Financial Best Practices for Managing Physician Contracts
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Healthcare organizations often struggle with developing processes and best practices for both the creation and the execution of physician agreements. By knowing the risks, you can avoid or correct issues before they become potential violations with serious consequences. This webinar will cover best practices healthcare leaders can use to refine their organization's compliance processes, including: --Educating staff --Determining and documenting FMV --Identifying and handling potentially risky contracts --Examples and solutions to risky situations
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Financial Best Practices for Managing Physician Contracts
- 1. Financial Best Practices for Managing Physician Contracts Commercially Reasonable Time Tracking Fair Market Value Streamline & Standardize Templates
- 2. Agenda § Introductions § Physician contract process § Financial management - from physician time logs through payments and reporting on spend § Best practices for ensuring integrity of physician arrangements that make financial sense September14,2017 2
- 3. Introducing MD Ranger § The foundation of your physician contracting program in an integrated, online platform § Access 275+ proprietary compensation benchmarks § Call coverage § Medical Direction § Hospital-based services § Diagnostics § Clinical professional services § Facility total benchmarks, percent paying, and more § Standardize FMV documentation across the organization § Audit spending § Monitor compliance 3 September14,2017
- 4. Introducing Ludi 4 § Active financial management of physician agreements § DocTime Log®: a mobile application for physicians to submit time and web-based SaaS that automates workflow § Documentation for compliance audits and reporting to CMS § Approvals of all submitted time with notes attached for audit trail § Payments for very complex physician agreements using software to track all payment rules September14,2017
- 5. PHYSICIAN CONTRACTING: BEST PRACTICES FOR SETTING UPARRANGEMENTS 5 September14,2017
- 6. Results of manual processes: 6 Expensive errors Wasted time and resources Compliance risks Spending too much money – Lost revenue opportunity September14,2017
- 7. 1. Assess commercial reasonableness § When payment is requested, never grant without analysis § If it is commercially unreasonable to pay a physician for a service in the first place, you have bigger problems than merely a high payment § Benchmarks can help you establish commercial reasonableness MD Ranger’s ”Commercial Reasonableness Toolkit” is available for download today 7 September14,2017
- 8. 2. Use market data with care q Consider sample size and participant characteristics of the survey q Who reports the data? q Where are the providers? q How are Antitrust Safety Zone Guidelines interpreted? q Is the data collected consistently and comprehensively, and is it routinely audited by experts? q Are the most helpful, relevant statistics reported? q What is the distribution of rates within the data? q Am I comparing ”apples to apples”? 8 September14,2017 Market data can be a powerful way to determine physician payment rates, but there are pitfalls to avoid.
- 9. 3. Determine payment within FMV range 9 • 75th percentile and under generally considered within “fair market value range” • It’s normal for an organization to have a small handful of agreements that exceed the 75th percentile, or even a few above the 90th percentiles • These contracts must be carefully vetted and reasons for higher payments should be justified • Paying above fair market value thresholds should be a rare occurrence, not standard! September14,2017
- 10. 4. Standardize your process! 1. Test for commercial reasonableness 2. Find benchmarks with appropriate sample sizes 3. Determine if scope of services is a good match 4. Find best payments within the market ranges (your organization should have a policy about this; if not, create one) 5. Negotiate payment with the physician or group 6. Document FMV! 10 September14,2017
- 12. 12 Paper-based documentation is often lacking necessary details to be compliant and be paid correctly LEGAL CONTRACT MGMT DUTIES FAIR MARKET VALUE TERMS Physicians want to get paid quickly September14,2017
- 13. 13 Software solves the gaps in current manual systems PaymentApprovalsDocumentation Automation ensures each step in the process is checked – Improves visibility to the expenditure September14,2017
- 14. 1. Physicians submit time § Mobile platform key to use § Select a duty that is compensable – always in contract § Physician sent reminders § Contract is active § Month is within time constraints § Only one log per period § Respects physician time § Transparent for physicians September14,2017
- 15. Monitor total payments Access to actual contract Rules of the contract are followed with software 2. Staff approve with easy access to financial and contract terms
- 16. 16 1 Software does the math and calculates contract limits 2 Physician always submits a duty that is part of the contract 3 Reminded to submit time, locked out after time allowed 4 Approvals are made, specific to each contract, time stamped 5 Smooth handoff to finance for payment 6 Improved internal and Cost Reporting 3. Software confirms all contract details September14,2017
- 17. Time Log Automation Financial Reporting 4. Ensures capture of all GME and admin time for the CMS cost report
- 18. 5 BEST PRACTICES FOR ACTIVE MANAGEMENT 18 September14,2017
- 19. 1. Remove Steps That Don’t Add Value 19 September14,2017
- 20. 2. Collect Time Logs for All Compensable Duties
- 21. 3. Standardize and Streamline Duties 21 § Ensure that the service line adheres to each hospital’s policies and procedures, applicable laws and regulations, accrediting body requirement and other regulatory compliance, and make recommendations to hospital personnel. § The Director shall ensure compliance with regulatory agencies governing the medical staff, including the Joint Commission and state and federal agencies with the assistance of hospital personnel in the service. § The Medical Director, in collaboration with the unit leadership, nursing director and hospital leadership, facilitates compliance with: department policies; TJC standards; federal rules and regulations; corporate integrity agreements 10 Unique Duties Per Facility (10 x 60 = 600) § Time consuming to check time log against specific duties each month – operational challenge Reduce Variation September14,2017
- 22. 4. Approver Training and Accountability Access to physician’s historical and current logs Access to actual contract
- 23. 5. Manage the spend with automation Current time log details Year-to-date view
- 24. Infrastructure needs to operationalize financial management of agreements Physicians are accountable Clear expectations Manage what you measure Dashboards and data Payments are within scope and more timely 24 September14,2017
- 25. Assess overall spend 25 September14,2017 Compare yourself to similar organizations MD Ranger calculates facility totals benchmarks by summing estimated values for all physician agreements. Taking each hospital total as a single data point, a distribution of facility total spending is formed and the percentile values are reported. Discover if you’re paying too many medical directors Determine if you’re spending too much on call coverage, directorships Analyze aggregate spending on physician contracts
- 26. Thank you Gail Peace Ludi gail@ludiinc.com 615.432.2910 Allison Pullins MD Ranger apullins@mdranger.com 650.692.8873 26 September14,2017