using market data to support your compliance program
TRANSCRIPT
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Using Market Data to
Support Your Compliance
Program
November 21, 2013
Allison Pullins,
Director
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Discussion Agenda:
• Introduce MD Ranger
• How to identify quality market data and use it
appropriately for physician contract compliance
• Outline benefits of using benchmarks for payment
rates in your compliance program
• Successful strategies and tips from MD Ranger
partner organizations
MD Ranger: your physician market
data and compliance resource
• Provides market data benchmarks for broad range of
administrative services
• Helps to negotiate competitive contracts
• Documents compliance and uncovers potential risks
• Identifies opportunities for cost reduction
• Provides tools to compare a hospital’s internal data to
benchmarks, tools for budgeting
• Generates contract-specific reports for compliance
documentation
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MD Ranger Subscribers
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Our Methodology
MD Ranger’s unique subscription service turns verified hospital
data into industry benchmarks. Subscribers submit data via online
survey, working with our implementation team to ensure data
accuracy.
Our unique approach to capturing all contract data from an
organization allows us to not only determine what to pay, but also
when to pay.
Who I am
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• Director at MD Ranger, Inc
• Background in physician
marketing, recruitment,
engagement, compensation,
negotiations
• Helps MD Ranger subscribers
leverage the data, analyze
internal costs, and document
compliance
How to Identify
Quality Market Data
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Attributes of High-Quality Data
• Sample size
• Participant characteristics
• Consistent, comprehensive collection method
• Thorough and transparent auditing processes
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What Does Market Data Reveal?
• What similar hospitals pay
• How rates are distributed
• Hours per month
• Annual payments
• Hourly rates
• Number of positions per service
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Using Benchmarks for
Physician Contracting
Compliance Programs
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Putting Data to Good Use
• Make only apples to apples comparisons
• Consider sample size
• Focus on similar organizations
• Consistently apply market data, especially within a
certain specialty or service
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Setting Internal Guidelines
• Write your policy with input from key stakeholders,
compliance professionals, and attorneys
• Put an executive in charge
• Communication is key!
• Be consistent and descriptive in your policy
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Example Compliance Policy Guidelines
• All physician call coverage contracts must be at or
below the 50th percentile
• Extenuating circumstances may go up to the 60th
percentile
• Exception: call coverage for general surgery and
orthopedic surgery may be at the 75th percentile
• If you must pay above 75th percentile, a written
exception request must go to CEO/CCO/etc
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Benefits of Using Market Data
for Your Compliance Program
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Standardization
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• Everyone across your organization adheres to the
same standard
• Consistency ensures fairness and transparency
• Protects the organization and physicians
Wide Applicability Across Physician
Contracts
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• Diverse data sets allow you to drill deep into
specialties, sub-specialties, etc.
• Facilities with special demographics can use the
most appropriate data cut
• Helpful data on DSH, Medicare status,
uncompensated care components, and incentives
can help inform contract negotiations
Consistently Measure Performance
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• Establishing targets for physician contracting costs
can be measured through using market data
consistently
• Aggregated spend on call coverage and physician
administrative positions can help measure your
financial performance
Strategies, Tips from MD
Ranger Subscribers
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Make Medical Directorships as Simple
as Possible
• Consider setting an organization-wide hourly rate
• Ensure that administrative positions that could be
held by physicians of any specialty are standardized
• Know and track hours spent by physicians doing
administrative, non-clinical duties
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Make Sure Medical Directorships Don’t
Carry Hidden Risks
• Is the role a typical directorship role, or are there
“above and beyond” duties like starting a clinical
program or service line from scratch?
• Beware of hidden compliance risks in number of
hours per month or number of positions per service
• Take a second look at low or average rates
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Discourage “Exceptions” by Making
Dispute Process Rigorous
• Be reasonable when creating a policy, yet
understand your upper limits
• Encourage accountability through using executive
involvement in process
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Health Systems: Empower Facilities to
Make Decisions within reason
• Publish and communicate reasonable guidelines
• Give facility decision-makers access to data;
empower them to make their own decisions within the
guidelines of your policy
• Anything within the policy goes (so be comfortable
with your policy!)
• Outline a fair process to dispute
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Always Put the Organization First
• Does our physician contracting rate policy help
achieve overall goals?
• Does your compliance program protect the
organization?
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Questions?
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We want to hear from you!
www.mdranger.com
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Allison Pullins
Director
650-692-8873