Physician Contracting at Small and Rural Hospitals
•
2 likes•440 views
In this webinar we discuss discuss the unique physician contracting and compliance considerations facing small and rural hospitals. We will cover: - Key considerations for physician contracting at small and rural hospitals - Spending trends in compensation at these facilities - Strategies for managing your contracting and compliance program - And more!
Recommended
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Physician Contracting at Small and Rural Hospitals
Similar to Physician Contracting at Small and Rural Hospitals (20)
More from MD Ranger, Inc.
More from MD Ranger, Inc. (18)
Recently uploaded
Recently uploaded (20)
Physician Contracting at Small and Rural Hospitals
- 1. 1 PHYSICIAN CONTRACTING AT SMALL AND RURAL HOSPITALS JANUARY 2019
- 2. Allison Pullins • 6+ years on the leadership team at MD Ranger • Worked with hundreds of hospitals across the US • Loves helping MD Ranger subscribers with physician contracting challenges, black coffee, and Fraiser re-runs 2 Your host
- 3. It’s a personal connection 3
- 4. • Key considerations for physician contracting at small and rural hospitals • Spending trends • Strategies for managing your contracting and compliance program • …and a bit about us at MD Ranger Today’s agenda 4
- 6. • Low patient volume • Poor payor mix • Remote geographic location • Modest budgets • Need for outside expertise and creative solutions for limited resources 6 Unique challenges at small & rural hospitals
- 7. • Workforce recruitment and retention very difficult • Limited and often aging medical staff • Frequently need to supplement physician income for services that can successfully bill and collect in busier facilities • More dependent on locums, telemedicine and paying physicians to staff clinics or coverage 7 Unique physician challenges, too
- 8. 8 Cost issues Physician expenses can be a large part of the budget if subsidies are high. Negotiating ability may be limited when physician resources are scarce. Documenting FMV important given Stark and OIG focus, but many surveys don’t address realities of small hospitals.
- 9. 9 Volumes lower Fewer total contracts to manage and negotiate means less time and energy spent on ”contracting tedium”… …however, this also means that a dedicated contracting resource is unlikely. …and documenting FMV can get expensive
- 10. 10 Small can be nimble Ability to innovate quickly and streamline processes means that you can create a simple, easy physician contracting process and implement today.
- 11. Telemedicine: a great opportunity Telemedicine arrangements are becoming more available as hospitals, physicians and technology evolve Rural hospitals can leverage telemedicine for significant gains in access and cost efficiency Brings services and responsiveness to your community
- 13. 13 Small hospitals on average pay less for ED call $- $200 $400 $600 $800 $1,000 $1,200 $1,400 $1,600 $1,800 $2,000 25th 50th 75th 90th PerDiemRate Percentile Call Coverage Per Diems by Hospital Bed Size Under 100 100 to 300 More than 300 Source: MD Ranger, Inc.
- 14. 14 Medical directorships less costly $- $20,000 $40,000 $60,000 $80,000 $100,000 $120,000 $140,000 25th 50th 75th 90th AnnualPaymentRate Percentile Medical Direction Annual Payment by Hospital Bed Size Under 100 100 to 300 More than 300 Source: MD Ranger, Inc.
- 15. 15 Overall spending smaller, yet still painful $- $5,000,000 $10,000,000 $15,000,000 $20,000,000 $25,000,000 25th 50th 75th 90th TotalFacilitySpending Percentile Total Facility Spending on Non-Employed Physician Contracts by Hospital Bed Size Under 100 100 to 300 More than 300 Source: MD Ranger, Inc.
- 16. 16 A case study of spending ED Call 49% Directorships 11% Leadership/Admin 18% Hospital-based Stipends 22% TOTAL SPEND ($2,150,000 PER YEAR)
- 17. 17 Most common contracts in small hospitals • Direction & Leadership: • Chief of staff/VPMA • Pathology • Coverage • General surgery • Orthopedics • OB/GYN • Pediatrics • Neurology/Stroke • Clinic rates • Hourly/daily rates • Telemedicine
- 19. 19 Process and policies are key • You must create a standard physician contracting and documentation process • It doesn’t have to be fancy • It doesn’t need to have many resources • Consistency is crucial
- 20. Some quick advice • The simplest thing to do is use market data as the foundation of your process. • Determine what payment ranges fit the profile of your organization best, and stick to those ranges in most circumstances • Outline your workflow; it should look something like this: • Check commercial reasonableness • Review contract’s scope of services • Identify benchmarks for the service • Select your rate or acceptable range • Negotiate • Document!
- 21. 21 Use benchmarks that meet your needs • Employment data • Hospital-based data • Telemedicine rates • Clinical hourly rates • Direction, call and leadership rates
- 22. 22 Setting the appropriate payment range • Best practice organizations use their ”profile” to determine where on the market ranges the vast majority of their agreements should fall • Typical thresholds are either at the median or the 75th percentile • Use MD Ranger’s new “Small Hospital Benchmark”
- 23. Determine sign-off process and timeline • Who is responsible for determining and documenting FMV at your organization? • When is supporting documentation reviewed and approved? • Who is the responsible executive for sign off? • How often does your board review contract rates and compliance?
- 24. Be thoughtful with exceptional agreements • Document valid reasons why your organization would consider a rate above your interval standard • Determine what supporting records and documentation are needed to qualify for an exception • FMV opinions are typically needed and advised for complex, expensive arrangements
- 25. 25 Summarizing your toolkit • Board-approved policies and procedures help mitigate risk • Apply consistent standards and processes • Use a recognized, stable source of market benchmarks • Standardize documentation • Maintain contemporaneous inventory of contracts – and knowledge of how they compare
- 27. 27 300+ Physician Benchmarks • Call coverage rates • Medical direction payments • Administrative and leadership • Hospital-based service stipends • Diagnostic testing, etc. • Clinic & hourly rates • Telemedicine rates Online Platform • Benchmark lookups • Contract proposal tools • Contract reports by facility and service • Total facility costs + benchmarks Research and Support • Resources for education and training • On-call experts to help subscribers use benchmarks and tools Compliance Documentation • Contract-specific FMV documentation reports • Reports to assist with real-time monitoring and annual reviews Our platform
- 28. 28 Standardize processes and rates Document FMV Access 300+ payment benchmarks Review and monitor contracts Have data- driven physician negotiations Mitigate compliance risks The foundation of your contracting process
- 29. 29 Our database
- 30. 30 • Call Coverage (55+) • Medical direction (85+) • Hospital-based services (20+) • Administrative (12+) • Medical Staff Leadership • Diagnostic/other services e.g. ROP, autopsy, dialysis • Hospital-based stipends • Clinics, professional services • Telemedicine • Residency/teaching/GME • Uncompensated care • Meeting attendance, peer review, IT/EHR and quality initiatives • 13 Pediatric services, with more emerging each year Hospital-characteristics drill down for ADC, bed size, trauma status, urban/rural, stroke centers, and more. Our benchmarks Used in such diverse settings as academic medical centers, integrated delivery systems, and critical access facilities nationwide
- 31. • Unique scope of benchmarks • Hospital characteristics • Providers vs. facilities • Thorough data audits • Physician contract experts on-call to review/advise on challenging contracts 31 Standing out from the crowd
- 32. 32 Do you need to know what other small hospitals pay non-salaried community physicians? Are you resource-constrained? Do you feel like your organization has risky agreements? Reach out: apullins@mdranger.com or 650- 692-8873 Need help?