Assessing Your Employment Options KarenZupko & Associates, Inc. 625 North Michigan Avenue, Suite Chicago, Illinois 60611 Phone: 312.642.5616 Fax: 312.642.5 5571 2225 December 2015 DSUS/INS/1215/1489b 1 08/ /16
What Are Your Goals and Tolerances? Control Own Destiny JOIN A GROUP HOSPITAL Revenue Potential Deal with Business Issues Meetings and Bureaucracy Politics Work-life balance Collegiality 1
Group Practice Values and Culture VALUES AND CULTURE What is the group's vision for how it cares for the community? Can you give me an overview of the governance policies? What is the philosophy around call coverage, work-life balance, and spending time with family? What investments have been made/are being made to improve patient satisfaction and convenience? How would you describe the leadership of Dr. Senior/Managing Partner? What are 3 or 4 words that describe the way the physicians treat the staff and the manager? How would you describe the working relationship among the partners? What qualities of the physicians are most appreciated by the staff? What are the things you enjoy most about working here? What do you enjoy least? If you needed (specify a surgical procedure that is difficult, risky that several of them do), which one of these surgeons would you select to operate on you and why? Do all of the physicians in this group operate under the same set of clinical management guidelines for (specify types of procedure(s)? Would you have anyone of the physicians in this group operate on you or your family members? 2
Group Practice Finance & A/R FINANCE AND A/R What are the practice's Days in Receivable and Net Collections Rate? Will you share the P&L and balance sheet with me? Are there any capital projects being discussed or in process? Have there been any recent tax audits? What is the shareholder loan policy? Any big ones outstanding? What is the retirement policy including any pull-back policies. Any specific age? How funded? Malpractice policy and claim history? Any capital reserves? What is the group s debt history? Line of credit? Borrowing power? 3
Group Practice Operations OPERATIONS What are the specifics around call coverage? Expectations? Ratios? Call pay? Which computer systems and other technologies are used? (PMS, EHR, appointment reminders, patient portal, payment tech). What new technologies are planned? What is the practice policy on e-mailing with patients regarding care? Who does the coding? Is there a shoulder specialist? What is the physician s participation in the process? Does the practice conduct internal coding reviews? Are staff trained annually? What s the expected turnaround for op notes, charting? Does each physician code his/her own cases? How are surgical and other hospital service codes/charges get communicated back to the staff for billing? Do you believe that the chart documentation of all of your associates would pass an audit? Does the practice collect patient responsibilities at the point of service? Pre-surgical deposits? Recurring payment plans. What are the scheduling protocols? Are templates used? How are new patients distributed among the physicians in the group? Who does the credentialing and how will I work with her/him? 4
Compensation Package Salary $ Health Insurance $ Life Insurance. $ Disability Insurance........ $ Malpractice Insurance... $ Pension Contributions... $ Automobile Expenses... $ Cell Phone... $ Educational Leave.. $ Educational Tuition. $ Journal Subscription(s).. $ Vacation... $ Holidays... $ Professional Society Dues.... $ Hospital Staff Fees. $ Parking.. $ Research Stipends & Honoraria... $ Call/Trauma per Diem.... $ Other.... $ TOTAL $ Bonus $ Moving Expenses (one time).... $ GRAND TOTAL $ 5
Group Compensation Options PRO Simple and understandable. Fosters group think. Supports lower paid subspecialty physicians. Eliminates any incentive to avoid non-revenue producing work, e.g., leadership of group, hospital or specialty society. Eliminates competition for patients and referral sources. Eliminates any incentive to avoid low-fee patients. Equal Shares CON Requires all MDs to have roughly the same production, or higher producing MDs to support lower producing. Minimizes incentive to increase your production or efficiency. PRO Incents hard work. Rewards individual success. Stimulates group energy. Easily measured. Productivity CON Fosters internal competition. Antithetical to group think. Incents avoidance of low-pay patients. Discourages lower pay subspecialties. (e.g., pediatric) Incents avoidance of non-revenue producing work. Could tempt churning or overcoding. 6
Group Comp pensation Options (Continued) PRO Best of both worlds. Enough equality to foster group think, with production incentives achieved via the balance. Hybrid CON Difficult to agree on appropriate equal share %. Difficult to agree on appropriate equal share %. Cost Allocation (Can be added to Equal Shares, Productivity, or Hybrid) PRO CON Deals with the important area of More complex. expenses, imposing them on the physicians incurring them. Can generate disputes as to proper expense category allocation. Incents utilization efficiency at the individual physician level. How Cost Allocatio on Works: Fixed costs: Shared equally (operating overhead) ). Variable costs: Allocate by relative production. Direct costs: Allocate to MD for whose benefit they were incurred. 7
Group Compensation Options (Continued) Non-Clinical Services (Can be added to Equal Shares, Productivity, or Hybrid) PRO Rewards and encourages nonrevenue producing work. Incents development of reputation-enhancing assets to the group. CON More complexity. Introduces an arbitrary value or hourly rate concept, which can be contentious. Reduces revenues in the equal share or productivity pools. 8
OPERATIONAL AND MANAGEMENT DETAILS Who is managing the practice? What is her/his experience? Do you have a say with personnel? Process? What reports and data will you receive? How do you participate in the management of your department? BILLING AND COLLECTIONS Do the billing people know your specialty? Do they receive annual coding training? What are the systems for denial management and account follow up? ADMINISTRATIVE RESPONSIBILITIES How many meetings? Committee responsibilities? QUALITY On what quality metrics will you be measured? Bonus impact? How is your patient improvement/satisfaction measured? How can you impact/improve satisfaction are there mechanisms for this? How do they define citizenship if you are measured on it? 9