Download PHYSICIAN EMPLOYMENT - Indiana Rural Health Association

PHYSICIAN
EMPLOYMENT
Heather F. Delgado
Partner
CONFIDENTIAL © 2014 Barnes & Thornburg LLP. All Rights Reserved. This page, and all information on it, is confidential, proprietary and the property of Barnes & Thornburg LLP, which may not be disseminated or disclosed to any person or
entity other than the intended recipient(s), and may not be reproduced, in any form, without the express written consent of the author or presenter. The information on this page is intended for informational purposes only and shall not be
construed as legal advice or a legal opinion of Barnes & Thornburg LLP.
PROS & CONS OF
PHYSICIAN EMPLOYMENT
CONFIDENTIAL © 2014 Barnes & Thornburg LLP. All Rights Reserved. This page, and all information on it, is confidential, proprietary and the property of Barnes & Thornburg LLP,
which may not be disseminated or disclosed to any person or entity other than the intended recipient(s), and may not be reproduced, in any form, without the express written consent of
the author or presenter. The information on this page is intended for informational purposes only and shall not be construed as legal advice or a legal opinion of Barnes & Thornburg LLP.
2
PROS
• May help with recruitment of specialists.
• Can bring greater stability to a specific medical
specialty.
• Can financially incentivize physician productivity
and quality.
• May be more effective way to recruit young
physicians.
• Hospital costs may be offset by practice revenues.
• May be retention tool.
CONFIDENTIAL © 2014 Barnes & Thornburg LLP. All Rights Reserved. This page, and all information on it, is confidential, proprietary and the property of Barnes & Thornburg LLP,
which may not be disseminated or disclosed to any person or entity other than the intended recipient(s), and may not be reproduced, in any form, without the express written consent of
the author or presenter. The information on this page is intended for informational purposes only and shall not be construed as legal advice or a legal opinion of Barnes & Thornburg LLP.
3
CONS
• Hospital bears ongoing cost of physician.
• Hospital bears risk of operating and capital
costs of practice ownership.
• May cause polarization of medical staff
between employed and independent
physicians.
• Hospital bears costs associated with
recruitment and retention of employed
physicians.
CONFIDENTIAL © 2014 Barnes & Thornburg LLP. All Rights Reserved. This page, and all information on it, is confidential, proprietary and the property of Barnes & Thornburg LLP,
which may not be disseminated or disclosed to any person or entity other than the intended recipient(s), and may not be reproduced, in any form, without the express written consent of
the author or presenter. The information on this page is intended for informational purposes only and shall not be construed as legal advice or a legal opinion of Barnes & Thornburg LLP.
4
EMPLOYMENT
AGREEMENT
PROVISIONS
CONFIDENTIAL © 2014 Barnes & Thornburg LLP. All Rights Reserved. This page, and all information on it, is confidential, proprietary and the property of Barnes & Thornburg LLP,
which may not be disseminated or disclosed to any person or entity other than the intended recipient(s), and may not be reproduced, in any form, without the express written consent of
the author or presenter. The information on this page is intended for informational purposes only and shall not be construed as legal advice or a legal opinion of Barnes & Thornburg LLP.
5
KEY TERMS
•
•
•
•
•
•
•
Duties and responsibilities.
Compensation and benefits.
Term and termination.
Insurance coverage and indemnification.
Restrictive covenants.
Confidentiality.
Miscellaneous.
CONFIDENTIAL © 2014 Barnes & Thornburg LLP. All Rights Reserved. This page, and all information on it, is confidential, proprietary and the property of Barnes & Thornburg LLP,
which may not be disseminated or disclosed to any person or entity other than the intended recipient(s), and may not be reproduced, in any form, without the express written consent of
the author or presenter. The information on this page is intended for informational purposes only and shall not be construed as legal advice or a legal opinion of Barnes & Thornburg LLP.
6
DUTIES & RESPONSIBILITIES
•
•
•
•
•
•
•
Services (where, when and what).
Completion of medical records.
Administrative responsibilities.
Call coverage requirements.
Licensure requirements.
Medical staff requirements.
Board certification.
