Here are our responses to some critical questions we have been asked by some of our subscribers relating to the unfolding COVID-19 crisis.
Question: Can we increase the hours that are defined in various physician contracts to address our response to COVID-19?
Answer: Yes. The response to a public health emergency is an extraordinary circumstance that can justify waiver of the Stark ‘set in advance’ guidelines.
Question: Can we compensate physicians for higher than our standard hours or hourly rates, if necessary, to secure needed services related to COVID-19?
Answer: Yes. These efforts epitomize the kind of extraordinary circumstances that reasonably allow for normal benchmark limits to be exceeded to secure needed physician services. In standard valuation practice, typical compensation benchmark guidelines are between the 25th to 75th percentile of market rate benchmarks, or in some cases up to the 90th percentile. Your organization should consider its current internal guidelines and determine if conditions require efforts above and beyond standard payment terms.
Question: How should the principle of allowances for extraordinary circumstances be translated into practice?
Answer: Consider and execute the following:
- Adjustments to compensation should be documented as directly connected to the COVID-19 response.
- Adjustments should be clearly defined as temporary with applicability only until the heightened response is no longer required (with a provision for periodic review).
- Work hours and compensation rates can exceed the 75th percentile or even the 90th percentile as indicated by sound justification of the need for services, and prudent negotiations that reflect reasonable judgement.
Question: What service benchmarks are relevant to this extraordinary event?
Answer: This depends on the hospital and how you are responding to the crisis. Some positions that we think may be relevant include infectious disease-related positions, medical directors of service lines such as emergency services, internal medicine hospitalists, OB and critical care. Similarly, hourly rates for urgent care or outpatient clinic staffing may be useful.