Insights from Ludi

5 Steps to Lower Your Physician Agreements Compliance Risk

Posted by Gail Peace on Mar 6, 2017 8:05:00 AM

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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:

Use Templates. One way to lower risk is to develop templates for the agreements and for the setup of the agreements. For example, make sure your medical director agreements are set up using the same structure while your on-call agreements all follow the same template. Using a consistent approach based on type of agreements makes it far easier to ensure you’ve accounted for all critical components of the agreement. This can make the setup faster all while decreasing legal time and unnecessary scrutiny.

Standardize Processes. Outline a series of steps for the whole process from need identification through contract co-execution. For each new agreement you’re considering, ask yourself the same questions from a business perspective: Why do we need to add this medical director? Is it commercially reasonable? How will compensation be determined? Having a concrete business plan for evaluation will make it easier for you and your organization to measure the investment over time.

[VIDEO] Learn how you can automate the complexities of compliance 

Collect Time Logs For All Subjective Time. To clarify, objective time is any service a physician bills for spending with a patient, so any clinical work. Time spent on administrative tasks, teaching, committee work, medical directorship or other non-patient care activity should be documented with time records and is known as subjective. Collecting time for all physicians, even those who are employed is non-negotiable to stay in compliance. Subjective time is scrutinized regardless of employment status and should be regularly collected to ensure proper reporting for your organization and for the Medicare Cost Report.

Mind The Math. Payment mechanisms in each contract are complex and continue to become more so as quality is considered, shared payment models are explored and productivity is weighed into the compensation discussion. Assign senior level to be accountable for this process. Physician services, legal and finance should all be involved, however there needs to be one person who owns and checks the math every time a payment is issued. We cannot stress this enough.

Automate Wherever Possible. With the complexity of the type of math written into physician agreements and the follow up of all the steps that need to take place for physician compensation to be approved, automating is key. Any administrative support within your organization should help in reviewing that hours being worked are accurate and that the final payment is correct, but no calculators should be used, this could lead to human errors…remember, agreements must be followed exactly as written. Physician agreements carry huge compliance risks and the process should be automated during each possible step.

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Topics: physician agreements, hospital compliance