Connect with us

Real Deal

Is It Okay for a Staff Member to Refuse to Serve a Specific Patient for Personal Reasons?

mm

Published

on

A staff person has a personal issue with a patient. Where does the manager draw the line?

Gina, the managing optometrist of Oxford Optics, was busy creating next week’s staff schedule when Bonnie knocked on her door. “Do you have a minute?” asked Bonnie.

Gina waved the receptionist in and cleared her desk. “What’s up?”

ABOUT REAL DEAL

Real Deal scenarios are inspired by true stories, but are changed to sharpen the dilemmas involved. The names of the characters and stores have been changed and should not be confused with real people or places.

ABOUT THE AUTHOR

NATALIE TAYLOR is an experienced optometry practice manager for Advanced Care Vision Network and a consultant with Taylor Vision. Learn more at tayloreye.com.

Advertisement

“I was looking at tomorrow’s schedule and saw that my ex-sister-in-law, Justine, made a new-patient appointment,” said Bonnie. Gina could hear rage in her voice.

Gina nodded for her to continue, not really understanding what Bonnie was saying.

“I just can’t be here. I haven’t seen her in a year, and there’s just no way I can be professional,” she said.

“Oh,” said Gina, bewildered. “Well, we don’t have coverage for tomorrow. Nicole’s on vacation. We need a receptionist to function.”

“It’s just for the morning. I’ll go get coffee — her appointment is at 8:45 and when she’s gone I’ll come right back,” pleaded Bonnie.

Advertisement

“Did you already try to find coverage?” Gina asked.

“The opticians think they can manage to do both departments for a few hours,” Bonnie replied.

Gina shook her head slowly. “I’m sorry Bonnie, I have a really heavy schedule tomorrow and I can’t have prescriptions walk because our optician was busy doing your job.”

Bonnie’s face dropped and she stood up. “I just don’t know what’s going to happen,” she said vaguely, and stepped out of the office.

Later, Gina shared her conversation with the practice owner, Phil.

“Justine? As in, the woman who caused Bonnie’s divorce?” he asked. Their village, a few hours east of Shreveport, LA, was tight-knit; everyone knew everyone’s business.

Advertisement

“I guess so?” Gina was at a social disadvantage, being a recent transplant from Texas.

“I wonder why she’d do that. I guess to get under Bonnie’s skin,” Phil said. “I mean, Bonnie’s been with me almost 20 years; it’s no secret she works here.”

“Well, I’m sure everyone will survive. It isn’t like they’ll ever be alone together,” said Gina.

The next morning was busy; Gina had half-forgotten the whole thing by the time she got to Justine’s exam room. Justine was pleasant, but stopped Gina cold when she asked, “Does Bonnie still work here?”

“What do you mean?” asked Gina. “Didn’t she check you in at the front desk?”

“No, it was someone wearing a lab coat,” said Justine.

“She still works here,” said Gina blandly. “I’ve been so busy back here I wasn’t aware she had called out.”

“Well, let her know I said hello,” Justine said with a slight edge to her voice.

Gina smiled and returned to refracting, seething. After the exam, she escorted Justine to the front desk, where one of the opticians was juggling a phone call and a patient trying to check in. Gina helped to get Justine out the door and then told the optician to call Bonnie to tell her to return to the office. Then, trying to decide what to do about her MIA receptionist, she went to talk to Phil.

The Big Questions

  • Is it acceptable for a staff person to refuse to work with a patient?
  • How should Gina discipline Bonnie for leaving without permission?
  • Justine may return to the office for eyewear, an eye injury, or other issues. Should Gina ask her to find another provider?

Expanded Reader Responses

Michelle W.
STOCKBRIDGE, GA 

From what I understand, Bonnie has been at the practice for almost 20 years? If a 20 year team member came to me to talk about a situation, I’m going to listen.

  1. If someone has been a GOOD employee for 20 years, again, I would listen. If the situation is upsetting to my 20 year team member, I would accept her removing herself from the situation.
  2. The problem is Gina. Gina was insensitive to Bonnie’s situation. While it is important to be professional at all times, I do not believe it is right to subject a team member to this unnecessary stress. Shame on Gina for not listening to Bonnie. If she has never left without permission in the past, it should speak volumes of the stress she was feeling.
  3. I would not ask Justine to seek another provider. I would put an alert on her file or EHR to make Bonnie aware and to schedule her when another person can be at the front.
Barbara B.
MT. STERLING, OH

Bonnie has been with the practice for 20 years so obviously she is a good employee. Unless she was constantly asking to have time off due to certain patients, Gina should have trusted Bonnie’s decision and allowed her to not be present at the front while Justine was in the office. Possibly she could have answered phones from a private area. The opticians may have been inconvenienced for a little while, but had Bonnie called in “sick” for the day they would have been inconvenienced even more.

