Doctor deals are great tools for fighting disease. This list identifies 14 types of business deals between physicians, hospitals, and other organizations that fight disease. They are listed in alphabetical order.
1) Ambulatory Surgery Center (ASC) Joint Ventures – ASCs are not a designated health service under the Stark Laws. Patients win when surgeons and hospitals partner together to provide fast, safe, cost-effective elective surgery. Compared to other surgery settings, both infection rates and patients’ out-of-pocket costs are generally lower in ASCs.
2) Call coverage– 24/7 emergency department call coverage ensures that panels of specialists are immediately available to treat patients that show up in hospital emergency departments. Call coverage arrangements provide for physician availability and create great accessibility to medical services for patients with acute needs like appendicitis, heart attacks, asthmatic attacks, and trauma from car accidents.
3) Cardiac Catheterization Joint Ventures – Though outpatient cardiac “cath” is banned in 13 U.S. states, with adequate pre-operative screening, diagnostic cardiac cath can be safely performed in outpatient facilities located in close proximity to a hospital for patients with heart disease, as well as post-transplant patients. Cardiovascular disease is the number one killer of Americans. We need to throw all the resources at it that we can.
4) Clinical management (co-management) – The next evolution of medical directorships involves pay-for-performances arrangements putting compensation at-risk for achieving pre-defined clinical goals. Hospital-based services for cardiology, orthopedics, and other surgical services are commonly managed by physicians under these arrangements to fight cardiovascular disease, hospital readmissions, and cancer.
5) Development Services – Developments of new hospital-based service lines always benefit from ample physician involvement. Buying equipment or building a surgery suite, imaging center, ED, ICU, or inpatient floor are all great opportunities to engage physicians to be part of the design process. Who would know better?
6) Dialysis Joint Ventures – Kidney disease is rapidly becoming one of the most threatening diseases around the globe. Countries like South Africa and Ireland struggle to meet the growing demand. In some countries dialysis service coverage is rationed or reserved just for kidney transplant candidates by nationalized healthcare plans. In the United States, dialysis is covered by Medicare for all U.S. citizens. Dialysis is not a designated health service under the Stark Laws, so nephrologists, hospitals, and national operators can develop and manage dialysis center collaboratively in a free market.
7) EMR Donations – In late 2013, the electronic medical record (EMR) donation Stark Law exception was renewed for several more years. Basically, hospital and health systems can subsidize up to 85% of ongoing EMR costs for independent physician practices without violating Stark or anti-kickback laws. The application service provider (ASP) model is common, whereby all systems are provided through the internet, with no servers in the physician practices. These deals allow patient records, labs, and imaging test results to flow seamlessly between providers.
8) Gainsharing And Shared Savings Programs – Eliminating unnecessary waste enables healthcare organizations to spend more time, money, and resources on providing services that matter. Gainsharing, now sometimes referred to as shared savings, refers to an arrangement between physicians and a hospital, whereby a hospital agrees to share money associated with reductions in the cost of care created by the efforts of the physicians. Though effectively banned, since 1999 the OIG has individually reviewed and approved thirteen gainsharing arrangements through published advisory opinions. The Medicare Shared Savings Program (MSSP) for Accountable Care Organizations (ACOs) grants gainsharing waivers to ACO participants under the Shared Savings Distribution waiver.
9) Independent Diagnostic Testing Facility (IDTF) Imaging Joint Ventures– IDTF imaging joint ventures between radiologists and hospitals are another great way to marry the medical expertise of highly trained physicians with the operational and financial expertise of major healthcare organizations. Having access to great imaging technology and great interpretive expertise is a key component of correctly diagnosing disease.
10) Interpretation – Interpretation contracts are an example of how medical professionals and facility-based services operated by non-physician personnel work together to fight disease. Hospitals and imaging centers often bill globally for imaging services and then negotiation an interpretive “read” fee with radiologists. Additionally, globally billed echocardiograms may be read by cardiologists and EKGs may be read by primary care physicians under contracts.
11) Medical directorships – Medical directorships are contractual arrangements used by hospitals, nursing homes, surgery centers, home health agencies, imaging centers, and insurance companies to ensure the physicians have oversight of health services provided by nurses, technicians, allied health professionals, and business people. Directorships ensure that physicians have leadership positions at healthcare organizations where many services are provided by non-physicians personnel.
12) MSO (managed service organizations) – MSOs provide business services to physician practices, enabling physicians to focus on providing great medicine rather than business issues. Common MSO services include management (finance, accounting), billing, and outsourced human resources.
13) PSAs (professional service arrangements) – The PSA is typically a guaranteed payment to a physician on a service-unit basis (i.e., wRVU, visit, surgery). For example, a hospital may elect to bill insurance directly for screenings and treatment of retinopathy of prematurity (ROP) in premature infants covered by Medicaid and contract with pediatric ophthalmologists to provide the services on demand. Similarly, the same hospital may use PSAs to engage neonatologists or other pediatric specialists to perform hearing tests on newborns.
14) Stipends, subsidies, & collection guarantees – Hospital-based physician specialists are often subsidized to provide continuous medical coverage for mission-critical emergency department services, neonatology, intensive care, anesthesiology, radiology, hospitalist coverage, pediatrics, and others. Support payment arrangements ensure that critically ill patients will have continuous, onsite access to physicians during their hospital stay.