The average physician employment contract exceeds twenty pages, not including exhibits. While they all include basic terms related to compensation, length and restrictions, many simply do not contemplate important terms that have serious impacts on physician’s daily lives. A physician’s first employment contract is the most significant financial decision of their lifetime. The same can be said for each subsequent contract, which means that understanding, and negotiating, your contract is the most valuable investment you can make prior to entering into a contract.
To understand what’s in your employment contract, simply read it over a few times. To understand not only how those terms affect you, but also what isn’t in your contract, hire an experienced health care lawyer.
The Medicare Access and CHIP Reauthorization Act was enacted to replace the flawed sustainable growth rate (SGR). MACRA contains performance measures for new payment models that will go in place in 2017. MACRA also established the Merit-Based Incentive Payment System (MIPS).
Physicians have to begin to learn about MACRA to improve performance and to avoid payment penalties.
We also have the Physician Quality Reporting System (PQRS), which penalizes providers for failing to report quality measures data on Part B services. To avoid a 2018 PQRS payment adjustment, for instance, providers have to report for a 12 month period.
There is also the Value Based Payment Modifier (VM) program that rewards groups for providing high quality, low cost care. It’s interesting to note that CMS proposes to publically report those providers who receive an upward adjustment. It’s being waived for Pioneer ACOs. It’s interesting to note that the measures used for the VM program are different than those used for ACOs; and this is causing a lot of confusion.
Bottom line: an increased use of benchmark establishment for quality and cost and financial incentive programs to achieve or surpass those benchmarks.
STARK LAW CHANGES
A new compensation arrangement exception is established for timeshare arrangements for the use of office space, equipment, personnel, items, supplies and other services. This sort of “overhead sharing” arrangement is done, but there hasn’t been a specific Stark provision for it till this year. It’s expected to be particularly useful in physician/hospital arrangements.
This exception amplifies the existing requirements that such arrangements must (1) be located where the physician or practice sees its patients, and (2) be used for designated health services that are incidental to what the doctor does, meaning E&M services and DHS that are provided at the time of such E&M services.
Medical Directors are used in an administrative capacity to oversee all medical services and care, specifically referring to substance abuse programs and services. Increasingly, commercial healthcare plans are targeting their role in addictions treatment facilities and denying payment of claims based on audit findings that Medical Directors in Florida may be responsible for far too many treatment facilities and too many patients.
Does Florida have any specific requirements or published guidance on the number of treatment facilities or number of patients for which responsibility falls to the Medical Directors in addictions treatment?
Florida’s Administrative Code directed to substance abuse programs and services does not have any directive which talks about a restriction on the number of facilities or patients recommended for oversight by a Medical Director. It specifies that addictions receiving facilities, detoxification, intensive inpatient treatment, residential treatment, day or night treatment with host homes and medication and methadone maintenance treatment must designate a Medical Director who oversees all medical services. This Medical Director must hold a current license in the state of Florida.
Health law is the federal, state, and local law, rules, regulations and other jurisprudence among providers, payers and vendors to the healthcare industry and its patient and delivery of health care services; all with an emphasis on operations, regulatory and transactional legal issues.