For Physicians

Appropriate Physician Payments within FMV Range

Negotiations with hospital administrators can be difficult.  Whether it’s because you don’t like confrontations, or you are dealing with a tough executive, there are steps you can take to prepare yourself for the conversation.

Use the market data, as well as your current payment rate, to determine an appropriate payment range for your services. If you are currently getting paid under the 50th percentile, determine the difference in pay that’s needed to get you to the 50th percentile.  Ask yourself if there could be a good reason for you to be paid at a lower percentile, like a robust payer mix or a large panel size.  If this is the case, think of additional reasons why your payment rate should change.  If instead you’re getting paid at or around the 50th percentile but have reason to believe you should get paid more, determine how much room you have to negotiate at or around the 75th percentile.  Keep in mind that most hospitals consider anything about the 75th percentile not to be “fair market value” unless there are special exceptions.  Special exceptions should include seniority within the physician community, a niche sub-specialty that you practice, any awards or special fellowships you’ve received, on-site presence requirement, or an extremely burdensome call panel.

If you have any questions, don’t hesitate to email me at This email address is being protected from spambots. You need JavaScript enabled to view it..  Check back next week for another tip!

allison

Avoiding Anti-Kickback Violations: Tips for Physicians

Though hospitals themselves are under the most scrutiny to have compliant financial relationships with physicians, it is nonetheless important for physicians to be aware of federal fraud and abuse laws.

Avoid violating the Anti-Kickback Statute with the following tips:

  • Don't receive payments from a hospital unless you have a contract with a payment rate negotiated in advance. Unless you have a contract which spells out the nature of the relationship and the services you provide the organization, you should not receive any payments for services. Not having a personal services agreement (or having an expired agreement) violates AKS.
  • Don't accept compensation or gifts from hospitals unless you know they are under the annual limit and being tracked by the hospital for compliance purposes. For 2014, the non-monetary compensation limit is $385 per year. In 2015, it's $392. It's not hard to reach this number. Keep in mind that if a hospital gives you a gift or entitlement worth money that is not given to the entire medical staff, this gift must be tracked with other gifts and the total cannot exceed the maximum. If it does, you will be responsible for paying back the facility.
  • Don't leverage your referral position during negotiations or conversations with a hospital. It is unwise to suggest that you can increase business for a hospital during negotiations. Though this could seem like a small business strategy for you, in reality you are offering and suggesting that the hospital reward you for referrals, which is explicitly forbidden in AKS and breaking the law.
  • Never threaten to stop referring patients to a hospital during a negotiation. Likewise, threatening to stop sending referrals to an organization in retaliation infers that you have been referring patients to the facility for money. Don't put yourself or your administrator in this position.
  • Do not accept payments or remuneration of any kind for referrals. Make sure that all payments a hospital makes to you are within fair market value. Even if the administrator isn't concerned about fair market value, it's important that you be concerned. If you or the hospital gets caught with payments above fair market value, if you are convicted you will most likely lose eligibility to be reimbursed by all government programs, not to mention be thrown in jail for up to five years. If you need help ensuring that your payments are truly fair market value, contact us to obtain data for your specialty.

allison

How Frequently is Your Specialty Paid for Call?

The percentage of physicians paid for call coverage in different services varies. Hospitals report paying radiologists in only 18% of arrangements while they report paying general surgeons in 75% of cases. If you are not being paid for call coverage and think you should be, consider the number of hospitals who pay for call coverage in your service. Though we can't list every service here, if you are curious about your specialty, email This email address is being protected from spambots. You need JavaScript enabled to view it..

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Is the Time You Spend on Administrative Duties Reasonable?

Medical directors have important jobs. In addition to their clinical duties, medical directors spend scores of hours a year providing guidance, leadership, and oversight to their department or specialty.

The number of hours you spend in your medical directorship role depends greatly on both your specialty and other circumstances like the size of the hospital where you practice or if it's a trauma center.

When hospitals contract with physicians for administrative services, maximum number of hours in the role per month are typically included in the agreement. Are the expectations set by your organization reasonable? Can you complete your administrative duties in the time allotted?

How many hours a month are medical directors in your specialty typically spending on administrative duties?

According to the MD Ranger database of 14,000+ contracts, the specialties who report the most time spent with medical directorship duties are as follows. Hours are per annum:

Before negotiating your next administrative contract, determine if the hours set by the hospital are appropriate and reasonable for your specialty.

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Negotiation Objectives for Hospital/Physician Contracting Conversations

Negotiations with hospital administrators can be difficult.  Whether it’s because you don’t like confrontations, or you are dealing with a tough executive, there are steps you can take to prepare yourself for the conversation.

Determine your objectives for the conversation.  Why do you want to discuss your compensation?  Are you hoping to get paid for taking call for the first time?  Do you want to raise your current rate that you’re being paid to be Chief of Staff, given the amount of time it’s taking away from your practice?  What is your desired outcome for the discussion?  Having a clear objective and desired objective for the negotiation will help ensure that you don’t walk away with an unsatisfactory conclusion or empty handed.

If you have any questions, don’t hesitate to email me at This email address is being protected from spambots. You need JavaScript enabled to view it..  Check back next week for another tip!

allison

Physician Compensation Negotiations

Negotiations with hospital administrators can be difficult.  Whether it’s because you don’t like confrontations, or you are dealing with a tough executive, there are steps you can take to prepare yourself for the conversation.

Once you have selected a rate, build your case for why your compensation should be at that benchmark. Though it may seem straightforward as to why you should be paid the median amount, it isn’t.  Don’t take for granted that you should be paid the average amount; half your peers are paid below the 50th percentile.  You must have a strong argument to get paid any amount for these types of services.  Keep in mind that the data is there to support you; it’s an objective source composed of rates from the same service you provide.  Others in the market are being paid these rates.  Things to consider when you are brainstorming are:

  • does your specialty have a particularly high burden for emergency coverage?
  • are you the only specialty that can fill this position?
  • is the payer mix particularly poor at this organization, such that you are covering the ER without much hope of reimbursement?

If you have any questions, don’t hesitate to email me at This email address is being protected from spambots. You need JavaScript enabled to view it..  Check back next week for another tip!

allison

Preparing for Physician Contract Negotiations

Negotiations with hospital administrators can be difficult.  Whether it’s because you don’t like confrontations, or you are dealing with a tough executive, there are steps you can take to prepare yourself for the conversation.

Anticipate, and prepare for, hospital push-back.  What are reasonable alternatives to what you’re requesting?  If the market data reveals that rates within your service and specialty are relatively close to one another, you don’t have a lot of negotiating room.  On the other hand, if the difference between the 50th and 75th percentiles isn’t that much monetarily, it could be much easier for you to secure the higher rate given the smaller risk taken on by the hospital.  Spend a few hours playing devil’s advocate, and coming up with all questions and pushback that you would give yourself, if you were the hospital administrator.  Here are questions you should know the answers to before walking into the negotiation:

  • I haven’t been paying you to provide this service.  Why should I pay you now?
  • Paying you at the 50th percentile seems unrealistic given your experience and our payer mix.  Why do you think you deserve it?
  • Aren’t you collecting enough during your coverage days to make this worthwhile?
  • How is this rate you’re asking for fair market value?  Who says?

If you have any questions, don’t hesitate to email me at This email address is being protected from spambots. You need JavaScript enabled to view it..  Check back next week for another tip!

allison

Should You Get Paid for Call Coverage?

Everyone wants to be paid for their time, however physician payments are regulated by government regulations. Use this checklist to determine if it is reasonable to ask to be paid for call coverage.

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