It’s important to spell out the care you deliver patients. It’s equally important to define acceptable and unacceptable treatment from patients. Here are four reasons why you should prepare a physician rights and responsibilities document along with what to include.
1. The document sets expectations.
Building a cohesive culture means that all physicians - from senior partners to junior physicians - know their role, purpose and place in the organization. Developing a physician rights and responsibilities (RnR) document facilitates this process faster than leaving it up to osmosis, chance or leadership changes.
Here are a few items we commonly find included as physicians
• The right to be trusted
• The right to benefit from their colleagues’ opinions and assistance on cases
• The right to receive respectful and courteous treatment from all staff
• The right to receive monthly financial statements and reports that illustrate their performance
(cont.)And here are a few examples of physician responsibilities we commonly see:
• The responsibility to treat business and clinical staff with respect and courtesy
• The responsibility to maintain professionalism in front of patients and their families
• The responsibility to arrive on time
2. An RnR codifies the culture.
Culture is a squishy topic that “men of science” prefer to avoid. Yet, most of the practice break ups we are called in to deal with are the result of cultural differences or lack of shared values. Most of these break ups could have been avoided had the practice leaders spent more time explaining and/or fostering cultural norms. An RnR puts commonly accepted practice principles on paper and defines the often nebulous subject of culture.
A simple example is to require attendance at meetings, which will reduce physician complaints about business decisions made when they were present. If referring physicians are the lifeblood of your medical specialty or surgical practice, specifying respect for referring physicians is another responsibility to consider including. And defining the dress code rather than saying dress professionally eliminates any ambiguity.
3. An RnR gives guidelines to new physicians and junior partners.
The newest generation of physicians has a decidedly different outlook on work habits, collaboration and organizational contribution than those before them.
Putting guidelines in writing not only establishes them, it’s also a welcome roadmap for the junior partner, who will be looking to physician leaders for direction. Remember, your practice is their first job. The RnR also outlines what the physician must do to be a good practice citizen. For instance:
• Participate in the development of clinical protocols and outcome reviews.
• Agree to abide by documentation guidelines and document services
• Complete all charge slips by the end of the day, correlating CPT and ICD-10-CM codes at all times.
4. An RnR clarifies the commonly opaque.
Are physicians required to submit hospital charges within 48 hours? Must they follow the practice’s sanctioned charity care and discount policy without going rogue?
Often, staff and managers just assume the doctors know these things. But why would they if you aren’t clear? The RnR renders “I assumed” or “I thought” ineffectual.
• Complete chart notes accurately, and dictate procedure reports within 24 hours. E/M services are audited as part of a practice’s compliance plan, and not all physicians were completing their notes within the 24-hour rule.
• Don’t schedule elective cases without pre-certification and determination of benefits. We suggest asking the billing staff to oversee adherence on this one and letting the physicians know they’ll receive this feedback directly. If compliance is a constant issue, the feedback will be provided to the board.
In order to be effective, a physician rights and responsibilities document must include details that are specific to your practice and culture. Add the development of this governance agreement addendum to the board’s to-do list. Ask that all physicians review and sign it when it’s ready for implementation.