, one practice removed the discount rate offered on multiple procedures to partially recoup the percentage loss incurred by the practice. Advice was rendered that the rates between programs should be investigated and routinely compared to assure the best rates. Patients have different credit scores, and therefore, different agencies may be required to capture the widest net of potential patients who are interested in financing.

Refunds and redos

Refunds and redos are always a difficult situation for both the physician’s practice and the patient. There was no consensus on this policy. However, a good recommendation is to stipulate one’s policies in the initial consent forms so that there is a known agreed-upon policy that is established in advance of the procedure. Another recommendation is to handle this situation on a case-by-case basis contingent on whether the surgeon thinks that the service rendered was really far inferior to the intended goal and/or the surgeon is encountering an inflamed, litigious, and vociferous patient. Accordingly, a surgeon may decide to waive the surgeon’s fee versus all fees including facility and anesthesia charges.

Some practices are outright opposed to refunds of any kind, whereas other practices emphasize that refunds would be awarded based on the above-stated constraints. In addition, any refund should be accompanied by a legal waiver of responsibilities or further request for damages. One practice emphasized that a refund is usually followed by loss of that patient compared with offering additional services for free or at a discounted rate to keep the patient in the practice. However, sometimes the practice desires divorcing from a particular patient, in which case a refund is an expedient solution to attain that end. One small point that was made for practices that carry skin care products is that, as a rule, no refunds would be made on these products. All refunds should be issued in the form of a check to avoid further credit card fees. Finally, if there is an increasing trend toward redos, the staff should meet to see whether realistic expectations have been sufficiently addressed during the initial consultation process.

Office meetings

In general, every practice emphasized the importance of establishing and maintaining a routine interval of office meetings, which varied from weekly or bimonthly to monthly. Staff meetings can be the most effective way to establish communication within the company. These meetings should stimulate productivity, set goals, discuss objectives, and share ideas about the betterment of the practice. One idea was to assign a staff member to review a major magazine article that is related to plastic surgery or related products/devices that are being currently discussed in the media so that the staff can be informed when a patient asks about the aforesaid procedure/product. Another topic discussed was allocating time to address patient’s written or verbal concerns about the practice so as to encourage critical evaluation of faults that need correction based on consumer perceptions. Having quick meetings with key staff members before the actual meeting can help minimize the chance of being broadsided at a meeting in public. The meeting can be used as an effective forum to recognize staff achievements and contributions in public and thereby create a positive morale. Scheduled meetings allow employees to express their concerns and offer advice in different areas in the office. These meetings help to maintain a respectful and positive attitude between employees and employers. Keeping a log of each meeting also serves as a verification of discussion of topics in HIPAA (Health Insurance Portability and Accountability Act)/OSHA (Occupational Safety and Health Administration) that are mandated by these regulatory agencies.