A medical billing company that never sleeps !
The prospect sounds appealing: Your local hospital or hospital-owned
medical group makes you an offer to join them. Money up front, the
practice is run for you, reduced calls, no payroll, no expenses — you
just do what you were trained to do and still get financially rewarded
for doing well. Whether you go with a group or as a solo, the precedent
is already well established — 65 percent of physicians are already
similarly employed, a number that is rapidly approaching 75 percent.
A
proposal is made and an agreement tendered. Assets are purchased, debt
goes away, and you have guaranteed income, performance incentives, and
benefits. It seems like heaven on earth, but the devil lives in the
details. Dense and often misinterpreted small print rises to get you
when you least expect it. But it is not just the small print; it is far
more often the plain, unambiguous terms and conditions having to do with
compensation that create problems.
Performance clauses are the most common cause of disputes and
disappointments, particularly when compensation includes bonuses
dependent on revenue-based goals. Not because they are unrealistic, and
most often not because of the physician, but because there is often
little or no marketing support, and little appreciation for the impact
of payer mix because hospitals are reimbursed more generously than
physicians.
Things are fine at first — the patients that follow
you will make your initial payer mix more balanced but, over time, as
your original patients thin out by attrition, the void is typically
filled with lower reimbursing patients through the general referral
system.
Complicating matters, hospitals are generally not very
good at collecting deductibles and copays, causing your accounts
receivable to mount, further impeding accessing performance incentives.
Further, hospitals are also quick to send past due amounts to
collections, alienating many patients and giving others incentive to
drift to other physicians, further diluting patient volume in the most
critical area, private insurance.
It gets harder and harder to achieve incentive income until, as often happens, you don’t.
These
are an often repeated laments, and ones that are difficult to remedy.
The obvious choice is to avoid the situation in the first place,
however, with precedent having been set by predecessors, it is easier
said than done. It’s no one’s fault, nor is it everyone’s fault, it’s
just business
.
The good news is that there are steps you can take to protect your interests:
•
Talk to physicians and staff already in the group. If they are happy,
be wary — you probably will be too, but only if you get the same deal.
If they are not, you don’t want the same deal.
• Don’t use your
regular attorney unless they are expert in negotiating physician
employment agreements. Hire a specialist to represent you, attorney or
not, with as much experience in negotiating hospital and medical group
employment agreements as you can find. They will know how to avoid terms
and conditions that may cause you to regret your decision.
• DO NOT get directly involved in the negotiations or discussions. Ever.
Let your representative do that. Your job is to approve terms and
conditions when you are comfortable with them, or when you believe you
have gotten the best deal to be had. Negotiations can be contentious.
Let any animus remain between administration and your representative.
Stay back, smile, be friendly, be reasonable — you’re the one that has
to work there for years to come. The hospital or practice negotiator
will rarely be the decision maker. There is good reason for that. Any
negotiator that does not need approval from others is at a substantial
disadvantage. That would be you without representation
• Make the
change for the right reasons. If, for example, you are leaving a
partnership because of the politics or issues with managing partners,
keep in mind that politics equally exist in the workplace, and you can
rarely effect a change in management as an employee. If you are leaving
because you are seeking stability, a better quality of life and relief
from the burden of running a practice, and are willing to trade control
and some upside in compensation for eliminating the downside, you are
likely making a good decision.
Thanks For sharing!!!
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