Hospital Employment v Private Practice. Las Vegas, Nv December 2014

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1 Hospital Employment v Private Practice Orthopedic Summit: Emerging Techniques Practice Management Course Las Vegas, Nv December 2014 Louis F McIntyre, MD, PC 311 North St Suite 102 White Plains, NY 10605

2 Presenter Disclosure Louis F McIntyre, MD Disclosure Information Information The following relationships exist: Stock Options: Tornier Medical Speaker Fees: Depuy-Mitek Research Grant: Depuy-Mitek Board Member: AANA, AIM, FairHealth PAB Member Coding, Coverage and Reimbursement Committee of AAOS

3 Hospital Employment 2012 AAOS Survey 9.1%

4 Is Hospital Employment of Orthopedic Surgeons a Good Model? Not ALL Markets are the same! Not ALL Hospitals are the same! Not ALL Orthopedic surgeons are the same! Not all CONTRACTS are the same

5 What you can count on. THE TOP TEN 1. Loose all leverage AFTER you sign so use it up front 2. Once you sign, you are a COMMODITY and will be treated as such 3. You will loose the ability to control your practice and patient care environment

6 What you can count on. 4. People with less knowledge of orthopedic practice management will make decisions about your workplace 5. Your opinion on this will be discounted 6. In the long run, that may hurt your salary

7 What you can count on. 7. You will be measure by RVU productivity and quality metrics 8. Avg physician loses ~20% productivity as an employee 9. Your ability to track productivity is dependent on hospital reporting and documentation

8 10. Second Contract Widespread concern that 2 nd contract will not be as favorable as the first There is always someone willing to do it for less.. We own you now The further you get form a private position the harder it may be to return

9 FIRST, think about what happens if you decide to leave. Consider the non-compete What happens to your OLD records and how will you access the hospitals?? Can you bring employees? Are YOUR patients YOURS? Can you contact them?

10 Hospital Employment: Orthopedic Perspective Negotiations: Maximize your leverage, you lose it when you sign! Even if stressed, remember AND KNOW your total value to the hospital Know MGMA benchmarks for compensation and understand practice valuation methodologies Get info on the hospital finances and case volumes; they will ask for this info from you!

11 Hospital Employment: Orthopedic Perspective Negotiations: Who are you negotiating with, what is there background? Speak to docs that have negotiated with that person in the past DO NOT ACCCEPT that something is NON- NEGOTIABLE Get info on the typical contract prior to initiating discussions

12 Hospital Employment: Orthopedic Perspective Negotiations: Always consider multiple opportunities; look for the best deal Should you negotiate as an individual, or a group? If you are a high earner, maybe better to negotiate alone.

13 Contract: Hospital Employment: Orthopedic Perspective Governance Issues are Key! What type of input will you have in the management of the practice? Try to establish a stable productivity assessment, RVU values change and may affect you salary What if any outside work do you do (IMEs) and will you be able to continue to do this? Will they cover society dues, hospital staff fees, parking, etc

14 Contract: Hospital Employment: Orthopedic Perspective Why accept non-compete, especially if you leave and still do cases at their hospital Pay attention to the termination clauses. You may want to get out of jail! Avoid Loan clauses Look for 1099 clauses Consider that if you leave THEY collect your AR!!

15 What is an Orthopedic Surgeon Worth??

16 Compensation Data: FTE without Ancillary Services Year MEAN MEDIAN 75th% 2006 $353,253 $323,080 $398, $343,648 $338,462 $410, $424,374 $411,503 $487, $450, ,716 $511, $468,987 $441,602 $529, $483,995 $470,917 $656, $470,938 $462,651 $611,278

17 Compensation Data: FTE with Ancillary Services Year MEAN MEDIAN 75th% 2006 $467,638 $445,788 $507, $472,006 $458,124 $543, $513,342 $490,419 $578, $556,801 $517,157 $658, $590,099 $573,109 $660, $600,558 $600,737 $800, $598,500 $572,738 $771,863

18 Hospital Employment: Orthopedic Perspective Loss of Autonomy Loss of Economic Control Loss of Staffing Issues Loss of Strategic Planning Frustration at Living Through Obvious Poor Decisions Uncertainty of Future Contract Terms Employment is a bad model!

19 On Hospital Employment Perhaps a better model is the joint venture Doctors contract with hospital to provide orthopedic services

20 Management Services Organization MSO Maintain all Practice Infrastructure Maintain all Practice Personnel Contract (Separate from Employment Contract) with Hospital for Services Needed to Operate Practice

21 Contractual Model Relationship defined by contract Time-share lease Based on Fair Market Value (FMV) of services provided No joint MD-hospital board MDs can participate in governance through advisory committee

22 Hospital Board Group A $$ Management fee Group B Management Co LLC $$ Hospital Indies Service Line Management Fee: % fixed, % performance

23 Thank You!!

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