I also think Phil should have encouraged Gina to work around this situation for Bonnie. He’s obviously aware of Bonnie’s past issues with Justine and since Gina is his employee, as well, he could have “suggested” that she consider Bonnie’s request this one time even without going into detail.

Justine may return at some point, but perhaps Bonnie will be more emotionally ready to deal with the situation then.

Pablo M.
WOODSTOCK, GA

This is one of the perils we face when we work with the public. Gina could discipline Bonnie for leaving without permission, only to have her quit; and then being left without an otherwise valuable staff member. Or, make Bonnie work with Justine regardless of their history and have a cat fight in an office full of patients. Or, (my preferred option) have Justine to come in when Bonnie is not around. If the issue is that Justine wants to come in just to have an excuse to have a confrontation, then she needs to be seen elsewhere.

Christine H.
ATTLEBORO, MA

I’ve been in a similar situation where I’ve had an individual that I’ve had issues with socially become a patient at my practice. If possible, I’ve asked if the other optician would mind assisting that patient, but that’s not always an option. While awkward and difficult at times, I’ve always remained calm and professional reminding myself to “kill them with kindness.”

Vlad C.
HACKENSACK, NJ

Bonnie has a good reason to want to stay away from Justine. Gina should have another conversation with Bonnie. If I were Gina, I wouldn’t discipline Bonnie severely. Employees like to feel like we have their backs. I would’ve offered Bonnie the opportunity to come in late that day.

William C.
ATLANTA, GA

An employee’s personal life should not come into play in the work place. You may not be excited or pleased but showing your professionalism is the right path in this or any hectic unwanted situation.

Bonnie’s outright disregard for the instructions given to her from management should be met with termination. She voiced her dislike but leaving the office due to her opinion of an individual caused an unneeded hardship on the other employees. Her blatant disregard and lack of respect for the management team should not be tolerated.

Gina should not be the deciding factor on if the patient should return to the office. The patient Justine has created no issues in the office and should not be the one punished for Gina’s feelings about her.

Pamela M.
Highland, CA

It is most certainly appropriate for a staff person to refuse to work with a patient – in this case, special circumstances existed; she gave advance notice; the practice owner knew the history. Gina was only the managing optometrist and had been put on notice both by the employee and the owner doctor.
This is not a case of being absent from the job without notice – frankly the employee could have just called in sick which would have been a lit. Instead, she gave the managing OD a heads up – everyone knew in advance. Let the managing OD seethe – she was given both fair warning and the circumstances behind it. And she probably needs to get a life and start understanding what transpires in an office. Would she have been forced to examine a patient under the same circumstances? I think not. In this instance, the employee was valued, long term, and had a legitimate concern.

Tracy G.
Hatboro, PA

In a perfect world, our employees would have no baggage, every day would be Friday, and dogs would be allowed to come to work with us. Unfortunately, we don’t live in a perfect world. Fact is, if a long-time, reliable employee who is good, if not great, at their job ends up having an issue with a pt, then guess what boss– you do too. Denying an employee the opportunity to excuse themselves from a potentially stress inducing confrontation is just bad business, plus, who needs that drama in their busy office? You have to trust your staff and respect it when they say that this will not be something they can handle. Respect them and they will respect you, ignore their plea for help in situations like this and you will probably end up short staffed for the day and possibly damage the employer/employee relationship for the future.

Angel M.
Cynthiana, KY

Sometimes, it is impossible to be professional. We aren’t robots, after all. 

Bonnie tried to fix the problem, and Gina should have listened. Bonnie wasn’t asking for the whole day, just the time of Justine’s exam. Sure we opticians can be socially awkward, but we can multi-task when needed. 

When Phil explained everything to her, Gina should have contacted Bonnie and permitted her to be away. 

We have had similar instances here, and we always look out for each other in our small town. 

Gina really dropped the ball; not listening to a valued and long time employee’s problem showed a lack of empathy.

Bad blood in a small town can be serious. Hadn’t Gina ever seen “Hot Fuzz”?

Cindy H.
Hixson, TX

Frankly I got a little irritated with Bonnie just reading this. Keep your personal life and issues away from work. Small town or not this is a business and her behavior is inexcusable. Be a professional and do your job. Her leaving was at best insubordination and she be treated as such.

