The Inbox: Asset Protection in Volatile Times

August 12, 2016

In our recurring blog "Inbox" we share comments from physicians and practice administrators telling us what keeps them awake at night.

Editor's note: We work hard to write about issues that will help physicians run their practices in a manner that is both prosperous and efficient, while still delivering quality patient care. And we are delighted when our readers let us know what they are thinking. This month we are excerpting two blogs by attorney Ike Devji about asset protection in volatile times and attorney Ericka L. Adler on treating patients who suffer from bed bug bites. The articles have been edited for space and are followed by comments made by readers at PhysiciansPractice.com.

Physician Asset Protection in an Uncertain Economy

As the 2016 Presidential election bears down on us there is a great deal of uncertainty among both advisers and consumers about our long-term and short-term economic prospects. This uncertainty requires proactive legal and financial planning by physicians.

In our last discussion, I provided caveats about the wide array of employment related exposures that peak during recessionary economic conditions including lawsuits, theft, and embezzlement and what you need to do to protect your practice. Medical practices and their owners in some states are already feeling this pinch, but given our current volatile political conditions and increasingly shrinking and fragile global economy, these issues could apply to any state and practice area without much notice.

Many physicians experienced significant losses and legal exposure during the last recession. Some have recovered, some never will, and most still haven't done anything different than they did before to protect themselves.

John says: The most important factor is to control your own assets. The average financial adviser will generate for you a 7 percent annual return and charge you huge fees for that. You can buy a monkey, have it throw darts at a stock chart, and get the same return, for a much lower cost. Or you can buy BRK/B [Berkshire Hathaway] and get 19.2 percent annual compound growth, doubling the assets every four years. This means that with $150 monthly investment you get $2,500,000 after 30 years, with $500 a month you get $8,500,000 after 30 years, and so on. Just enter your monthly disposable income into the Bankrate Compound Interest Calculator and see how much you can generate and how soon. You may be pleasantly surprised. With a Roth IRA this will be tax free after the age 60. With a regular savings investment account the tax rate will be 15 percent long term (after one year) capital gains investment tax, at any age.

Kesav writes: Then why doesn't everybody do this? These returns are better than a Hedge Fund. Or it is a best kept secret nobody knows about?

John replies: These numbers are published and easy to verify. It requires a certain knowledge of statistics and mathematics, plus an open, inquiring mind, saving discipline, planning and life-long patience. Ignorance is bliss. I was forced to learn it after a $5,000,000 fraud in Las Vegas, in 1996. The stock market is the best business in U.S. You are in control, don't need to worry about any alcoholics, drug addicts, and thieves. Thankfully, the U.S. has the best regulated and transparent stock market in the world. If we do not do stupid things, we can look brilliant, according to Charlie Munger and Warren Buffett of Berkshire Hathaway, Inc.

Have you changed your investment strategy significantly in response to recent economic factors? Tell us what you think; join the conversation at bit.ly/2aZci64.

Can You Turn Away a Bed Bug Ridden-Patient?

I was asked by a physician practice whether it could turn away a patient with bed bugs and refuse to treat the patient any longer.  The practice had already lost the use of its waiting room and treatment rooms numerous times due to this patient (in order for furniture and carpets to be fumigated). This was not as easy a question to answer as you might think and there are few helpful guidelines on how to handle a patient with bed bugs!

Generally, physicians need to be careful not to discriminate against a person for ethnic, racial, or religious reasons or because of their sex (unless it has to do with the physician's specialty). Physicians also should not refuse to see patients who are part of a protected class. Physicians can also be forced to see patients they do not otherwise prefer to see if required by payer contract. For example, if you are required to see a certain population of HMO patients, the payer may not allow you to turn a patient away with bed bugs (although you would try to work this out with the insurer).

Elizabeth ask: Would dusting the waiting room with the special earth product that repels bed bugs perhaps help in any way with this issue?

Richard comments: I think it's fair to say "I'm sorry, but we don't have the facilities necessary to provide the service you deserve without compromising the care of our other patients and our obligations to staff. For that reason we feel you would be better served in a practice prepared to meet your specific needs."

K says: Typical of a lot of other things, it always comes down to an issue for the physician and an expense for the physician.

Robert writes: This is confusing. Bedbugs stay on furniture. People are not "covered with bedbugs." They are covered with bites.

Stephanie responds: True, but they will hide in clothing and personal items like bags and coats.

Robin says: I truly appreciated this article and would like to ensure that the practice side is understood also. We have the utmost concern for patients' treatment, however in a small accredited office-based surgery practice to risk further contamination of other patients in a surgical setting seems incomprehensible. When a patient comes in for urgent care and is unquestionably covered with bed bugs, is treated by the practice, and then the practice has to immediately call for exterminator, pay thousands of dollars, cancel other patient procedures until it is safe, it seems little to ask that patient follow-up should be handled in another setting. [We] recognize that the patient may not be able to afford the expensive cost of exterminating or may live in an apartment or area that unless the entire building is treated, the problem would still not be resolved. I am wondering why our health departments and social service agencies can't take on that task, they should have responsibility for helping patients…

Nazeer writes: We as medical practitioners are duty bound to holistically manage the patient, which entails attending to the presenting problem, as well as the associated psycho-social issues - since the two might be linked. This would necessitate appropriate referral and follow-up to social workers, psychologists, etc. Fumigating the practice is a pain but this could be managed depending on the practice setup, e.g. these patients could be whipped straight to a spare waiting/examination room, minimizing contamination to the practice.

Robert comments: Not if you need to see 40 patients a day.

Elaine says: The act team has two separate waiting rooms, one for bedbug-infested clients only. This minimizes spread and no need to throw out the furniture since all the other bedbug clients can't get any worse and once they are treated, they can join the rest of the clients. If someone had measles, would you worry about separating them from the rest of the patients? I had a patient sit down and fleas started jumping off into the carpet and onto the furniture. No more visits in that office!

What is your policy on treating bed bug-infested patients? Tell us what you think; join the conversation at bit.ly/2aJqyzb.