Every hospital has a medical staff that functions as an indispensable partner in quality oversight, credentialing, accreditation, and operations. The medical staff elects officers to represent its physicians. Payment for medical staff officers varies by facility and position and can be a complex area to navigate. With healthcare organizations spending more and more on these types of roles, it is important to think strategically about this area of increasing concern. In this webinar, we will talk about paying physicians in leadership positions reasonably and fairly. Join MD Ranger for this 30-minute webinar as we discuss: -The (growing) diversity of physician leadership roles -When to pay -How much to pay -Ways to structure payment

1. 1
Navigating Medical
Staff Officer and
Physician Leadership
Compensation

2. 2
Overview:
• Evolving physician leadership roles
• Medical staff leadership positions:
• When to pay
• How much to pay
• Ways to structure payments
• Other leadership and administrative positions such as committee
chairs and members, department chiefs, quality initiatives, and peer
review
• Why and when to pay
• How much to pay
• Ways to structure payments

3. But first, a disclaimer
• MD Ranger doesn’t give legal advice
• Physician agreements should always be reviewed by
an attorney (or two)
• All matters regarding potential legal/compliance
issues should go to counsel
• A formal review and approval process is foundational
to compliance
3

4. About Us
4
ABOUT US

5. 250+ Physician Benchmarks
• Call coverage rates
• Medical direction payments
• Administrative and leadership
services rates
• Hospital-based service stipends
• Diagnostic testing, etc.
• Clinic & hourly rates
Online Platform
• Benchmark lookups
• Contract proposal tools
• Contract reports by facility and service
• Total facility costs + benchmarks
Compliance Documentation
• Contract-specific FMV documentation
reports
• Reports to assist with real-time
monitoring and annual reviews
Research and Support
• Resources for education and training
• On-call experts to help subscribers
use benchmarks and tools
5

6. The foundation of your compliance process
Standardize
processes
and rates
across the
organization
Look up and
document
physician
rates for FMV
Access 250+
payment
benchmarks
Review
contracts
annually and
monitor with
ease Have smarter,
data-driven
physician
negotiations
Mitigate
compliance
risks with
comprehensive
source of
benchmark
data
6

7. 7
Our subscribers

8. 8
Our benchmarks
• Call Coverage
• Medical direction
• Administrative
• Medical Staff Leadership
• Hospital-based services
• 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
Hospital-characteristics drill down for
ADC, bed size, trauma status,
urban/rural, stroke centers, and more

9. Our methodology: key differences
• Providers vs. facilities
• Verified data
• Thorough data audits
• Physician contract experts on-
call to review/advise on
challenging contracts
• Comprehensive scope of
benchmarks based on full
hospital contracting practices
9

10. 10
Extensive education and analysis for
subscribers
Contracting
• What You MUST Know About Compensating Call Coverage
(video)
• Benchmarking Total Physician Costs (video)
• Making Physician Contracting More Efficient (white paper)
Compliance:
• Defining, Determining, and Documenting FMV (video)
• Stark Law and Physician Contracting (video)
• Audit Smart (video)
• Four Signs Your Organization Could Have Risky Contracts
(checklist)

11. Your speaker
11
• Ten years experience in healthcare
consulting and technology;
specializing in physician marketing,
recruitment, engagement,
compensation, negotiations
• Helps MD Ranger subscribers
leverage data, analyze internal costs
and structure physician contract
compliance programs

12. Physician Contract Attributes and
Components
12
PHYSICIAN LEADERSHIP:
A BRIEF HISTORY

13. Growth over time
13
Physician
leadership roles
have grown and
proliferated as the
delivery system
has grown in
complexity and the
need for
coordination has
increased

14. Examples of leadership roles are:
14
ü Medical directors
ü Medical staff officers
ü Committee chairs and members
ü Non-director administrative positions
ü Physician champions

15. Payments increasing
15
Direction and
admin total
hospital payments
now $1.8M, up
25% from 2014
Leadership
position payments
at the 75th
percentile grew
from $52,630 in
2015 to $60,000 in
2016
Chief of Staff
median payments
increased from
$36,000 in 2015 to
$48,500 in 2016

16. Time commitments can be significant
16
Healthcare organizations must
acknowledge time commitment
required – which can run into
dozens of hours a month,
particularly when an
accreditation or merger is
happening

17. 17
MEDICAL STAFF LEADERS
When to pay
How much to pay
Payment structures

18. The role of the medical staff
• Assists with
quality
oversight,
credentialing,
accreditation,
and operations
• Leaders are
chosen by the
medical staff
18

19. Payment source is evolving
• Historically, officers often
volunteered their time; however,
many hospitals now pay at least for
the top positions
• A growing number of hospitals are
paying, or splitting the cost of
stipends with the medical staff, at
least for Chief of Staff positions
19

20. Growth in median Chief of Staff annual
payments
$0
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
2013 2014 2015 2016
20

