Critical Care Agreements: Key Considerations

Critical Care agreements represent formally organized services staffed by intensivist physicians with special training (usually pulmonary and/or critical care) to manage acutely ill patients in a critical or intensive care unit. Physicians are contractually obligated to spend a portion of each day on-site in the ICU serving as the primary attending physician for patients receiving critical care in the hospital. Critical and intensive care coverage contracts are most common in larger hospitals. Many hospitals only pay for medical direction for critical care units, but some pay for coverage.

Key Factors to Consider in Contract Analysis:

  • What is the average daily census of patients covered by the service and what fraction of the hospital’s total ICU census is attended or covered by the contracted physicians?
  • For those patients not attended by contracted physicians, is there a payment arrangement with the hospital?
  • Are the contracted physicians required to be board-certified in critical care, pulmonary critical care, or surgical critical care?
  • Is there an electronic ICU (eICU) service that provides back-up or after-hours coverage?
  • Is the in-house coverage requirement for less than 6 hours per day or 42 hours per week?
  • Is the proportion of Medicaid, Medicare, or unsponsored patients extremely high or low?


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