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Mon, Oct 12 2009 5:57 PM EST
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By one consultant’s prediction, in 10 years as many as 90 percent of physicians will have a new employer—a hospital. “Clearly, that’s where the trend is headed,” said Max Reiboldt, president and CEO of the Coker Group, Atlanta.
In the meantime, medical group practices are employing more sophisticated strategies in contracting with hospitals to provide their services. He outlined some of those tactics in a presentation this morning at MGMA’s annual conference. They include some tried-and-true methods like per-diem payment, joint ventures and hospitalist arrangements. OIG scrutiny has forced other arrangements such as gainsharing out of favor.
Compensation arrangements are evolving to keep up with the creative new strategies. One gaining favor is based on a form of relative value scales, Reiboldt said. A defined unit of work for, say, an orthopedist and a rate of compensation for each RVU is agreed to, based on benchmarks produced by MGMA and other groups. Doctors like the system because it often means more revenue for them each year. Hospitals like them because they make for an efficient way to measure productivity, Reiboldt said. An added bonus: Many contracts call for hospitals to assume the revenue from ancillary procedures such as infusions and imaging that previously went to the doctor.
However, the increasing complexity of these doctor-hospital work arrangements boosts the risk of regulatory scrutiny, he added. He urged medical groups and hospitals to adhere strictly to the concept of fair market value when setting compensation deals. That’s particularly true when it comes to ED call arrangements, an area that is clearly the most prominent issue facing physicians and hospitals—so prominent, in fact, that MGMA recently issued its first survey on call arrangements.
The activity around ED call negotiations has not escaped the OIG’s attention, and Reiboldt said there will be a plethora of opinions on the topic from the watchdog agency in the future. “This is far from being fully vetted,” he said. “Many hospitals are really struggling with this.”
Rick Haugh is a contributing writer with H&HN blogging live from MGMA 2009 Conference.