21. Factors driving increased payments
Increased demands of physicians in the positions
• JAHCO requirements for physician involvement
• Technology and quality initiatives
• Peer review
• Committee and meeting attendance
• Board responsibilities
21

22. Factors driving increased payments
• Trend of increased hospital-based medicine
22

23. Factors driving increased payments
• Other economic and market forces, such as:
• lower reimbursements,
• larger group practices with productivity incentives,
• more part-time and employed physicians, and
• competing internal governance demands of a practice are
These factors are likely reducing the pool of physicians
interested in committing time without reasonable payment
for their time.
23

24. Competing priorities for doctors
24
More physicians are reluctant
to volunteer and run for office if
it results in lower revenue and
fewer patients, or if duties
impinge on either clinical or
after-hours activities.

25. 25
When to pay
• First: is it reasonable to pay for this position? What is
the precedent at your organization? How frequently do
other organizations pay for the service?
• There are no hard and fast requirements for payment
unless the facility’s Medical Staff Bylaws specify
payment.

26. 26
Help is hard to find
• If finding volunteers to run for office is a challenge, or if
the duties of a position involve a significant time
commitment that can reasonably be expected to impact
a physician’s clinical practice, payment may be
justified.

27. Adopt a formal policy
27
• Define which
positions are paid
• Formulate a
method for
determining
payment rates and
have the medical
staff approve it
• It may not be
necessary to pay all
medical staff
officers

28. Paying for leadership positions
28

29. Distribution of payment methods
29
73%
23%
4%
Calendar (annual, monthly, weekly)
Hourly
Per Meeting

30. How to determine payments
30
• Use market data
• Make contract language as specific as possible
• Hours can be difficult to pay due to the nature of this role and
responsibilities
• Stipends or annual payments usually make the most sense

31. Monitor higher payments and riskier
contracts
31
• Chief of staff
• 340 hours
• Annual payment: $50,000
• Calculated hourly rate: $147

32. Monitor higher payments and riskier
contracts
32
• Vice Chief of Staff
• 60 hours
• Annual payment: $30,000
• Calculated hourly rate of $500 is unlikely to be FMV

33. Comply with regulations
33
ü IRS
ü Stark
ü Anti-Kickback

34. Hot Topics in Physician Contracting
34
OTHER ADMINISTRATIVE POSITIONS
When to pay
How much to pay
Payment structures

35. 35
Non-director positions grow
• As health care delivery becomes more complex, more
administrative positions are needed to coordinate care,
manage patients, etc.
• Positions that have emerged in recent decades or are
new to getting compensated are:
• Care/Case Management
• EHR Initiatives
• IT Directors
• Data Management
• Quality Initiatives
• Peer Review
• Physician Champions

36. How frequently they are paid
36

37. More positions
• Many organizations pay one physician for these types
of roles, but some pay more than five
37
Paid Administrative Position Count
Paid Position Count
Service 1 2 3 4 5+
Case/Care Management 75% 17% 0% 0% 8%
Committee/Meeting Attendance 32% 21% 5% 16% 26%
Peer Review 62% 8% 31% 0% 0%
Utilization Management 74% 13% 4% 4% 4%

38. Deciding when to pay (and how much)
• Specific initiatives or
issues such as a medical
staff merger, major
quality initiative, or EHR
implementation may
warrant payment to
ensure goals are
achieved
38

39. Sometimes there are special
circumstances
• Hospital size and complexity may also impact the need to
pay and the amount
• Academic institutions often pay for resident supervision,
mentoring, training, department chiefs, research, etc
39

40. How much to pay?
• Hourly rates remain fairly stable across non-director
administrative roles, though there are some exceptions
• Remember: opportunity cost for certain specialties may not
be justified in these types of roles, particularly if a physician
of any specialty may perform them
40

41. How many hours?
Hours per year can and do vary
For example:
• IT/EHR: 240
• Case Management: 300
• Quality Initiatives: 180
41

42. Payment types & options
42
Distribution of Payment Methods
Service Calendar Hourly Per
Meeting
Other
Case/Care Management 29% 69% 0% 2%
Committee/Meeting
Attendance
31% 53% 15% 1%
IT/EHR 4% 95% 1% 0%
Peer Review 6% 76% 18% 0%
Research and Data
Management
12% 61% 26% 1%

43. Best practices for all physician leadership
agreements
• Comply with all federal regulations
• Adopt formal policies about when and how to
compensate leaders
• Always monitor riskier agreements
43

44. Document, document, document
• Particular
circumstances
• Background
information
• Demands and scope of
the position
44

45. Don’t just sit on less than ideal
agreements: do something.
45
Ø Do you feel confident in your organization’s physician
contracting and FMV documentation process?
Ø Are you confused how much to pay physician leaders
for their time?
Ø Do you feel like your organization has risky
agreements?
We can help! Reach out: apullins@mdranger.com or
650-692-8873