Physician Contracting for Exceptional Hospitals
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Transcript of Physician Contracting for Exceptional Hospitals
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Physician Contracting for Exceptional Hospitals A MD Ranger On-Demand Webinar
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Are you an exceptional organization?
• Trauma Center • Children’s Hospital • Academic Medical Center • Critical Access/Rural/Small Hospital • Unique geography or other circumstances • A health system with a combination of the above
If yes:
You are likely to have unique considerations and challenges when it comes to physician contracting.
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The Challenge:
• Creating a compliant, standardized and cost efficient FMV documentation process for physician contracts
• Finding resources and tools that address your organization’s unique features
• Adapting resources and processes to optimize your time, costs and documentation output throughout the negotiation and contract approval process
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Suggestions for Physician Contracting at Exceptional Organizations
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Trauma Centers • Level I and II trauma centers statistically pay significantly more
for physician services so it’s important to compare your organization to other trauma centers when determining appropriate payments
• Not only do trauma centers pay more, but they have more paid positions for a broader range of services • Call coverage may be more intensive and round-the-clock • Hospital-based services such as anesthesia may have higher demand • Uncompensated care may be a more important factor • Medical directorships may be managing more complex service interactions
• It is important to manage your overall contract spending strategically and document compliance carefully
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Children’s hospitals
• Outsourcing contracts for pediatric intensivists, pediatric surgery, neonatology, ROP and other pediatric sub-specialties are important to building market share
• Benchmarks for these contracts can be hard to find • Unique, super-star surgeons and specialists may drive high
compensation that requires strong documentation for directorship or leadership positions
• Strong market data can also support budgeting internal funds flow for faculty and affiliated physicians’ coverage and medical directorships
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Academic Medical Centers
• Community hospital partnerships for marquis program development and management are growing in strategic importance
• Outsourcing contracts for highly specialized coverage such as interventional radiology and vascular surgery can be important to building market share – and revenue
• Strong market data can also support budgeting internal funds flow for faculty and affiliated physicians’ coverage and medical directorships
• Unique, super star surgeons and other recruits may drive high compensation that requires strong documentation for directorship or leadership positions
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Critical Access, Small, and Rural Hospitals
• Providing adequate coverage for key hospital services can be a huge challenge
• Physician expenditures can be high as a percent of total hospital expenses, despite low ADC and bed capacity
• Benchmarking against large hospital and trauma centers can drive costs higher than necessary for some services
• A broader range of payment benchmarks may be helpful to address hourly rates, clinic rates, RVU-based payments, per episode payments and uncompensated care
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Diverse Health Systems
• Payment policy should be consistent across the organization which may not translate into homogenous payment rates
• Different facility characteristics often yield very different payment expectation and payment benchmarks
• A strong benchmark product with broad scope and rates for differing facility characteristics allows consistent benchmarking
• Identification of outlier facilities and opportunities for savings support is a plus
• Multi-facility contracts and appropriate adjustments for rates
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Physician Contracting Compliance for Everyone
All contracting programs should have these elements:
• Executive oversight • Strategic and tactical contract management • Financial management • Compliance management • Rigorous FMV determination and documentation
process • Routine internal audit process
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Create a standardized process that is simple and effective
• Designate an executive to oversee the process • Automate as much as possible • Ensure that analysis of contract expenditures is done
annually, if not more frequently • Determine a rigorous and straightforward way to
document FMV consistently • Define a process to address exceptions to your internal
benchmark standards
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Determine and document FMV with market data
• High-quality market data is the fastest, most straightforward way to determine and document physician payments
• Test for commercial reasonableness • Determine if there’s a match in scope of services • Find the appropriate market range and determine
payment • Document FMV • Internal review and sign-off
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Seek outside help when needed
• If there is no comparable market data or the position demands particular qualifications with exceptional pay, consider getting a valuation.
• If you must pay above the 75th percentile, make sure documentation is solid.
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If you need a comprehensive physician contracting program that works for your unique organization… We can help!
MD Ranger, Inc. 650-692-8873 [email protected]
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