Martha D.
Wheatfield, IN

First of all, it is never acceptable to leave your office in the lurch because of a personal problem. You have to remain professional no matter what your personal feelings are. There has been many times I have seen someone on staff leave the rest of the office short staffed because they would hide or leave rather than deal with a difficult patient. There comes a time when you just have to screw a smile on your face and suck it up. It is not your other patients or staffs problem. Bonnie should at least get a verbal warning. She was told they couldn’t spare her but she left anyway. Gina should at least have a sit down with Bonnie and explain to her, that while she is a good receptionist, leaving without permission, is totally unacceptable. This won’t be the first time someone came in she didn’t want to deal with and it won’t be the last.

Vicki K.
Waco, TX

I realize that this is a professional setting and you should leave personal stuff at home. Let’s get real — life comes into play no matter were you are. I would speak with Bonnie about the leaving and let her know that this was unprofessional and that she needs to understand that. Then I would flag Justine’s file for the office personnel and make sure that Bonnie did not have to interact with the patient. Some matters are just too far gone to try and just confront them. Bonnie has been with the office for a long time and the whole town and office understand the situation. So should Gina. Eventually things may change and the situation will diffuse, but why take the chance that this could blow up in front of the patients? A little effort would go a long way to maintaining a calm and smooth running office.

Pam P.
Downers Grove, IL

If a patient makes a staff member uncomfortable personally, then the staff member might have some ground to request to be reassigned temporarily. Bonnie acknowledged that she would not be able to maintain professionalism with this individual, with a 20-year record behind her, acknowleging this one circumstance was something she was trying to do in the best interest of the practice. Before disciplining Bonnie, Gina should verify that perhaps the dr, who seemed to understand the situation, did not approve Bonnie’s temporary escape. While I’m sure it was a little hectic while she was in the office, Bonnie’s teammates willingess to cover for her says a lot about how they view her and wanted to help her. With the small town scenario, possibly the doctor or office manager could approach Gina to ask why she wanted to be seen in this office knowing Bonnie was there. For a 20-year, high-performing employee, I might support them over the potential new patient.


This article originally appeared in the June 2017 edition of INVISION.

 

What’s the Brain Squad?

If you’re the owner or top manager of a U.S. eyecare business serving the public, you’re invited to join the INVISION Brain Squad. By taking one five-minute quiz a month, you can get a free t-shirt, be featured prominently in this magazine, and make your voice heard on key issues affecting eyecare professionals. Good deal, right? Sign up here.

Advertisement

SPONSORED VIDEO

SPONSORED BY SAFILO

Safilo’s “American Eyes” Video Celebrates Elasta and Emozioni starring ECPs Peter Tacia and Heidi Dancer

For the third year in a row, Safilo has looked to trusted eyecare professionals to star in its American Eyes campaign for its Elasta and Emozioni collections.Their latest testimonials are from Peter Tacia, O.D. and Heidi Dancer, optician, of Alma, MI, talking about two best-selling collections: Elasta and Emozioni.

Promoted Headlines

Real Deal

If This Team of Expo Slackers Worked for You, What Action Would You Take?

They spent most of the all-expenses-paid trip in the hotel bar.

mm

Published

on

DR. BENNIGAN’S STAFF of 12 was buzzing. Liz, the office manager, was spreading the word that for the first time ever the practice would be sending some team members to a big optometry conference. The lucky staff members would fly from their home in Lexington, KY to Atlanta, GA for three days of continuing education, special events and expo exhibits.

ABOUT REAL DEAL

Real Deal scenarios are inspired by true stories but are changed to sharpen the dilemmas involved and should not be confused with real people or places. Responses are peer-sourced opinions and are not a substitute for professional legal advice. Please contact your attorney if you have any questions about an employee or customer situation in your own business.

ABOUT THE AUTHOR

NATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at info@meredithoptical.com

Liz asked everyone to email her a short “essay” describing why they wanted to attend and what they hoped to get out of the experience. Based on these essays Dr. Bennigan chose four staff—two opticians and two technicians—plus Liz to lead the trip. She immediately booked the flights so the group could sit together. Dr. Bennigan agreed to pay each staff person their regular wages for an 8-hour workday. Liz carefully scheduled each staff person with CE lectures as well as time to attend the expo. She printed the course handouts and made binders for each attendee.

The morning of the flight Liz met her four co-workers in the office parking lot and everyone loaded into an airport shuttle van. It was early, just after dawn. As they pulled out onto the highway Liz shushed the group to go over some of the details, beginning with her binders.

