Insights from Ludi

This is funny. (Well, if you are giant hospital nerd focused on broken processes, it’s funny.) Do you know what you are spending on your hospital administrative agreements with your physician partners? You have to know where they are located to start the count. You need to know your “official count” of partnerships (co management, call, employed, medical directorships to name a few.)

Who’s on first to quote Abbot and Costello…..hospital and health systems are notorious for having silos. We are witnesses to health systems acquiring other hospitals which continues to increase the silo effect and more layers of disconnect. With physician agreements, the complexity is intense and a gap for hospital operations.

Medical directorships are necessary for the effective management of patient care. However, medical directorship payments can cause headaches for hospital administrators.

Duties are most often outlined in the agreements, however because they are so complex, they become impossible to manage over time. Many agreements include duties that are paid at different rates depending on holiday, weekend or weekday hours. Some duties can be paid quarterly, while others are paid monthly. One agreement with a series of payment amounts and payment timeframes can be detrimental to making accurate payments.

Administrative physician agreements have been written for your physicians with help from your legal department or counsel. The clauses are there to be followed for numerous reasons. Perhaps it is to meet your organization’s goals with the way you align with doctors as well as for a variety of compliance reasons. Whatever the reason, it’s important to handle your physician agreements in the way they’re written, even if they’re complex. Failure to do so leaves room for incredible consequences that can affect your organization in a variety of ways.

Finding a ‘foolproof’ process to manage physician agreements can be a greater challenge than anticipated – perhaps so much so that it's often a task that’s put off within the organization. Once you make the decision to better manage physician agreements, there are a number of advantages you can expect to gain throughout the organization. Here’s a 30,000 foot view of changes you will see once you put time and energy into this problem by automating.

Physician agreements are complex with tremendous detail around how the relationship will be governed, what duties are included and how compensation will work. While most organizations are quite proficient in the setup of these agreements, few are very good at managing the complexities of the agreement after they are executed.

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.

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:

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.