Navigating Physician Contracts with Ease

Editor's Notes

• #2: Hi everyone thank you for joining us today for our educational webinar on physician contracts and physician contracting programs. I’m Allison Pullins, CMO at MD Ranger, and it’s my pleasure to host today webinar. I think we can all agree that physician contract compliance can be difficult work. The good news is: there are best practices you can use to make your job a little bit easier. A couple of housekeeping items. First, my colleague Julia Ogburn is on the line to help with any incoming questions or comments. If you have any, please feel free to type them into your GTW console. If Julia is unable to follow up with you during the webinar, she will return your message by email or phone very soon. If you have feedback or questions to share with me, I will show my contact information at the end of the webinar so we can be in touch. I’d love to hear from you. Lastly, we will send everyone a copy of the presentation by the end of the week and we’ll make a video available within a week too. I also hope it goes without saying that MD Ranger experts are always available for questions or for a chat. Especially if you have follow up questions after the webinar today, I encourage you to send me an email or give me a call.
• #3: First I’m going to share some information about who we are and what we do at MD Ranger, in particular because we do have some people who are new to MD Ranger on the line with us today. Then we’ll cover a handful of the challenges that most organizations face when it comes to physician contracting. Then, we’ll talk about the key elements of all physician contracting programs. Even though each organization might take a different approach to designing a physician contracting program that works for them, there are most definitely some elements that you won’t want to be without. Then, we’ll talk about some very practical, tactical best practices for managing your physician contracting program. Lastly, we’ll cover some of the very best tools to facilitate communication and workflow in physician contracting programs. Let’s dive in!
• #4: MD Ranger is an online platform that integrates over 250 proprietary physician compensation benchmarks with a suite of compliance and financial tools. Our platform includes features like A secure, web-based Contract Data Tool to collect and organize contracts Analytics to benchmark contracts, review expenditures, identify compliance issues, and compare facilities Cost and compliance reports to compare your contracts to MD Ranger benchmarks Resources and research to support compliance efforts And Support from experts in physician compensation, FMV documentation, and compliance
• #5: we aim to be the foundation of their physician contract compliance programs, all in an integrated platform. MD Ranger helps subscribers standardize their physician contracting process in the way that is best for their organization. Because our benchmarks and online platforms can be integrated into all types of compliance and legal processes, we can be a resource to all types of organizations. . These types of financial arrangements can be very risky to organizations and to physicians—given federal regulations and hightened scrunity by the government. Our subscribers use the MD Ranger platform to mitigate that risk and monitor risky arrangements.
• #6: We began producing benchmarks in 2009 have have grown from a database of 4,000 to 24,000 contracts since. MD Ranger has more than 225 participating healthcare organizations. We work with all types of facilities from large urban trauma centers to small, rural critical access facilities and everything in between. This is a map of our subscribers and where our data comes from.
• #7: Here is a comprehensive list of the types of different physician agreements we benchmark. We easily outpace competitors when it comes to the scope of our call coverage and medical direction benchmarks, with over 55 and over 85 services, respectively. We have a solid set of hospital-based services, benchmarking stipend level payment as well as other service-specific metrics. We also benchmark a number of difficult to find positions for administrative services and medical staff leadership, in addition to our diagnostic tests and clinical professional services. Throughout our benchmarks we offer 13 pediatric services, more than any of our closest competitors. We’ll take a closer look at these in just a moment. We drill down all our benchmarks by meaningful hospital demographics, like hospital size, trauma status, and more.
• #8: We have some key differences in our approach and methodology that I wanted to share. First of all, when it comes to sample size and reporting benchmarks, we take a more conservative approach. ATSZ guidelines require that a minimum of five providers be included to publish a compensation benchmark. While some surveys interpret the word provider to mean physician, we interpret it to mean hospital owner or corporation—not physician or even hospital! This ensures that our sample size has enough data to produce meaningful benchmarks. Instead of collecting data from physicians themselves, we get our data from hospitals and healthcare organizations contracting with doctors for services. We feel this approach is more reliable, especially when it comes to reporting annual hours. Not only do we thoroughly audit our data every year by reviewing line by line all new contracts coming into our database, we also have contracting experts on call and ready to answer our subscribers’ questions. We also produce benchmarks on total hospital spending so that you can benchmark your organization’s performance against others like you.
• #9: And for those of you new to our webinars, here’s me your host. My career has been focused on the hospital/physician relationship
• #10: Let’s dive in my summing up some of the big challenges that hospitals and healthcare organizations face within physician contracting.
• #11: First of all, physician contract decisions take a lot of strategic thinking. Beyond merely contracting with groups and setting payment rates, organizations must think of how the relationship might impact the organization overall. We believe it is important to ensure your financial relationships with physician align with your organization’s overall goals. You may think of your goals in several types of categories. One are clinical and quality goals—key. Second are financial and operational goals either your leadership or your board have set for you. Making sure that you are on the same page re: physician alignment is also critical as you take a hard look at physician arrangements. Having discussions with both physicians and administrators on all of these points is best practice.
