Issue link: https://beckershealthcare.uberflip.com/i/351959
32 Clinical Integration & ACOs T he increasing employment of physi- cians by hospitals and health systems has heightened the importance of un- derstanding physician employment contracts for providers. Below are a few areas of importance in every physician employment agreement. 1. Work/call schedule Every physician contract should include the ex- pectations and requirements surrounding the physician's work and call schedule. This includes specifying the days to be worked and the hours required to be present at each location. Many con- tracts will specify a minimum number of required of hours per week but fail to include a maximum. Also, if the physician needs, or is required, to have protected administrative or research time, this should be included in the contract. As lifestyle becomes increasingly important for the next generation of physicians, call require- ments are one of the most often negotiated terms in physician contracts. It is important that the call pool is defined, as well as how call is allocated between those in the pool. The contract section regarding call coverage should be clearly defined so it is easy to understand what the physician is responsible for covering, including evenings, weekends and holidays. 2. Equipment/space/ personnel If the hospital or health system has not employed the physician's specialty in the past, this section of the agreement will need to be reviewed carefully. Generic language, stating that the employer will provide all necessary space, equipment and per- sonnel may not be sufficient. Healthcare administrators are already aware that equipment can be very expensive; the physicians' leverage in acquiring the equipment will be most effective prior to signing the employment con- tract. The hospital should also appreciate under- standing early on what capital outlays will be nec- essary if the physician hire is made. Staffing personnel is also important to clarify in the agreement. If having a physician assistant or scribe is a requirement, this should be detailed in the contract. 3. Malpractice insurance Most, if not all, physician employment agree- ments discuss malpractice insurance coverage. The type of coverage and amounts should be defined. If the type of coverage provided is a "claims-made" policy, there should be further language that discusses who is responsible for providing tail coverage upon termination or ex- piration of the agreement. The cost of tail coverage can be paid entirely by the employer, entirely by the physician or split be- tween the two. Often, a vesting schedule is used to slowly shift the burden from the physician to the employer over a number of years. Another com- mon feature is to have the cost paid by the party who terminates the agreement. 5 Key Provisions in a Successful Physician Employment Contract By Sidney Christiansen, MD, Founder, Resolve Physician Agency T he following statistics or study findings about ACOs help paint a picture of the model today, in terms of prevalence but also in function. The following provides an update on the number of ACOs today, the most common contracts and what entity — physician groups or hospitals — are lead- ing the model. Also, find stats for some of the trends within the ACO model itself, such as surgeons get- ting placed on the backburner and the majority of beneficiaries leaving their ACOs for specialty care. 1. The number of ACOs in the United States now exceeds 600. A May analysis from Salt Lake City-based Leavitt Partners identified 626 ACOs around the country. 2. The total number of ACO-covered lives is ap- proximately 20.5 million, according to Leavitt Part- ners. Another way to measure the number of people impacted by ACOs is to count the number of pa- tients that are served by providers participating in an ACO. Though the provider is not actually at risk for the majority of their patients, there is the pos- sibility that all patients will benefit from the organi- zation's participation in accountable care. Using this method, researchers at Oliver Wyman calculated that ACOs serve between 46 and 52 million patients. 3. Most ACOs are through federal healthcare programs: 329 of the 626 ACOs have government contracts, 210 have commercial contracts and 74 have both, according to the Leavitt Partners anal- ysis. (The other 13 have not yet made specific an- nouncement about their contracts or are still in the finalizing process.) 4. A little more than half (51 percent) of ACOs were physician-led last year, according to a re- cent study in Health Affairs. Thirty-three percent of the ACOs were jointly led by physicians and hospitals. 5. Medicare's early ACOs have put little empha- sis on surgical care, even though it accounts for roughly half of hospital expenditures. Research- ers examined how surgical care has been orga- nized in the initial 59 Medicare ACOs and how surgeons are being engaged, if at all. When asked to indicate the priority that they were placing on various objectives during their ACO's first per- formance year, only 10 percent ranked the goal of reducing unnecessary surgery as a high or very high priority. On the other hand, 97 percent of re- spondents considered reducing avoidable hospital readmissions as a high or very high priority. 6. The majority of beneficiaries assigned to an ACO left it for specialty care, according to a study published in JAMA Internal Care. Among ACO-assigned beneficiaries, 8.7 percent of office visits with primary care physicians were provided outside of the assigned ACO, and 66.7 percent of office visits with specialists were provided outside of the assigned ACO. 7. Most physician practices have not joined ACOs. Researchers surveyed 1,183 physician practices, finding 35 percent of the physician groups have already joined an ACO or plan to join one soon, and 60 percent did not join an ACO and have no plans of joining one. 8. Seventy-five percent of healthcare providers participate in at least one type of value-based payment model, according to a report from Availity, a revenue cycle management and busi- ness solutions provider. n ACOs by the Numbers: 8 Recent Statistics and Findings By Molly Gamble There are now more than 600 ACOs in the United States.