“I’d recommend reading through your handouts on the plane,” said Liz. “Dr. Bennigan has scheduled a 3-hour staff meeting for when we get back home, and each of us is going to need to present a 3- to 5-minute summary of what we learned at each lecture.”

The group collectively rolled their eyes and shifted in their seats, but no one argued.

“Tomorrow night at 7:30pm we are going to meet up in the hotel bar and walk across the street to a restaurant so we can talk about the first day, okay?” The girls tiredly sipped cups of coffee and stared out the windows.

Liz was booked in a room by herself and spent the first night zoned out in front of the TV. The next morning, she saw one of the opticians on the shuttle bus.

“Where’s your partner in crime?” Liz asked amiably.

“Oh, we met up with a few of my old co-workers at a bar last night. She got pretty drunk,” the optician said, chuckling. “She’s still out cold; I left her in the room.”

“Oh boy,” Liz tried to hide her frustration.

That evening, Liz waited for her team as planned but by 7:40pm she sent a group text asking for an ETA.

“I forgot!” wrote the technicians. “We’re at the big optometry party – come here!” “We have drink tickets!”

“We’re too tired,” texted one optician. No reply from the other.

Liz called the restaurant to cancel their reservation, and backed off the group for the remainder of the trip.

At Dr. Bennigan’s staff meeting the presentations were of varying quality: one of the technicians did an adequate job, but the other had clearly not taken any notes during her classes. The two opticians confessed to missing several classes and largely worked off the handout binders.

Dr. Bennigan held the four back for a recap. “Ladies,” he began, “Liz and I are not satisfied with your efforts—not today, and not while in Atlanta. I was OK paying you for the time you put in to your education, but you clearly have taken advantage of the situation.

I think we need to revisit the terms of this trip.”

The Big Questions

  • Would it be fair of Dr. Bennigan to subtract from an employee’s daily rate for each missed course?
  • Should the team be held accountable for missing team-building events? How?
  • If Dr. Bennigan decides to send staff next year, what should he do differently?
Becky M.
Osawatomie, KS

We have to show proof that we attended our classes. If we don’t have our schedule stamped we don’t get paid for the time in that class. The staff should not be paid for the classes they did not attend. The staff was disrespectful for not attending the dinner they were aware of ahead of time. If the doctor sends staff next year he should spell out, in writing, what is expected of staff and none of the staff that attended this year aside from Liz should be allowed to attend again. We have never had to put the expectations in writing at our practice. We have a lot of fun at conferences but we also attend our classes and take notes because we’re being paid to be there and our doctor is paying for CE. Common courtesy and respect.

Thomas W.
Myrtle Beach, SC

The doctor paid the staff to attend the classes. They did not attend, so it would be fair for him to subtract for each missed course. The team should be held accountable for missing the team-building events, but as these were clearly after hours and not during their paid work hours, there should be no financial consequences for missing these events. If the doctor decides to send staff next year — and I think he should—he should personally explain his expectations to the staff. Additionally, it would be wise for him to attend the conference along with his staff. It would also be a good idea for him to take them out to dinner as a team-building event and not as a business meeting. I would encourage keeping the team together as much as possible. The office manager zoning out in front of the TV by herself is not acceptable.

Deanna A.
Fort Collins, CO

Express your concerns and document it in their employee file. I would consider sending less people the following year and certainly not the ones who didn’t follow through. There seemed to be a lot of hand holding and trying to make sure they follow through. There needs to be some point of responsibility of the employee. They go to learn and share. The partying and missing classes is abuse of the situation. Next year if they miss class, then they would be docked those hours and asked to reimburse for the cost of education.

Brian C.
Prescott Valley, AZ

We had a similar situation when I took my entire staff of five to Vegas Expo West about 20 years ago. Most of my staff did not attend the education I paid for, and were off drunk/gambling the entire time. Time dedicated to purchasing new frame lines and evaluating equipment was spent trying to find errant employees who were passed out/vomiting in their rooms after the “Marchon party.” It was a terrible experience. I was furious that I closed my clinic for three days (thousands in lost revenue), paid for the entire thing (a couple more thousand dollars), the staff’s hourly wage for three days, and I netted no positives at all. It was a complete waste of time and money. The staff noted my resentment for years afterward, and never brought up going to Expo again. I have never paid for any employee to go to Expo since. I attend it alone, sober, and only for one day.

