The document discusses the importance of physician compacts or codes of expectations to help manage physician behavior and ensure the success of medical practices. It provides a 12-point framework that can form the basis for a solid physician compact, covering expectations around customer service, work ethic, reliability, adaptability, teamwork, accountability, communication, handling stress, problem-solving, sensitivity, professionalism, and financial standards. These compacts represent an agreement between physicians about acceptable standards of behavior and can help practices better facilitate expectations and address issues.

1. B u s i n e s s O p e rat i o n s
Reprinted with permission for six months from MGMA-ACMPE. MGMA Connexion, Vol. 12, No. 9. Expires April, 2013
DISCOURSE Note: MGMA-ACMPE does not endorse any solutions
Commentary, interpretations, put forth in this column. We urge readers to explore
thoughts, opinions
the legal issues — federal, state and local — that
might arise from a particular course of action.
Who’s in the driver’s seat? Physician
compacts help you steer your practice
T he pace of change and complexity in
the healthcare industry continues to
accelerate. Government and commer-
“A key component to long-standing
tenure in the practice and the avoidance of
surprises is to clearly spell out expectations
cial payers are refining reimbursement — what the practice guidelines include
methodology based on quality measures, and [how they] frame the culture, behav-
outcomes and patient satisfaction. And iors and day-to-day practice parameters,”
a common perception is that you must says Marshall M. Baker, MS, FACMPE,
rely on EHRs, standardized processes and consultant, Physician Advisory Services
extensive collaboration between hospitals, Inc., Boise, Idaho.
physicians and other healthcare provid- “For example,” Baker says, “‘Care will be
ers to be successful. But the truth could be documented on the date of service. Charg-
much simpler. es will be submitted within 24 hours of the
Physicians continue to be the core date of service. Attendance at professional
component of healthcare delivery systems. staff meetings is expected. Participation
And successful change will rely on col- on medical group committees is a require-
laboration with physicians as drivers of ment of membership/shareholder status/ By Rick Weymier, MBA, FACMPE,
director, Navigant Consulting,
healthcare services. Whether you are inde- employment.’” Healthcare Practice, Dallas,
pendent or part of an integrated delivery To see an example of this type of expec- rick.weymier@navigant.com
system, success depends on the clinical tation, go online (mgma.com/
skills of physicians and the intangible fac- virtualconnexion1012D) and click on the
ACMPE Fellow
tors that support the success of physician October issue of MGMA Connexion.
practices. “With expectations presented, under-
One of the key intangible factors is stood and agreed to prior to association/
physician behavior, which can be directed membership/employment, the medical
and managed with the use of a physician group should more easily facilitate the
compact or code of expectations. These management of the group’s expectations,”
documents are created by physicians and adds Baker, who wrote the book Physician
act as a standard by which they agree to Policies: A Practical Guide to Governance
run their practices; they are guiding prin- Issues.
ciples of the organization. They can create A physician compact represents physi-
a performance expectation framework for cian expectations. Each of the following 12 Get tips on how you can set
physician partners, support staff, hospital items forms the basis for a solid physician expectations early from
relationships and, perhaps most impor- compact, which can be expanded and Marshall Baker, MS, FACMPE.
tantly, how to treat patients. modified with examples, requirements and
The compact should be discussed other relevant factors to support the mis-
with all physician recruits; it should be sion and vision of an organization.
an integral part of employment and/or
shareholder/member/partnership agree- Customer service: The physician will
ments and should be used as a guide when demonstrate attentiveness, respect
addressing physician behavioral issues.
see DISCOURSE, page 28
©2012 MGMA-ACMPE. All rights reserved. MGMA Connexion • October 2012 • p a g e 2 7