• #12: Don’t forget how many players are involved in physician contracting. The volume of parties alone should signal that first, discussions will happen…and second, there will be many of them. Ensuring proper buy in from key stake holders must happen in order for contracts to get negotiated and signed off—and given the amount of stakeholders in these types of agreements you should anticipate many conversations.
• #13: There are also a high volume of contracts involved. Even at super small organizations, there are usually between 20-50 different contracts, some with overlapping physicians. In larger organization, the volume of agreements can be exponentially more. High volumes of contracts mean lots of internal coordination, and anywhere you need to be coordinated you need to be talking.
• #14: Ensuring you have conversations at a macro level about your organization, like total spending or overall compliance risk, is very important. If you haven’t discussed how much you are spending across these various types of arrangements or at least how you might go about finding this information, you are missing out on a huge opportunity to be more streamlined AND you could be overlooking potential compliance risks. Not only should you be monitoring total physician spend, it is impossible to determine if the amount you are spending is appropriate without reliable benchmarking of how an organization of your size should be looking at its financial commitments in this space.
• #15: Though many things do stand in your way, it is possible to create a physician contracting program that works for your organization and will help you and your colleges deal with these challenges appropriately and effectively. Let’s talk about the five key elements of all successful physician contracting programs.
• #16: Because each organization is different, there are hundreds of ways to operationalize a well functioning team—however, incorporating these areas is important and missing even one will have less than optimal results. Now, I’ll go through each one by one and at a high level, share some thoughts from our expert team.
• #17: Having an accountable leader for physician compliance is essential. We’ve seen many different executives take on this role, from the CEO to the Compliance Officer or General Counsel. It will depend on your organization, but a compliance background or legal background is quite helpful. Make sure the executive is empowered to make decisions and run her team. The buck stops with her All exceptions for contracts go through her Rates are set with her guidance The daily physician contracting director/manager reports directly to this person (ideally) If your organization has some sort of larger compliance committee, involve them in the physician contract piece quarterly or half-yearly; whatever makes the most sense for your organization.
• #18: Contract management is absolutely foundational for a well-run program. Though these items may seem like obvious parts of contract management, it’s the consistent application of them that is difficult for many organizations. Make sure that you have a contract for all financial arrangements with physicians—even small ones. Keep your contracts organized either in a CRM or a homegrown system of your own is essential. You’ll want to set up a process to alert your team of expiring arrangements 3-6 months in advance, and perhaps longer for more complex agreements that could have a challenging negotiation. You’ll also want to formalize a renewal process internally, and document it step by step. Not only will this help with staff transitions you’ll experience, but it will get you as close to automating the process as you can.
• #19: Financial oversight is obviously quite important when we’re talking about physician contracts. Some key questions to ask yourself about the financial health of your program are Commercial reasonableness—it’s important to put checks into place to establish if your physician contracts on an individual level are commercially reasonable. You also want to discuss the most appropriate benchmark guide for your agreements. Within fair market value, what particular benchmark will you aim for at your organization? Another great way to check the overall financial health of your finances in physician contracting is to compare yourself to like organizations in terms of physician contracting spend. Do you spend a normal amount on physician call pay? MD Ranger publishes facility total benchmarks for subscribers so that they can use these numbers as a guide for budgeting, planning, and more.
• #20: Compliance management is obviously a huge part of your program, given that one of your central aims should be to have each physician contract compliant with federal regulations. Some tips we have for your team: -educate. Make sure everyone is up to speed on Stark law, the Anti-Kickback statute, and the false claims act. -It’s also important to educate what “fair market value” means, particularly as it’s defined by Stark. -It’s important that you create a process that is consistent for determining FMV -Lastly, but perhaps most importantly, compliance management includes how you are going to document the work you’ve put into determining that a physician rate or agreement is fair market value. This is important if your organization is audited.
• #21: The last essential element of all physician contract compliance programs is to figure out how you are going to determine FMV. Discuss what’s best for your organization Research various approaches (pros and cons) Document your organization’s philosophy and approach to FMV Record step by step the process you’ll use to document FMV You’ll want to ensure that you define your process in what I’ll call a foundational document, which records and documents how you’ll reach these decisions fairly and objectively.
• #22: What’s some practical advice to get you started off on the right foot? Let’s talk about some of these best practices now.
• #23: You’ll want to have a document that very thoroughly outline what your program’s processes are. The things you’ll absolutely want to mention are the steps your organization will take to ensure compliance for all physician financial arrangements and the safeguards you’ll put into place to ensure it. You’ll want to talk about the accountable executive, who is involved day to day and what their responsibilities are, what your program’s strategic goals are, what the actual FMV process is at your organization, and how you will handle agreements that go outside the norm at your organization.