Chris D.
Tampa, FL

I would not touch the employees’ pay for the trip. But not having filled the agreed requirements, I would suspend them for three days for gross negligence of their duties. This was not vacation; this was work and education. The expectations were set. They failed to deliver — three of them, at least. I would bar them for one year for any company paid events or education. I wouldn’t rub their noses in it, but set the tone to know it will never be tolerated again. And why.

Cherlyn F.
Decatur, IL

Speaking as an office manager, I would write up the employees who did not participate according to the agenda. I would also forbid them from any future trips for a period of time, say one to five years. Our policy on continuing education: Continuing education and the expenses involved will be left to the discretion of management. There may be times when you will be required to attend a seminar scheduled after office hours, or on a Saturday or Sunday. The doctors will pay your registration fee, and you will be reimbursed hourly pay for time spent in classes and for two hours for exhibit hall time. No reimbursement for travel expenses will be considered.

Pamela M.
Highland, CA

1. Would it be fair of Dr. Bennigan to subtract from an employee’s daily rate for each missed course? ABSOLUTELY.
2. Should the team be held accountable? YES.
3. No further out of area continuing education except for the staff person who adhered to the rules. No exceptions for staff members who took advantage of their employer and office manager. The staff, despite the rules, took this as a vacation at the employer’s expense. Shame on the employees. This breach of trust has now created an office problem and will remain as part of the employees’ records. Trust will have to be earned back, if that is possible, and it is up to the doctor and the office manager.

Taylor K.
Ellington, CT

1. Yes, it would be appropriate to subtract the daily rate for missed courses. The staff was being paid for the hours they were attending the conference/expo, so why would they be paid for not going? Especially considering typically you pay per credit hour, so not only would the staff be paid to not be working, they were wasting money for attendance fees.
2. While it is frustrating the team didn’t attend, if they weren’t being paid for that time, there isn’t much to do for this specific issue, unless staff was told it is mandatory.
3. I would call a meeting with the doctor and the attending staff and express disappointment with what transpired. I would then explain that I will not be considering any staff members who missed courses for the next education trip. In the future, having very clear expectations of the staff will be essential.

Judy C.
Wilkes-Barre, PA

Yes, the doctor should hold the staff members accountable. Rather than docking their pay, it should be considered during their annual review process and the costs reflected in any resultant pay increase. I also believe there should be a written agreement between the doctor and any staff members attending a conference stipulating what will be required during the event. I would hope that any staff members offered this opportunity would jump at the chance. I know I would have.

Pam P.
Downers Grove, IL

It’s disappointing when a staff member does not value an opportunity like this! However, without expectations set prior to the trip, I don’t know that it would be fair to not pay for something promised. Spelling out expectations and letting staff select classes that might interest them, or covering CE requirements if they are certified, would give staff the ability to decide if they could meet the doctor’s expectations. Additionally, it should have been noted that any missed classes/days/activities that are required (and most likely already paid for) would result in a reduction of any reimbursement or pay. Working together as a team to cover any aspects of the meeting the doctor needed information about would have benefited all. But the girls all missing the meeting Liz had asked them to attend at the end of the first day could have derailed plans for the following days and was blatantly disrespectful to Liz. Action might be considered in that respect. The staff acted irresponsibly.

Martha D.
Wheatfield, IN

I definitely think he should subtract some of the hours for the ones who didn’t attend their classes. They didn’t live up to their part of the bargain. If he does send anyone next time, I would draw up paperwork specifically letting them know what is expected of them and what is expected of the doctor and have everyone sign. That way, when they come back afterwards and the doctor goes over the conference with them, all parties will be held accountable. If I was the doctor, I would have been really upset with my staff; they were chosen to go and all they did was play around.

Dennis I.
Monroe, CT

The doctor should have laid out all expectations and consequences prior to the meeting. This way, if someone didn’t fulfill their duty, there would be no questions regarding consequences. The staff manager should not only have made sure the staff met for an appropriate meeting, but also allowed for free time. Because the doctor and manager did not lay out their expectations, the only consequence should be that the individuals do not qualify for another trip.

Rigo L.
Indio, CA

This is funny, and at the same time sad but true. The staff should be held accountable for this. There is no reason why the doctor has to pay/lose for their staff to party. The staff should be ashamed, but I understand how things got out of hand. I give props to the manager for not trying to babysit her staff. I would subtract their pay — they would understand why. They need to understand that this is not acceptable. If they get bonuses, I would consider skipping them or cutting them significantly. I would also consider a write-up as well. As for the following year, I would still send staff but not those same staff ever again. There is no room for immature staff.

