Becker's Hospital Review

25 Clinical Integration & ACOs 2. Physicians are paid a base fee with opportunities to earn bo- nuses. In such agreements, physicians are compensated for the time they dedicate to overseeing, managing and sometimes overhauling the care pro- cess. This is a fixed, annual base fee consistent with the fair market value of the physicians' time and efforts. Physicians typically are eligible to also receive certain bonuses if they meet or exceed mutually agreed-upon quality goals. "We generally see a base compensation of $200,000 to $300,000 per year plus incentive compensation payments," says Scott Becker, JD, publisher of Becker's Hospital Review. "Here, the core base fee must be defensible as fair market value and a valuation is needed to support the valuation. Further, the incentives cannot be based on the volume and value of referrals." 3. Co-management agreements should be set up in a way to en- sure compliance with civil monetary penalty and anti-kickback laws. Organizations should take time to ensure their fees and services are of fair market value to avoid legal complications. Many organizations refer to the HHS Office of Inspector General's Advisory Opinion No. 12-22 as a tem- plate for developing a legally compliant agreement. This document assessed a typical co-management agreement of a catheter lab in a hospital and found it to be in compliance with healthcare fraud laws. Several initial issues raised by the opinion were the potential occurrences of "stinting on patient care," choosing to treat healthier patients, steering sicker ones to other hospitals and offering payments to increase referrals. However, the OIG ultimately said it would not impose sanctions for those because analysis indicated physician compensation is fair market value for services provided, physician pay is not dependent on the number of patients treated, and the specificities of the ar- rangement were clearly laid out. 4. Agreements should have a set time limit. Benchmarks and quality goals continuously change, so there is less room for improvement if such mea- sures are not regularly revisited. Additionally, part of the OIG's opinion on the legal compliance of that co-management agreement cited the finite time param- eters of the agreement as a positive factor in its review of the legal compliance. 5. Elements of co-management agreements and bundled pay- ments overlap, but they can still coexist in a hospital for the time being. Both arrangements seek to improve quality while lowering costs by a higher degree of interaction between hospitals and physicians. Physicians earn bonuses for reaching certain quality measures, though the bonuses are calculated in different ways and reward different measures. Co-management agreements are centered on physician management of an entire service line, while bundled payments are focused on specific episodes of care. In the cur- rent market, the two models seem to coexist, though some thought lead- ers project one model may become more prevalent in the years to come. n N early 60 percent of health system and hospital CEOs ranked popu- lation health as the "hardest" skill set to find within the broader healthcare field. The finding is one of many from the American Hospital Association's April survey, "Building a Leadership Team for the Health Care Organization of the Future." After community and population health, executives ranked change manage- ment experience (54 percent), innovative thinking (40 percent) and nontra- ditional health partnerships (39 percent) as the hardest skill sets to find in healthcare. Authors of the AHA report said the perceived rarity of population health skill sets may leave more healthcare organizations seeking candidates from other industries. And as it turns out, executives are seeing a shortage of experience in the broader industry and also feeling the population health pinch within their own C-suites. Forty-eight percent of executives identified community and population health management as a talent gap within their organizations, making it the second-largest talent gap recorded after experience in leading nontraditional health partnerships (54 percent). Some organizations are filling the gap by adding senior-level positions and teams related to population health: 30 percent of respondents said their man- agement team includes a risk officer and 10 percent have a chief population health manager. Also, COOs are taking on more responsibility for population health outcomes and the financial risks of coordinating inpatient care with other providers, according to the report. Organizations may also bring add insurance and risk management experts who can help manage nontraditional risk and risk related to chronic disease manage- ment. Some organizations are also bringing on quality experts who can find ways to improve the quality and consistency of care delivery, according to the report. Findings are based on responses to an online survey of more than 1,100 ex- ecutives, 95 percent of whom were CEOs and 5 percent of whom were strat- egy executives with their organizations. The majority of respondents worked with health systems or community hospitals. n CEOs: Population Health Experience is Hardest Skill Set to Find By Molly Gamble 10 States With the Fewest Primary Care Physicians by Population By Heather Punke M assachusetts has the most primary care physicians by popu- lation, boasting 131.9 active primary care physicians per 100,000 people — but many states are not as lucky, as the nation averages 90.1 primary care physicians per 100,000. Some states have even fewer. The following are the 10 states with the fewest active primary care physicians by population, according to data from the Association of American Medical Colleges' 2013 State Physi- cian Workforce Data Book. 1. Mississippi (63.4 active primary care physicians per 100,000 people) 2. Utah (65.2) 3. Nevada (69.4) 4. Idaho (70.1) 5. Texas (70.1) 6. Alabama (72.8) 7. Oklahoma (75.3) 8. Wyoming (75.6) 9. Arkansas (75.9) 10. Georgia (76.1) n

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