By Pascale Dargis, guest blogger from Ludi
Physician contracts have a variety of nuances that make it difficult to manage them over time. From a compliance standpoint, this means that even if the agreement has been properly written and signed by all necessary parties, there is still a lot of maintenance work to be done until the agreement expires. Here are the ways in which these living documents should be better managed once they’ve been co-executed.
Request and review time log submissions. The agreements should clearly outline a process for physicians to submit their time. It can be done on a templated piece of paper or excel file, but ideally it will be done through an application that can be used in real-time. The contract should say how often the submissions of time should be made. This makes it easier for all levels of approval to review the details of the submission with the details in the original document. Without these submissions, it’s impossible to know if a physician is being paid correctly and on time. This process should occur on a realistic schedule, but should take place until the contract ends.
Understand and approve duties. Any lawyer will tell you why it’s critical to clearly define duties within an agreement. This is great practice and helps all parties understand the functional role a physician will be working on. Duties can, however, be a double-edged sword since they are 100% necessary, but can be so complex, it’s nearly impossible to verify and pay out correctly. For example, let’s take an on-call agreement.
If a physician receives one payment amount to be on-call during weekdays and is paid a higher amount during weekend shifts, how is this being reconciled using the time log submissions? If the approval process is to review the original agreement next to the time log and also look at the on-call calendar to verify the physician actually worked that day, there is a lot of room for error but also for improvement. Simplifying duties to better manage them over time will help immensely, though they still need to be submitted on a time log and adjudicated for payment.
Make more accurate payments. Treating physician administrative agreements like living documents will without a doubt make your payments to physicians more accurate. If you’re going through the appropriate approval process using the original contract alongside time logs and accurate duties, the math becomes simpler.
Have a defined ‘audit trail’. By simply including the request for a time log submission, your organization is building up a ‘paper trail’ that can be tied back to the original contracts and can be used to in case of an audit, but also to think through the kinds of changes you can make to agreements. An example here might be that a physician receives a monthly stipend payment for 10-hours of work, however he continuously submits 8-hours on average. Perhaps a determination would be to amend the original agreement so that only 8-hours are being paid to the physician for his time.
Revisit the Fair Market Value. When you negotiated the contract, hopefully, you documented that the payment was FMV for the services being provided and considering your organization’s characteristics. As part of treating the arrangement as a living document, as the needs for physicians change, be sure that the contract still fits within the FMV definition that was approved when the contract was put into place.
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