Hospitals and their many contracts have long been determined as a problem to manage. Several organizations have created top-of-the-line software for hospitals to eliminate paper, wasted time, and automated preparation for those looming threats of an audit.
Hospitals need physician partnerships in nonclinical settings and activities. Many hospitals often choose physician arrangements known as “medical directorships." These arrangements designate a physician leader to be responsible for a number of activities related to the delivery of medical care and clinical services. The "activities" typically include things like cost management, utilization review, quality assurance, and medical protocol development. Medical directorships are a popular partnership vehicle to assist the hospital in necessary clinical administrative leadership. They also align their physicians as partners for smart and intuitive direction. Read on to learn what should (and shouldn't) exist in an optimal medical directorship contract.
Managing your hospital’s relationships with physicians can seem nearly impossible due to the compliance landscape that surrounds them. In order to keep your physicians happy and your hospital compliant, you need the right physician management strategies in place, beginning with the physician contract.
In September, 2015, the Department of Justice (DOJ) published the Yates Memo, a document outlining the accountability of individuals for corporate wrongdoing. This means that any individuals responsible (whether knowingly or unknowingly) for the wrongdoing are now being involved in the case where all facts of the alleged crime must be disclosed to the DOJ. Hospital executives fall into this area of accountability and since the release of the Yates Memo we are now seeing the punishment of individuals.
Physician administrative agreements are complex largely because of the challenging compliance regulations they must follow. Based on the thousands of agreements we’ve read on behalf of our clients, there is a cycle taking place where the agreements are getting more complicated as the compliance landscape becomes more rigid. This can create a series of problems when it comes to writing and managing these agreements over time. Take a read through the physician contracting errors that we’ve seen throughout agreements that can cause both short and long-term problems.
Physician contracts should, in theory, be created using templates as a best practice. The reality is that physician contracts are like snowflakes: it’s difficult to find two that are alike. In practice, having too much variation in your physician contracts can be detrimental to the organization. High level of variation can lead to operational problems while trying to execute agreements.
Ludi has had the pleasure of reading close to 7,500 physician contracts in the last three years. From this experience comes a tip sheet on how to construct the optimal physician contract.
Over the last five years, the industry has been largely focused on ensuring physicians have an Electronic Medical Record (EMR) in their private practices to capture clinical practice time. There has been a focus on capturing the work flow to collect the clinical documentation and to ensure the appropriate variables are accurate for billing. These systems are expensive and time consuming to implement.
The four top areas for regulatory risk for hospitals include: Patient privacy, coding, quality, and physician agreements. Physician agreements tend to have the most opportunity for points of failure due to the process, structure, and people involved in making sure agreements are appropriately written and managed over time.
Read through the following 5 tips and consider them a guideline to lower your risk related to physician agreements:
The regulatory environment is deep with rules governing how healthcare organizations (HCO) behave. One particularly strict law is the Stark Law, governing how HCOs interact with referring physicians. The law prevents HCOs from paying physicians unless a safe harbor is met. Assuming the HCO takes proper care in setting up this agreement, problems can still arise in how the agreement is operationally managed over time. If not followed exactly as written, the organization may fall outside the safe harbor rendering the organization in violation. Because the law is non-intent based, the OIG will not be swayed if the HCO inadvertently violates the law. Meaning, even if there is a technical violation of the law, the full wrath of the law applies.
Many hospitals have embraced the Lean Six Sigma method to collaboratively identify opportunities and reduce waste. Some hospitals even have teams that shine a laser focus on large cost savings opportunities. These projects are collaborative and can also take time and resources to manage appropriately. We have thought of a handful of ways that are rooted in the Lean approach but also take advantage of the work that has been performed by others to date. These four findings aim to improve your hospital's physician agreements and how you manage them. These could be any of the following: an employment agreement, a medical directorship, an on-call agreement, a research agreement or a teaching agreement.