CONFIDENTIAL © 2014 Barnes & Thornburg LLP. All Rights Reserved. This page, and all information on it, is confidential, proprietary and the property of Barnes & Thornburg LLP,
which may not be disseminated or disclosed to any person or entity other than the intended recipient(s), and may not be reproduced, in any form, without the express written consent of
the author or presenter. The information on this page is intended for informational purposes only and shall not be construed as legal advice or a legal opinion of Barnes & Thornburg LLP.
7
TERM AND TERMINATION
• Evergreen clauses.
• Without cause termination.
• With cause termination.
CONFIDENTIAL © 2014 Barnes & Thornburg LLP. All Rights Reserved. This page, and all information on it, is confidential, proprietary and the property of Barnes & Thornburg LLP,
which may not be disseminated or disclosed to any person or entity other than the intended recipient(s), and may not be reproduced, in any form, without the express written consent of
the author or presenter. The information on this page is intended for informational purposes only and shall not be construed as legal advice or a legal opinion of Barnes & Thornburg LLP.
8
INSURANCE COVERAGE AND INDEMNIFICATION
•
•
•
•
Professional liability and state requirements.
Claims made v. occurrence based.
Tail coverage.
Indemnification (i.e. unlawful activities, HIPAA
breach, etc.).
CONFIDENTIAL © 2014 Barnes & Thornburg LLP. All Rights Reserved. This page, and all information on it, is confidential, proprietary and the property of Barnes & Thornburg LLP,
which may not be disseminated or disclosed to any person or entity other than the intended recipient(s), and may not be reproduced, in any form, without the express written consent of
the author or presenter. The information on this page is intended for informational purposes only and shall not be construed as legal advice or a legal opinion of Barnes & Thornburg LLP.
9
RESTRICTIVE COVENANTS
• State law governs scope.
• Non-competition.
– Reasonable in length of time and geographic.
– Blue pencil clause.
• Non-solicitation.
• Liquidated damages provision.
CONFIDENTIAL © 2014 Barnes & Thornburg LLP. All Rights Reserved. This page, and all information on it, is confidential, proprietary and the property of Barnes & Thornburg LLP,
which may not be disseminated or disclosed to any person or entity other than the intended recipient(s), and may not be reproduced, in any form, without the express written consent of
the author or presenter. The information on this page is intended for informational purposes only and shall not be construed as legal advice or a legal opinion of Barnes & Thornburg LLP.
10
CONFIDENTIALITY
• Prevents taking of patient lists, charts, records
and proprietary information.
• Limits disclosure of terms to third parties.
CONFIDENTIAL © 2014 Barnes & Thornburg LLP. All Rights Reserved. This page, and all information on it, is confidential, proprietary and the property of Barnes & Thornburg LLP,
which may not be disseminated or disclosed to any person or entity other than the intended recipient(s), and may not be reproduced, in any form, without the express written consent of
the author or presenter. The information on this page is intended for informational purposes only and shall not be construed as legal advice or a legal opinion of Barnes & Thornburg LLP.
11
MISCELLANEOUS
•
•
•
•
Governing Law.
Venue.
Boilerplate provisions.
Insurance Authorization/Power of Attorney.
CONFIDENTIAL © 2014 Barnes & Thornburg LLP. All Rights Reserved. This page, and all information on it, is confidential, proprietary and the property of Barnes & Thornburg LLP,
which may not be disseminated or disclosed to any person or entity other than the intended recipient(s), and may not be reproduced, in any form, without the express written consent of
the author or presenter. The information on this page is intended for informational purposes only and shall not be construed as legal advice or a legal opinion of Barnes & Thornburg LLP.
12
COMPENSATION MODELS
CONFIDENTIAL © 2014 Barnes & Thornburg LLP. All Rights Reserved. This page, and all information on it, is confidential, proprietary and the property of Barnes & Thornburg LLP,
which may not be disseminated or disclosed to any person or entity other than the intended recipient(s), and may not be reproduced, in any form, without the express written consent of
the author or presenter. The information on this page is intended for informational purposes only and shall not be construed as legal advice or a legal opinion of Barnes & Thornburg LLP.
