OVERVIEW

Iroquois members are faced with a growing physician shortage. It is increasingly difficult to attract and retain physicians to the Upstate New York region for many reasons. As one strategy to address this shortage, Iroquois member hospitals are expanding their activities in employing physicians. Hospitals are positioning themselves to become integrated delivery systems in anticipation of future changes in reimbursement where payment for hospital and physician services will most likely be bundled. Your hospital association is well positioned to deliver solutions to you in this area to assist you with the many challenges that arise when employing physicians. We are pleased to introduce a suite of services for you to consider as you employ physicians.  We call our program Integration Services for Hospitals and Physicians.

CORE SERVICES

W-2 PARTNERSHIP SERVICES- Provides assistance for hospitals in working with private practicing physicians to consider an employed relationship.

Consulting Process:

1. Qualitative Phase- A UI Select (UIS) consultant will meet with principals of the medical practice to gain an understanding of a group's concerns and business interests.  Included is a joint meeting with hospital leadership and physician group principals to outline structure and benefits of an employed relationship and to outline the feasibility process.
2. Practice Audit-To assess overall practice efficiency and to identify opportunities for enhanced revenue and profitability through operating expense, reimbursement, billing and collection, and provider productivity enhancements.
3. W-2 Partnership Modeling- This outlines for a physician what life would be like in an employed arrangement.  Pro forma financial projections of the group's performance under an employed structure are developed; each physician is shown what income may look like as an employed physician, compared to what the physician is currently earning. The Pro forma also outlines what the hospital's working capital needs will be and outlines a business plan and timeline for developing the employed program. This program allows both the hospital and prospective physicians to make an intelligent decision on the relationship for the future.

PHYSICIAN WORKFORCE PLANNING SERVICES- Hospitals are faced with very high costs in recruiting and attracting qualified physicians to the area to meet patient needs. This service will generate a market assessment as part of a physician workforce review to properly determine physician needs and priorities and forecast the impact of recruiting specific physician specialties on expanding the hospital's revenue.

Consulting Process:

1. Market Assessment Review- Evaluates market demand and a hospital's market share by geographic area to determine opportunity.  Specialty demand and surgical demand are identified to determine surgical and specialty resource needs.
2. Quantitative Physician Assessment- Provides an inventory of primary care, medical specialty, surgical specialty, and hospital-based specialty resources by age, full/part time status, and geographic location; Physician requirements are projected by current and 5 year needs. The needs projection covers primary, surgical, and hospital-based needs.
3. Qualitative Physician Assessment is performed to get input from face to face interviews with hospital medical staff.

FINANCIAL AND OPERATIONAL REVIEW OF EXISTING HOSPITAL-BASED PHYSICIAN PRACTICES- On average, hospital employed physician practices operate at a loss, with the amount varying as a function of specialty. This review identifies which factors are negatively impacting financial performance, quantifies the fiscal impact of each issue, and outlines specific initiatives that will enhance a medical practice's overall financial performance.

Consulting Process:

1. Operating Expense Review- This review process analyzes staffing requirements, facility needs (on a cost per provider/cost per square foot basis), and other operating expenses.
2. Provider Compensation and Production Review- This review analyzes provider productivity and compensation against national standards and regional benchmarks.
3. Third Party Reimbursement Review-This review compares coding practices to both internal and external peer group and national benchmarks and quantifies the fiscal impact of changes in coding practices. The group's charge master structure, payer mix, and collection rate by payer are reviewed, and the top 20 CPT codes and top 5 payers are reviewed. Reimbursement is profiled as a percentage of Medicare for each payer.
4. Billing and Collection Review-Perform a review where front end operations are analyzed to assess adequacy of charge capture processes as well as charge lag timing and cash collection processes. In addition, the back end operations are assessed to evaluate adequacy of third party denial management, account follow up procedures, and account turnover procedures. The group's overall accounts receivable management is measured in terms of number of days of A/R and percentage of days over 120 days.

REIMBURSEMENT ANALYSIS OF HOSPITAL AFFILIATED MEDICAL PRACTICES-As part of the development of hospital affiliated medical practices, hospitals typically set up a nonprofit professional corporation or directly employ the physicians as hospital employees. Changes in Medicaid reimbursement plus the addition of hospital affiliated specialty physicians has warranted a new review as to whether the current corporate structure is maximizing government funded reimbursement.

For hospitals with primary care providers practicing in health professional shortage areas, cost based reimbursement is also a possibility.  

1. This program models the fiscal impact of new models of physician organization to determine whether a hospital should convert the hospital's employed physicians to an alternative corporate structure. 
2. The program models the reimbursement that the hospital would receive for physician services as a nonprofit professional corporation from both a Medicaid and Medicare perspective, and models this same reimbursement under a direct employment relationship.
3. In addition, the program helps to determine whether a hospital's primary care practices are in a qualified HPSA, MUA, or state governor designated underserved area.
4. The program also models the fiscal impact of cost based reimbursement for both Medicare and Medicaid.

For more information about our Integration Services for Hospitals and Physicians, please contact:

Edward J. Enos MS RPh, CMPE

United Iroquois Select, LLC

Phone 518.348.7435

Email eenos@iroquois.org