What’s the Brain Squad?

If you’re the owner or top manager of a U.S. eyecare business serving the public, you’re invited to join the INVISION Brain Squad. By taking one five-minute quiz a month, you can get a free t-shirt, be featured prominently in this magazine, and make your voice heard on key issues affecting eyecare professionals. Good deal, right? Sign up here.

Continue Reading

Real Deal

Ever Feel Like Your Billing Policy Is Backfiring?

This practice does. How can it get back on track?

mm

Published

on

IN FOCUS VISION CARE, a private practice in Olive Branch, MS, was adding a new billing manager to the office. Sean had four years of experience submitting optometry claims and 12 years billing for a physical therapist; this would be his first position as a supervisor. Erin was office manager and spent a lot of time training Sean during his first few weeks. After lunch on his third day, Erin brought Sean to the conference table and spread out several documents.

ABOUT REAL DEAL

Real Deal scenarios are inspired by true stories but are changed to sharpen the dilemmas involved and should not be confused with real people or places. Responses are peer-sourced opinions and are not a substitute for professional legal advice. Please contact your attorney if you have any questions about an employee or customer situation in your own business.

ABOUT THE AUTHOR

NATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at info@meredithoptical.com

“I’ve delayed going over Medicare but I think it’s time,” Erin began. “We made a decision that doesn’t really seem to be panning out for us, so you and I need to work with the doctors to edit our protocol.”

Sean was intrigued. “I’ve always known Medicare to be straight-forward. What’s happening?”

Erin pulled one of the documents toward Sean: an EHR-generated pie chart. “As I mentioned earlier, 44% of our comprehensive exams in the last five years have been Medicare exams. Eighteen months ago we saw a major increase in Replacement plans.”

Sean nodded. “Right, patients on Medicare can buy a hardware benefit. I’ve seen this advertised on television.”

“Well, the plans these patients pay for also include a well-visit.”

“The doctor I used to work for always sent the exam to Medicare. I understand these plans to be for optometrists to ‘identify – don’t treat.’ Elderly patients usually have a medical diagnosis and require actual care.”

“I agree with you. Their comprehensive exams are, on average, too complex to bill to these kinds of plans — not to mention the significant difference in reimbursement!”

“So what’s the issue?” Sean asked.

“Several patients complained, first to our doctors and then to me, that they wanted to use the services they had purchased. Most of the patients I spoke to were in their early 60s and relatively new to Medicare. One patient even went to our local newspaper and got a reporter involved. ‘Potentially deceptive practices.’ We were pushed into the spotlight.” She sighed, pulling the newspaper clipping out of the pile towards Sean. “We did what we thought was best at the time: the doctors only do a refraction and the minimum level required for the Replacement plan, delay all patient counseling and education, then schedule a comprehensive visit using Medicare for a few weeks later.”

Sean nodded. “That sounds reasonable. The patient uses both plans and I imagine at the second exam you skip the refraction and only collect the 20% co-insurance?”

“Yes, but the problem is most patients are no-showing to those exams, or canceling last minute and never rescheduling. We’re now seeing these initial patients pass the 12-month mark and call to book again. One doctor believes as long as we document carefully and have a signed consent that each patient understands the difference between the well-visit and a comprehensive exam, it’s the patient’s right to select their level of care. The other doctor told me she plans to refuse well-visits for patients who skipped their Medicare-level exams last year, because she doesn’t think a piece of paper will protect us from the consequences of subpar health care.”

Sean drummed his fingers on the table. “I think I need to do a little research before bringing my professional recommendation to the doctors,” he said.

The Big Questions

  • How would you have solved this dilemma if it was your practice criticized in a newspaper?
  • If your parent/grandparent was a patient at this practice and wanted to use a Medicare Replacement plan, which doctor would you side with?
  • Would your own protocol be affected if your Medicare base was only 10%? How about 80%?

Real Deal Responses

John M.Victoria, TX

I recommend the practice stop participating in the Medicare advantage plan and see patients that have regular Medicare.

Nina C.North Chesterfield, VA

This is hard. I would like to do the wellness on the vision plan, but Medicare patients have more complex ocular situations than most. We have a large Medicare group. Most will not return for the Medicare exam and liability is such that I cannot give a “lesser vision exam.” We tell patients when making the appointment and again on checking in that we are Medicare providers and will be filing Medicare. We will be collecting refraction fees unless the patient has a vision plan that coordinates benefits to cover refraction. We can use their material benefit towards glasses or CLs. Those who disagree never make an appointment or leave. If the optometrist was to forsake filing Medicare, we would soon be dropped as physician providers.

