6.26.20
![管理安排和医疗董事网](/Areas/CMS/assets/img/blank.gif)
Most hospital executives are at least familiar with the term “comanagement arrangement,但这个概念对不同的人有不同的含义.
一般来说, a comanagement arrangement is an agreement under which physicians contract with hospitals to manage care delivery for a given service line in partnership with hospital administration. The physicians are involved in managing daily operations and incentivized to achieve target goals for agreed-upon performance measures.
但在探讨管理安排的细节之前 is,了解它是什么可能会有所帮助 不. 具体来说,管理安排不是医疗董事. A medical director provides leadership to the service line and assists with operational, 财政, 人力资源管理.
While a comanagement agreement includes the same services, it goes further. Physicians involved in a comanagement arrangement are able to offer more in-depth services than a single medical director could and are more coordinated with hospital management.
The difference between the terms is neither trivial nor academic—and it can have a direct impact on how fair market value (FMV) is determined.
理解差异
Some cynical observers have described comanagement as “medical directorship on steroids”—a thinly veiled justification to increase medical directorship hours and hourly rates. Such allegations might ring true if comanagement was simply a means for medical directors to make more money while maintaining an operational status quo. But additional compensation for medical directors—even when warranted for achieving extraordinary results—does 不 transform a directorship into a comanagement service.
A true comanagement arrangement is more than just a few administrative hours provided by physicians, or a third-party management fee where the hospital has little administrative involvement. 如果操作正确, comanagement arrangements can be powerful tools to drive value across an enterprise, 特别是对住院病人. 共同经营 agreements should be structured in a thoughtful way that coordinates services among multiple physicians and hospital leaders. The service line should experience an increase in quality and deliver a more efficient service to patients as a result.
这两种安排可能包含彼此的各个方面, so it is 不 surprising that “comanagement” means different things to different people. The following chart helps illustrate the differences between the two arrangements:
共同经营 | 医疗管理者的职位 |
薪酬是基于业绩的. | 云顶集团40011官网的时间是有报酬的. |
通常是一个独立的管理公司 | 补偿直接支付给云顶集团40011官网. |
云顶集团40011官网通常不受雇. | 云顶集团40011官网可以是受雇的也可以是独立的. |
Multiple physicians and members of hospital administration are involved. | 一名云顶集团40011官网担任医疗主任. |
正确估值
Failing to distinguish between a medical directorship and comanagement arrangement will directly impact the valuation of the agreement. A hospital could overpay physicians if a medical directorship is valued as a comanagement arrangement, or could underpay them if the physicians are providing a more comprehensive service offering.
The process of assessing the value of a comanagement arrangement is more complex than it is for a medical directorship on account of the additional providers involved and coordination required in executing the agreement. 医疗主管职位的价值通常基于工作时间.
Failure to appropriately value your arrangements can have two major impacts.
一分钱一分货
A comanagement arrangement without the proper incentives can function as more of a medical directorship. 在FMV和CR观点中,激励指标经常被忽视, 评估人员应该仔细审查它们. Health systems are unlikely to see a positive shift in service line performance if compensation is 不 sufficiently tied to the incentive component, or if performance is already at the target metric and no improvements need to be made. Performance measures must be based on some level of improvement to the service line; otherwise, 云顶集团40011官网拿薪水是为了维持现状.
政府的审查
Organizations that fail to appropriately structure and value comanagement arrangements can run afoul of federal regulations. 2018年8月,威廉博蒙特医院被勒令支付84美元.5 million to settle false claims act allegations arising from improper payments to referring physicians. The government cited a whistleblower who stated that cardiologists were provided medical directorships in which little to no work was performed, 这些钱的真正目的是为了引荐.
Part of the issue in the Beaumont case stemmed from the hospital paying for medical directorships separately from the comanagement arrangement—a commercial reasonableness concern, 因为组织更有可能为相同的云顶集团支付两次费用. 因为基本收费云顶集团非常相似, medical directorship duties are often included in the comanagement agreement. If medical directorships are paid separately from the comanagement arrangement, then organizations run the risk of stacking services and paying for services where 不hing was provided.
跟上你的管理安排
因为管理协议是, 从本质上说, 旨在推进特定的性能目标, service line executives should review the performance metrics on an annual basis. 度量标准是改进了云顶集团线还是只是维护了它? 如果云顶集团线路没有改善, then physicians should 不 continue receiving payment for performance metrics.
另外, 如果期望管理实体对云顶集团线进行转换, 云顶集团40011官网应该得到更多的补偿. But this arrangement should 不 be continued into perpetuity; if incentive compensation is being paid, 这意味着达到了绩效目标, 因此, 应该为下一个安排年制定新的目标.
考虑到这些安排的复杂性, 以及他们的目标随时间改变的可能性, comanagement agreements should be periodically reviewed by an independent appraiser to ensure FMV and CR are being met.
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