Best Practices to Avoid Stacking

Stacking can be a huge compliance risk for healthcare organizations and physicians. Here are some quick tips to avoid stacking in the first place.

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1. Develop a policy and review process regarding physicians who hold more than one position or perform more than one service with the hospital or affiliated organizations.
2. If physicians are holding two call positions at the same time, set guidelines around how much they can be paid. If they are effectively an employed physician, set an aggregate payment cap from all sources.
3. Ask physicians for time documentation that delineates activities for each role. Time tracking should be standard for all physician administrative positions.
4. As much you can, automate time tracking and coordinate effectively between all parties: physicians, finance, and administration.
5. Don’t pay a physician to take call for two services at the same time. Common service combinations where stacking most frequently occurs:
6. Orthopedic surgery and hand surgery
7. Plastic surgery and hand surgery
8. Non-invasive and invasive cardiology
9. Stroke and non-stroke neurology
10. Trauma and general surgery
11. Ask the physician to sign a statement to certify that his or her private practice cannot be rearranged to avoid lost income. Another way is to monitor physicians’ OR utilization to compare elective volume with and without on-call coverage.

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