Rigo L.Indio, CA

Newspaper! Who reads a newspaper nowadays? Anyways, it could have been worse with social media or TV. Patients with Medicare usually require extra time and visits and they think Medicare works the same everywhere. I have seen offices take Replacement plans with Medicare only if they have a vision insurance plan and refer out for medical exam or not take Medicare at all if it’s a Replacement plan. Well visits don’t do much for a patient and most of the time they need comprehensive exams or medical during an office visit. That being said, I would change protocol for the Medicare patients to only see them for comprehensive or office visits. I make that clear when the appointment is made. Having a good relationship with MDs and co-managing patients works best.

Maureen G.Oak Park, IL

I see the problem as one of a lack of educating the patient. Our office sees maybe 10 percent Medicare patients, but the doctor takes time to explain so the patient understands the importance of the medical visit. We have few if any patients that do not schedule a medical visit. And it has to be the doctors doing the explaining, not a manager or technician. Patients will listen to a doctor more than anyone else.

What’s the Brain Squad?

If you’re the owner or top manager of a U.S. eyecare business serving the public, you’re invited to join the INVISION Brain Squad. By taking one five-minute quiz a month, you can get a free t-shirt, be featured prominently in this magazine, and make your voice heard on key issues affecting eyecare professionals. Good deal, right? Sign up here.

Continue Reading

Real Deal

A Sublease Eye Doc Didn’t Work Out

Should the optician/owner pursue their non-compete?

mm

Published

on

ROXANNE WAS AT HER desk on a Sunday afternoon reviewing bills and rubbing at stress hives on her neck. The optician-owner of a gorgeous boutique near Sioux Falls, Roxanne was at her wits’ end with her sub-leaser, Dr. King. The women had a meeting scheduled to try to resolve their differences.

ABOUT REAL DEAL

Real Deal scenarios are inspired by true stories but are changed to sharpen the dilemmas involved and should not be confused with real people or places. Responses are peer-sourced opinions and are not a substitute for professional legal advice. Please contact your attorney if you have any questions about an employee or customer situation in your own business.

ABOUT THE AUTHOR

NATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at info@meredithoptical.com

The pair met the previous year at a CE event and hit it off. Dr. King, a stay-at-home parent of several years, was inspired to return to work part time, and Roxanne was inspired to offer eye exams to her loyal client base. They created a two-year contract including a non-compete clause limiting Dr. King from practicing within 3 miles of her office within a year of contract termination, on penalty of several thousand dollars. Once the commitment was made, Roxanne retrofitted storage space into an exam lane and purchased second-hand equipment.

Roxanne, waiting impatiently, now ran through the details in her mind to prepare for a contentious discussion. The terms of their agreement were 8-10 comprehensive exams in 4 hours for a flat rent. Patients scheduled with Dr. King directly so she could book around her family commitments. She billed and collected all exam fees, while Roxanne’s employees pretested, collected co-pays, and processed contact lens orders.

For a few months everything went well. Then the financial disagreements began: Dr. King started scheduling just 2-3 patients a day and decided it would be fair to only pay rent every second or third week. Payments on the equipment leases were now greater than the rent. Roxanne was also seeing lots of shipping charges for contact lens trial orders, which Dr. King felt were the responsibility of the business as they profited from supply sales.

The front door squeaked and a moment later Dr. King sat down at Roxanne’s desk. She looked worn but resolute. “I know you called this meeting,” she began, “but I’d like to speak first.”

Roxanne nodded and pushed her paperwork to the side. “Okay, I’m ready.”

“I’ve given it a lot of thought, and I just don’t think this is a good fit for me,” said Dr. King. “I’m tendering my resignation, effective 2 weeks out. I don’t have any patients booked past then anyway.”

Roxanne’s eyes bugged. “You’re quitting?!” she managed to get out, throwing her head back and staring at the ceiling. “You’re quitting.”

“This just isn’t fun for me,” she continued. “I don’t like your stress towards me, and I feel like I’m being nickel-and-dimed.”

“Are you leaving to go work somewhere else?” asked Roxanne.

“No, my wife and I don’t rely on my income,” she said.

Roxanne sighed. “Well, it sounds like your mind is made up. It stinks we weren’t able to resolve things, but … I get it.” As soon as Dr. King left, Roxanne got to work posting the job vacancy online.