13
COMPENSATION
• Total compensation (base salary, bonus, benefits,
deferred compensation) should be consistent with fair
market value of the services provided.
• Cannot take into account value or volume of referrals
or other business generated.
• Commercially reasonable.
• No payments to reduce or limit services to Medicare or
Medicaid enrollees.
• Stark, Anti-Kickback and tax-exempt laws all require
physician compensation arrangements to be FMV.
• Enforcement climate is focused on FMV and
commercial reasonableness.
CONFIDENTIAL © 2014 Barnes & Thornburg LLP. All Rights Reserved. This page, and all information on it, is confidential, proprietary and the property of Barnes & Thornburg LLP,
which may not be disseminated or disclosed to any person or entity other than the intended recipient(s), and may not be reproduced, in any form, without the express written consent of
the author or presenter. The information on this page is intended for informational purposes only and shall not be construed as legal advice or a legal opinion of Barnes & Thornburg LLP.
14
FMV/COMPENSATION
• Determination of fair market value:
– National databases (i.e. AMGA, MGMA, Sullivan,
Cotter & Associates, etc.).
– Data available (i.e. primary specialty, annual
salary, hours worked annually, etc.).
– Use of percentile of reported compensation levels,
state or regional data.
CONFIDENTIAL © 2014 Barnes & Thornburg LLP. All Rights Reserved. This page, and all information on it, is confidential, proprietary and the property of Barnes & Thornburg LLP,
which may not be disseminated or disclosed to any person or entity other than the intended recipient(s), and may not be reproduced, in any form, without the express written consent of
the author or presenter. The information on this page is intended for informational purposes only and shall not be construed as legal advice or a legal opinion of Barnes & Thornburg LLP.
15
METHODS OF COMPENSATION
• Fixed compensation.
• Fixed compensation with productivity and
incentive-based adjustments.
– Revenue minus expenses.
– Pay based on RVUs or other productivity measure.
– Quality and patient satisfaction with wRVU based
outcomes.
– Fixed comp rate per wRVU.
– Graduated scale.
• wRVU compensation.
CONFIDENTIAL © 2014 Barnes & Thornburg LLP. All Rights Reserved. This page, and all information on it, is confidential, proprietary and the property of Barnes & Thornburg LLP,
which may not be disseminated or disclosed to any person or entity other than the intended recipient(s), and may not be reproduced, in any form, without the express written consent of
the author or presenter. The information on this page is intended for informational purposes only and shall not be construed as legal advice or a legal opinion of Barnes & Thornburg LLP.
16
COMPENSATION
• Percentage of Revenue.
– Based on professional revenue (charges and collections).
• Hybrid/Mix and Match.
– Collections.
– Cross Charges.
– Visits/Patient Encounters.
•
•
•
•
•
Benefits.
Sign-on bonus.
Retention bonus.
Quality Incentive Pool.
Mid-Level Provider Supervision.
CONFIDENTIAL © 2014 Barnes & Thornburg LLP. All Rights Reserved. This page, and all information on it, is confidential, proprietary and the property of Barnes & Thornburg LLP,
which may not be disseminated or disclosed to any person or entity other than the intended recipient(s), and may not be reproduced, in any form, without the express written consent of
the author or presenter. The information on this page is intended for informational purposes only and shall not be construed as legal advice or a legal opinion of Barnes & Thornburg LLP.
17
EVALUATION OF EMPLOYMENT
• Availability and costs of recruitment and
retention of employed physicians.
• Resources available to compensate.
• Payor mix of hospital.
• Efficiencies or cost savings from relationship.
• Physicians needs assessment.
• Specialists v. primary care.
CONFIDENTIAL © 2014 Barnes & Thornburg LLP. All Rights Reserved. This page, and all information on it, is confidential, proprietary and the property of Barnes & Thornburg LLP,
which may not be disseminated or disclosed to any person or entity other than the intended recipient(s), and may not be reproduced, in any form, without the express written consent of
the author or presenter. The information on this page is intended for informational purposes only and shall not be construed as legal advice or a legal opinion of Barnes & Thornburg LLP.
18