• #24: A quick thought about creating these guidelines and structure to your program. We think it’s important to point out that you won’t facilitate open communication if your procedures don’t build it into the process itself. Build in communication guidelines, decide what events trigger alerts and to whom they go to, and ultimately use technology to facilitate and track these conversations. Don’t worry—we’ll talk about some of these tools later.
• #25: What good is a plan without someone telling you what it is? Communicating your intentions and plan is so important because you’ll need all the individuals involved at your organization to be on board and fully compliant with all parts of the plan. This is also helpful for transparency at your organization.
• #26: So it’s very important that your physician contracting program have and use a contract management system. There are so many options when it comes to selecting a vendor. Some questions to ask yourself and your team during the evaluation process are things like, what features are must have and which ones are nice to have. Another good question is what level of customization do you need, and would you like to be able to change the format of your database quickly and internally. Will you need all your contracts scanned or do you already have electronic copies waiting for a home? What features and add on’s do you need to have, for example, do you want a physician time tracking module that integrates into your CRM? These are just a few of the questions you’ll want to answer.
• #27: It’s best practice to have a contract for every physician arrangement in place. Don’t forget those services like chief of staff, medical staff positions, payments for attending or chairing meetings, and even non-monetary compensation. Though it’s no longer a technical violation of Stark law not to have a formal agreement in place it is still best practice to have a contract for each and every service.
• #28: Have a system for handling renewals, and make it a machine. There’s a lot of detail involved in renewal, so make sure you allow plenty of time into this process.
• #29: Set how you’ll get appropriate rates and do so consistently. You’ll want to consider cost, effenciency, and your organization’s culture. What is most realistic for your organization? Consider the scale you’ll be dealing with.
• #30: We’re huge fans of consistency at MD Ranger, and we feel that internal documents should be no different than external documents in terms of standards. Having a streamlined report to facilitate internal discussions about contracts and keeping them similar to each other I promise will make your job easier. In fact, MD Ranger subscribers can use the portal to create these streamlined reports instantly.
• #31: In addition to a standard renewal process, you’ll want to consider how you will handle exceptions in advance. There will be a handful of situations you’ll encounter that might be difficult contracts, services, or something tricky that makes the situation unique or need a more nuanced approach. Setting limits in advance and details on who signs off on exceptions is really important. If you can, consider ways that you can discourage exceptions through the ways you set up your exception process.
• #32: You don’t want to be in a position where you are scrambling a month away from when an important contract expires. Plan this in advance. This also includes flagging multiple deals with one doctor. It’s important to view these payments in aggregate to avoid issues with contract stacking.
• #33: We think it’s extremely important to understand, at a macro level, the impact of your physician contracting program on your organization financially. Sadly, this is not a number that the vast majority of organizations know. It’s important to know how many arrangements you have with doctors. How much you’re spending on these arrangements, in total. It’s also important to make sure you don’t have too many medical directors that you’re paying at your organization. MD Ranger has benchmarks to help organizations understand where they compare to their peers in all these areas. For example, the average hospital in our database spend around 3 million dollars a year on call coverage, but if you’re a trauma center, expect to spend a lot more.
• #34: As leaders, it is important to ensure that your team is 100% clear on who is responsible for what and the timeline in which they are expected to do their jobs. Contract negotiations, even the simple ones, take multiple steps and involve multipe parties. Don’t complicate matters by making your internal processes and roles unclear
• #35: Another good best practice to facilitate communication among your contracting team are quick check in’s about contracts up for neogitation. It doesn’t have to be fancy or ellaborate--in fact, we think the simplier, the better. We recommend keeping the agenda consistent from quarter to quarter, making sure you revisit minutes each meeting so that things don’t go unchecked, and recap at the end of each meeting with concrete follow up’s and who is responsible for these follow ups.
• #36: Lastly, Keep accurate records of everything!
• #37: What are the best tools to facilitate these types of discussion and increase communication and coordination across your team? Let’s talk about some of those now.
• #38: Data can also facilitate communications and ensure that everyone is on the same page when it comes to selecting physician payment rates. We like benchmarks available electronically so that you can easily share between your colleagues.
• #39: The internet has made it possible to streamline communications—and trust us, there are much better options than email for communciating with your team. At MD Ranger, we use Slack to talk and keep track of our conversation histories. There are so many other options to use and take advantage of.
• #40: Project management tools are also great to use and are available as web-based tools. We prefer Trello but there are plenty of other options for project management out there.
• #41: We’re a data company, so we know firsthand that if you put garbage into your database, you get garbage out of it. Your contract management system is only as good as the information in it. Make sure that your contract management system is part of your workflow and that your team updates it religiously. If team members are not logging into this tool and using it actively, it’s not a good sign. In fact, we think it’s best practice for key members involved in this process to always have the contract management system open and active on their desktop. A good comparison is here at MD Ranger, all staff who work directly with our subscribers are expected to have our CRM up and running at all times.
• #42: Thanks for joining us today. We’re glad to have you. If you haven’t already, please sign up on our website to receive MD Ranger materials or follow us on twitter @MDRanger