2. from page 27
Discourse Reprinted with permission for six months from MGMA-ACMPE. MGMA Connexion, Vol. 12, No. 9. Expires April, 2013
and courtesy to internal and external change the way they practice, code and
customers. A patient’s time is valuable, document. Hanging on to outdated meth-
and it is incumbent on the physician and ods is more costly than adapting to the
support staff to be accessible, attempt to evolving structure of healthcare delivery.
Teamwork: The physician
Physicians continue to be the core component should show that he or she is
of healthcare delivery systems. And successful a team player through helpful
and cooperative interactions
change will rely on collaboration with physicians with partners, other providers,
as drivers of healthcare services. clinical support and admin-
istrative staff. Relationships
should be honest, nonjudg-
run on time, keep the patient informed of mental, respectful and supportive of others.
any delays and give options for alternative It is important to recognize that everyone
care and/or times, if requested. The physi- plays a part in the success of an organiza-
cian and staff should ensure that a patient tion and that each person’s contribution
has an excellent overall experience and is essential. Staff and physicians should
receives high-quality medical care, which take initiative to help others, be outwardly
marks a change from a physician-centric to positive and avoid unprofessional criticism.
a patient-centric model. It is relatively easy for patients to pick up
on tension and dysfunction in the practice,
Work ethic: The physician will demon- which could lead to concern about the
strate a high degree of dedication to the quality of care they receive.
profession and organization. He or she will
remain compliant with all work standards Accountability: The physician will be
regarding patient contact hours, participa- held accountable for a variety of tasks and
tion in call coverage, maintaining hospital items that will be used to measure basic
affiliations, and showing dedication and performance standards. Examples include
commitment to the organization’s mission completion of dictation in a timely manner;
and vision. participation in committees; maintaining
hospital credentials; coding compliance;
Reliability: The physician will take and patient satisfaction scores.
responsibility for his or her personal behav-
ior and will support staff to ensure a high Communication: The physician will
level of patient satisfaction. Phone messag- demonstrate clear communication, respect
es and medication refills will be taken care the ideas of others and employ active
of in a timely manner. Physicians and staff listening skills. Two critical avenues of
will arrive on time and ready to work. The communication are with staff and patients.
physician is the captain of his or her team; The physician must maintain a high level
the physician will interact with staff daily, of open and positive interaction with staff
exhibit a positive attitude and stress the to ensure patient satisfaction, attentiveness
importance of flexibility and teamwork. to patient needs and avoidance of errors.
It is essential to listen to what the patient
Adaptability: The physician will says, take time to answer questions, discuss
maintain an open mind, demonstrate ac- issues so they are understood and ensure
ceptance to change and show a willingness that when a patient leaves, he or she
to learn. With the accelerating implemen- knows what to do next. The increasing use
tation of EHRs and the push for quality of social media, practice websites and other
and outcome measures, physicians must
p a g e 2 8 • MGMA Connexion • October 2012 ©2012 MGMA-ACMPE. All rights reserved.

3. Reprinted with permission for six months from MGMA-ACMPE. MGMA Connexion, Vol. 12, No. 9. Expires April, 2013
electronic formats presents significant op- vendor relationships; and maintain all
portunities to enhance communication. credentialing, licensing and educational
requirements. Patients now expect a part-
Ability to handle stress: The physician nership with physicians instead of one-way
will project a professional, cooperative communication, and this expectation
attitude and a pleasant, even-tempered should be met.
demeanor at all
times. Although
this seems straight- These compacts represent a step beyond the mission,
forward, it can vision and value statements that enforce compliance;
be difficult to
maintain a profes- an added bonus is that these documents also spell out
sional and positive
demeanor with
the terms of acceptable behavior.
documentation
requirements, overhead expenses, patient
volume and external rules. Financial standards: The physician will
actively participate in the management of
Problem solving: The physician will the practice to minimize costs and maxi-
demonstrate strong problem-solving skills mize revenue in a compliant manner that
by investigating all aspects of a problem, allows for appropriate quality care. Criti-
identifying alternatives and including cal areas include accurate coding, timely
other members of the team to reach a submission of charges, and complete and
resolution. This includes looking for appro- timely documentation. Proper order-
priate and cost-effective care, using clinical ing and approval guidelines for ordering
pathways and disease-management tools, medical equipment and supplies must be
and using resources in the context of qual- followed. Physicians will follow any pre-
ity. The physician should strive to manage authorization requirements imposed by
the patient appropriately within the frame- contracted payers and fully inform each pa-
work of overall group goals as they pertain tient of his or her financial responsibility.
to referrals, use of ancillary services and
hospital care. It isn’t easy to complete a physician
compact. It can require many meetings to
Sensitivity: The physician will demon- create an acceptable framework and to gain
strate compassion, understanding and buy-in. The main hurdle is physicians’ per-
respect for both internal and external ception that it is a performance evaluation
customers. Dignity and a high regard for and might affect their ability to make in-
others will be exhibited at all times. First dependent decisions. When explaining the
and foremost, the physician should be an need for this type of document, it helps to
advocate for the patient. Next, physicians explain that these compacts represent a step
should show compassion and respect for beyond the mission, vision and value state-
the support team, clinical and adminis- ments that enforce compliance; an added
trative staff, and other physicians in the bonus is that these documents also spell out
practice. the terms of acceptable behavior.
Professionalism: The physician will mgma.com
maintain patient confidentiality at all • mgma.com/store;
times; avoid inappropriate interactions search item 8260
with staff; limit personal activities dur-
ing patient hours; steer clear of improper
©2012 MGMA-ACMPE. All rights reserved. MGMA Connexion • October 2012 • p a g e 2 9