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ROADMAP FOR PHYSICIAN CONTRACTING:

SETTING UP FOR SUCCESS IN 2017

DECEMBER 2016

Today’s topics

• Who we are

• Guidance from OIG

• Our crystal ball: physician contracting in 2017

• Best practices to kick off the year

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MD Ranger: the foundation of your

compliance process

Standardize processes and rates

Document FMV

Access 250+ payment

benchmarks

Review contracts and monitor with

ease

Have smarter, data-driven physician

negotiations

Mitigate compliance

risks

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Our benchmarks

• Call Coverage (55+)

• Medical direction (85+)

• Hospital-based services (15+)

• Administrative

• Medical Staff Leadership

• 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

• 13 Pediatric services, with more

emerging each year

Hospital-characteristics drill down

for ADC, bed size, trauma status,

urban/rural, stroke centers, and

more.

Used in academic medical centers,

integrated delivery systems, and

hospital organizations.

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Our subscribers

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LESSONS FROM THE OIG

Yates Memo

• Published September

2015

• Discusses the personal

accountability of

physicians and

healthcare executives in

fraud

• Example: Tuomey CEO

Jay Cox fined $1 million

this year for violations

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Settlements abound

• ACA turns up the heat

• DOJ funnels more resources

into investigating fraud

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Tenet Healthcare Corporation: $513 million

• Two Georgia hospitals charged with paying kickbacks

in exchange for referrals

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Lexington Medical Center: $17 million

Dr. Venkateswara Kuchipudi: $786,000

• Violated Stark by improper financial arrangements with

28 physicians

• Involvement in complex Medicare fraud scheme

landed this physician jail time, too

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PHYSICIAN CONTRACTING 2017

Medical directorships are both risky

and expensive

• Many organizations auditing medical directorship

payments and looking for ways to streamline

spending

• These administrative payments attract scrutiny

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Call coverage demands from

physicians could increase

• Some organizations don’t pay for call; others spend

millions annually

• With incomes uncertain, physicians may ask for

additional payments for financial security

• If coverage becomes an issue, providing ED

coverage services could become even less appealing

to doctors

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Healthcare organizations face larger

fines

• The Bipartisan Budget Act of 2015 mandated that

federal agencies make inflation adjustments to the

amounts of civil monetary penalties.

• This year’s increases are substantial: False Claims

Act penalties have not been adjusted in 20 years. • The fines for False Claims Act violations are now $10,781 at the

minimum and $21,563 at the maximum.

• Stark Law fines increased from $15,000 to $23,863 per violation

• Anti-Kickback Statute fines increased from $50,000 to $73,588.

• Penalties are expected to increase based on inflation

each year.13

False Claims Act in the spotlight

• Since the passing of ACA, the False Claims Act has

become more prominent in healthcare

• The FCA could apply to any fraudulent government

payment (like Stark and Anti-Kickback violations)

• Experts seem to think that the False Claims Act will

continue to be a liability for organizations.

Remember: FCA penalties substantially increase the

potential repayment amount.

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BEST PRACTICES FOR KICKING OFF

2017

Outline your organization’s process

• Give your process the organization it needs with a

foundational document:

• Include the purpose of your physician contracting

process and the intended outcomes.

• Outline step by step how contracts will be processed

as well as team roles and responsibilities.

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Get buy-in and consensus

• Get buy-in from key executives, committees, and

board members

• Ensure that leadership understands importance of

physician contracting compliance process and agrees

upon processes and guidelines

• Communicate compliance measures and safeguards

to hospital employees and medical staff

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Store all your contracts in a centralized

location

• Contract management systems are key to all

physician contracting programs

• Find the right vendor to meet your needs

• Demand utilization

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Develop a process to determine FMV

consistently

• Certifying that physician agreements are FMV should

be the cornerstone of effective physician contracting

programs

• Discuss what is best for your organization with your

team

• Once determined, codify your process in a

foundational document

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Create (or update) guidelines for

handling exceptional agreements

• Not every agreement should be negotiated above the

75th or 90th percentile; however, organizations always

have one or a few exceptions

• Be prepared and create an exceptions process in

advance to process these requests

• If you are smart about it, you can structure guidelines

in a way that discourage exceptions—always a good

thing

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Educate your staff on regulations and

enforcement actions

• Join associations or attend

conferences

• Keep up with the OIG online

• Consider yearly trainings

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Make a plan to audit physician

contracts

• Annual audits are always a

good idea

• Consider smaller audits

each quarter

• Whatever your schedule,

use technology to make

your job easier

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Thank you!

MD Ranger, Inc. | 1601 Old Bayshore Hwy, Ste. 107 | Burlingame, CA 94010

www.mdranger.com

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