A few weeks after Dr. King’s last day, Roxanne’s lab tech stopped her in the hallway. “I just heard through the grapevine, Dr. King is seeing patients over at Family Vision Center,” he whispered. Exasperated, Roxanne thanked him and went to call her lawyer about enforcing the non-compete clause. Family Vision Center was less than 2 miles away!

The Big Questions

  • In what way could Roxanne and Dr. King have changed their agreement to mutually improve the situation?
  • If Dr. King bills for a contact lens fitting and the boutique bills for the supply, who pays the shipping and handling of trial lenses?
  • Is a non-compete clause justified for a sublease doctor? If the lawyer deems the contract enforceable, would you pursue?

Expanded Real Deal Responses

Andy H.
Jacksboro, TN

This scenario poses a significant problem for the optician/owner. I’m not sure how I’d resolve this situation, but it could’ve been avoided if a reputable business consultant had designed the contract. A professional consultant would have covered all the disputed variables. I think it’s interesting that a recent INVISION survey showed a mere one in four ECPs use consultants, and this Real Deal demonstrates the need to do just that. We’re all pretty smart about eyes, but not many of us can claim to be experts in business.

Chris G.
Inver Grove Heights, MN

First, I didn’t see a copy of the non-compete document. Some of these documents are unenforceable depending on the laws in the state where this occurred. Second, all costs should be negotiated at the beginning of the employment. Third, even if a lawyer deems the contract enforceable, it can still be nullified by a myriad of other factors. Having said this, if all the contingencies are met in the agreement and it is enforceable, I would go after it immediately. Another part is who owns the files in the office. That should be negotiated as well.

Bill K.
Houston, Tx

Bad terms of agreement upfront. Starts bad, ends bad.
1. More concrete terms and understanding.
2. Cost of trials? Ever hear of fitting sets?
3. Non-compete should hold up if written correctly.
Not a bunch of 2-year-olds at play. Grow up and live up to your commitments. “I don’t feel like I am respected.” Blah blah blah.

Anna T.
Claremont, CA

First of all, they should have spoken more about what was expected from the lease. Possibly going through a broker to have a legal agreement prepared with terms stating that the lease was to be paid every week and that X amount of patients were expected per week. Also, they should have agreed upon the costs of the lenses, and who was paying for shipping charges in the agreement. Ultimately, I think that the doctor just did not have the right work ethic for this sort of collaboration. I think that the doctor’s fees should cover the trial shipping costs. I believe the non-compete is justified. However, since this doctor did not spend very much time working at the location, I am not sure that she would be much competition if she were to set up office in a nearby location. Most likely with her work ethic she would not be much of a business owner in the future.

Rigo L.
Indio, CA

Ohh, the drama! It’s always easier to blame the other person. Both Roxanne and Dr. King gave up too soon; communication is key. It was unprofessional for Dr. King to quit. It’s not expected but the doctor should feel heavily responsible — in this case it looks like it was all business. The shipping and other stuff could have been worked out if both were willing to keep to their agreement; at the end of the day they still made a profit. As far as pursuing the non-compete clause, it sounds exhausting, expensive and time-consuming, but if this is going to save my business, I would go ahead with it.

Darrell L.
Goodlettsville, TN

The contract should have spelled out the particulars of fees, bills and supplies. Leaving things open-ended always creates problems. The non-compete is justified and was agreed to in writing, therefore it is binding. If the tables were turned, the doctor would likely pursue reimbursement for damages from the optician.

Frank U.
Bakersfield, CA

No lawyer; lesson learned, find another doctor.

Wilfredo M.
Philadelphia, PA

Unless Roxanne and the doctor agreed to bringing another doctor to work more hours, I don’t see how. Two or three exams a day doesn’t justify the expense of equipment, or cutting the space to put in an exam room.

The optical should pay for shipping for trials, but also keep in mind that for trials at least a commitment for the sale of the contacts should be engaged, or an order for glasses should be placed — and then seen as a courtesy from the optical, not from the doctor.

Whatever is the right and legal thing to do. If the income was not the issue based on Dr. King’s answer, why work in a place that close? People should not be allowed to conduct a market study while working with you and then become your competition! Keep in mind that patients are the “property” of the doctor, who did the billing.

What’s the Brain Squad?

If you’re the owner or top manager of a U.S. eyecare business serving the public, you’re invited to join the INVISION Brain Squad. By taking one five-minute quiz a month, you can get a free t-shirt, be featured prominently in this magazine, and make your voice heard on key issues affecting eyecare professionals. Good deal, right? Sign up here.

Continue Reading

Advertisement

Advertisement

Advertisement

Most Popular