August 29, 2019

6 Questions to Ask When Assessing a Physician On-Call Arrangement

On-call pay is the hospital’s payment for access to physicians providing call coverage. The provision of on-call pay to physicians continues to be a hot topic for hospital leaders and physicians. Therefore, it is important from a strategic, financial and regulatory perspective to properly structure physician on-call pay arrangements.

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Topics: Physician Compensation

August 15, 2019

Fair Market Value Physician Compensation Fails

Determining fair market value (FMV) compensation in a healthcare setting generally requires the use of multiple, objective data points and an understanding of how to apply that information given the unique facts and circumstances of the subject arrangement relative to the overall market.

Understanding what the government considers as support for FMV, and what it does not, is critical to selecting and enacting policies and procedures for establishing FMV physician compensation.

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Topics: Physician Compensation, Fair Market Value

July 19, 2018

Getting it Right: Traits of Effective Physician Compensation Models

As value-based payment models gain traction, healthcare organizations are feeling pressure to control costs and improve the quality of patient care, all at a time when the supply of physicians is falling short of demand.

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Topics: Physician Compensation, Value-Based Care

July 12, 2018

How Will You Win the War for Physician Talent?

Competition for physicians is already heated. It’s about to get scorching. Demand is on a trajectory to drastically outpace supply, with a projected shortage of up to 120,000 physicians by 2030, according to the Association of American Medical Colleges.

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Topics: Physician Compensation

February 16, 2018

CMS Bundled Payment Train Back on Track. Should You Board?

After scaling back its two mandatory bundled payment programs last year, CMS recently signaled that the value-based payment train remains on track for the current administration.

Bundled Payments for Care Improvement Advanced (BPCI-A) opened to applicants on January 11. With the application deadline of March 12, 2018, just around the corner, the pressure is on to decide whether your hospital or physician group practice is going to participate.

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Topics: Physician Compensation, Payment Models

February 23, 2017

3 Steps to Reduce Fraud and Abuse Compliance Risks in Hospital-Physician Deals

The most astute executives in health systems are rightfully concerned about compliance risks in physician contracting. Among these risks are that a transaction or an arrangement between a hospital and a physician are consistent with fair market value (FMV) and are commercially reasonable (CR) as those terms are defined in the healthcare regulatory context.

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Topics: Physician Compensation, What is Fair Market Value

November 15, 2016

My Hospital System is Losing Millions on Physician Practices. Is it a Death Sentence?

Recent DOJ settlements provide clear evidence of the position of qui tam relators, prosecutors, and government experts that hospital losses on physician practices are clearly targeted. For example, in U.S. ex rel. Parikh v. Citizens [No. 6:10-cv-00064 (S.D. Tex.)], the court denied the defendant hospital’s motion to dismiss in part because of an inference between the plaintiff’s allegations of practice losses and improper remuneration to induce referrals.

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Topics: Physician Compensation

July 12, 2016

Setting Quality Metrics for Value-Based Pay - Part One

Government and commercial insurers are transforming payment models from fee-for-service (FFS) to arrangements that include incentives for quality, outcomes, improved patient satisfaction, and reduced cost. In the FFS environment, hospitals, physicians, and other providers have been subjected to insignificant financial risk relative to the risk borne by payers; however, with time, transformed payment arrangements have encouraged, if not required, more providers to assume downside risk. Why? One reason is to hold providers accountable for the cost and quality of care. The table below by The Commonwealth Fund summarizes this need by showing where the United States ranks relative to other industrialized nations in health outcomes and risk factors:

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Topics: Physician Compensation, Value-Based Care

June 14, 2016

What Will Future Physician Compensation Look Like?

Currently, one of the more perplexing issues around fair market value physician compensation relates to designing comp models that effectively reward physicians for quality and cost savings in a market that is still driven by fee for service (FFS) reimbursement. Compliance-minded hospitals are understandably concerned about adopting (seemingly aggressive) models that stack quality payments on top of existing FFS models, particularly if total compensation exceeds what is commonly considered outside the upper range of FMV. Unfortunately, what those models should look like, especially what resulting (compliant) physician compensation should come from those models, represents somewhat unchartered waters.

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Topics: Physician Compensation, What is Fair Market Value

April 12, 2016

3 Pitfalls to Avoid With Compensation-per-WRVU Contracts

Today, WRVUs are one of the most prevalent measures by which employers determine physician compensation.  WRVUs have the benefit of rewarding physicians for personally performed services based on relative values utilized by CMS without penalizing the physician for charity care provided on behalf of the hospital or for revenue cycle issues outside of the physician’s control. However, misconceptions still exist surrounding the selection of appropriate conversion rates for physician arrangements. Here are three common pitfalls to avoid when establishing a compensation-per-WRVU contract.

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Topics: Physician Compensation

February 25, 2016

What You Need to Know About MACRA and FMV

Although physicians around the country cheered the permanent repeal of the sustainable growth rate (SGR), the resulting reimbursement and payment model changes could significantly impact the fair market value of physician practices. The passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) changed the valuation environment significantly. The HORNE Healthcare team has been researching the changes, and here is what you need to know:

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Topics: Physician Compensation, What is Fair Market Value, MACRA Summary

February 18, 2016

How the Transition from Volume to Value Will Impact Your Physician Compensation Models

With the passage of MACRA in April 2015 we began to get some real clarity regarding Medicare’s plans for moving physician reimbursement from volume-based to value-based. With MACRA set to be implemented over the next few years, now is the time to begin addressing how changing reimbursement will impact physician compensation models. Because future reimbursement will be greatly impacted by physicians’ ability to deliver value and quality, hospitals will need to design compensation models that reward and encourage physician behaviors that support these goals.

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Topics: Physician Compensation, Value-Based Care

February 10, 2016

How’s the Volume-to-Value Transition Working for YOU?

After our second day at the AHLA Physicians and Hospitals Law Institute, some clear themes are beginning to come into focus around the volume-to-value transformation in physician compensation. Quality-based compensation is fraught with challenges—quantifying value as compared to physician productivity is foreign to many. Also, missteps in the implementation can wreck the entire process.

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Topics: Physician Compensation, Value-Based Care

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