How should your organization prepare for negotiations and contract conversations with physicians and groups? Here are some best practices to integrate into your preparation strategy.
Do your research.
Before starting any sort of negotiations, have a good idea of what the market ranges of payment for the specialty and service in question. When entering into negotiations, you should have a good idea of how your institution and the physician compare to the “typical” provider.
Consider agreement scope.
All positions are not created equal and should not be considered equal when determining payment. Consider the scope of what is included in the agreement.
Acknowledge the nuances of the situation.
Situational details of the position (intensity of workload, exclusivity) or of the hospital (payer mix, trauma status, hospital size) may distinguish a contract from other contracts.
Identify where you can compromise.
Before you begin negotiations with the physician or group, discuss internally what you are willing and able to pay and where you can compromise to reach an agreement.
Discussing alternative approaches can often yield savings or more efficient ways to achieve the same objectives. It can also open the door for both your organization and the physician to discuss their challenges and needs.
Document, document, document.
One of the most important aspects of compliance and protecting your organization is thorough documentation. Always air on the side of more rather than fewer supporting documents about how and why you reached the conclusion.
This is admittedly a tricky topic. Physicians can become suspicious when hospitals talk about FMV and think it’s an excuse for hospitals to pay them less. This often is because of lack of education. If this is the case at your organization, you must work hard to mythbust.
We recommend being straightforward about the definition of FMV and give real-world examples of what that means. Talk about ways to determine FMV: market data, valuation methods, and your organization’s preferred method. Give case examples. Try writing up some FAQ’s relating to FMV, Stark Law, and the Anti-Kickback Statute for doctors.
When it comes to discussing methods to determine specific doctor’s compensation, organizations take one of two positions. Some choose to share their methodology, data, and research with physicians on how they are determining their compensation. Others choose not to reveal sources. There are legitimate reasons for each position. We recommend that whatever approach your organization chooses, be consistent. Always explain your reason(s) why.
Communication, even in the most positive relationships, can be challenging at times. What are the best practices for communicating with physicians?
As a compliance department, you likely have experience with using all different forms of communication for your message to effectively reach different types of people. Not only must you experiment with what works best with physicians at your organization, you will likely need to communicate in different terms and through multiple channels. Even within the medical staff, there will be all different types of learners and communicators.
Another best practice is what we call the “train the trainer” model. For physicians especially, this can be an extremely effective way to disseminate messages throughout the medical staff. First, identify physicians that would make good leaders. Educate them, engage them, and ensure they will carry the most important compliance messages to other physicians. Trust them to talk to their peers and address issues of compliance, while of course giving them the proper tools to do so.
We cannot emphasize enough how important setting the tone from the top of the organization is. If your C-suite doesn’t care about compliance, your physicians will not care about compliance. Culture can make or break an organization when it comes to compliance and legal issues. Work with your executive team to ensure that compliance, safety, and quality are among the most important goals of the organization.
Unfortunately, many healthcare organizations are full of physicians who have no idea what the compliance team does. If it’s the case at your organization, you must first educate your medical staff.
Minimally, physicians must be told about regulations, enforcement news, advisory opinions, the OIG work plan, trends in your state, and information relevant to their specialty. But there are many other ways to educate physicians about the compliance process.
Best practices include offering different types of training (online, in person, etc.), incorporating tactics for all different types of learning styles, and asking physicians themselves how they prefer to receive training. One thing you should avoid is scheduling an educational session for members of the medical staff during their negotiation with your facility. If you try to talk to a doctor about regulations during a negotiation, it can be difficult and can lead to mistrust. If you can’t avoid training during ongoing negotiations, consider having training leader hired from outside the organization.