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Building a Cost-Effective Physician Contracting
Compliance Program Using Market Data
May 28, 2014
Allison Pullins, Director
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Outline:
• Introducing MD Ranger
• Identifying high-quality market data
• Finding the appropriate rates with benchmarks
• Documenting FMV with market data
• Using market data vs. a formal valuation
• Quick tips on integrating market data into your physician
contracting program
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MD Ranger
MD Ranger is a market data company that collects non-employed
physician contract data directly from hospitals. Our unique
approach to capturing all contract data from an organization allows
us to not only determine what to pay, but also when to pay.
We help hospitals analyze their internal physician contracting
costs, negotiate competitive rates with physicians, and document
their FMV and compliance with Stark.
Introducing MD Ranger: A
Breakthrough in Physician Contracting
• Calculates benchmarks from high quality market data for broad
range of physician services
• Uncovers potential compliance risks
• Identifies opportunities for cost reduction
• Includes tools to compare a hospital’s internal data to
benchmarks, tools for budgeting
• Generates contract-specific reports for compliance and FMV
documentation
• Provides a foundational resource for hospitals and health
systems looking for high quality, consistent data to support
physician contracting
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MD Ranger Includes:
• A secure, web-based Data Tool to collect and organize contract
data (uploads via Excel available, too)
• Benchmarks, available as reports and online queries, with
market data for call, medical direction, administrative services,
hospital-based services, uncompensated care programs, and
diagnostic testing services
• Web-based Analytic Tools to benchmark internal data, identify
compliance issues, and analyze where dollars are spent
• Consultations with our experts
Our Benchmarks:
• 80+ administrative services: hours, hourly, and annual rates
• Includes hard to find data on: • Committee and meeting attendance
• Quality initiatives
• EHR and IT initiatives
• Department chairs and section chiefs
• Medical staff officers and leadership
• 50+ positions emergency call coverage
• 10 hospital-based services (pathology, hospitalists, etc.)
• Diagnostic and testing services
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MD Ranger Subscribers
Introducing Allison
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• Director at MD Ranger, Inc
• Background in physician
marketing, recruitment,
engagement, compensation,
negotiations
• Helps MD Ranger subscribers
leverage the data, analyze
internal costs
How to Identify High-Quality
Market Data
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Sample Size
• Big?
• Diverse?
• Provider: physician or
hospital system?
• Look at the distribution
for clues
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Consistent, comprehensive collection
• How is the data collected?
• Is it collected in the same way year after year?
• Does the collection method lend itself to good or poor
data quality?
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Transparent (and exceptional) auditing
process
• Are auditing processes clear?
• Is the data reviewed annually?
• How are the statistics calculated?
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Ability to see specific characteristics
through data slices
• How detailed are the data?
• Are you able to compare your hospital to like
hospitals?
• Are the data slices helpful?
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Specificity of job description
• Ensure the most accurate match
• Small tweaks could affect rates significantly
• Quiz: what’s the better benchmark to use: surgical
specialties OR orthopedic surgery?
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Finding an Appropriate Payment Range
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First, test for commercial
reasonableness
• Must we pay for this service?
• Check market data (MD Ranger publishes “Percent
Paying” tables)
• Determine commercial reasonableness
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Research additional payments, and align
with your organization’s overall physician
compensation strategy
• Does this physician have multiple directorships?
• Does paying for this service fit into your overall physician
compensation strategy? Your budget?
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Determine if the scope of services match the
scope of services described by the
benchmarks
• Is it the exact service and specialty?
• Could it be performed by a physician of any specialty,
or is it specialty specific?
• Are there special circumstances? Is it restricted
coverage? Must the physician be “in-house” during
the shift? These details could impact rates.
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Apply the market data to find an
appropriate payment range
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• What type of agreement is it?
• How complex is the service?
• Use the most applicable data slice.
Consider:
• Size
• Trauma status
• Payer mix
Use the market data to determine FMV
• Taking your organization’s policies into account, find
the most appropriate market range for FMV
• Determine what rates fall into this range
• Select a rate for negotiation
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How to Document FMV with
Market Data
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Create and follow a consistent
documentation process
• Organizations should determine what documentation
process works for them
• Standard reports for documentation
• Executive sign off/oversight
• Record and file proof of compliance
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Suggestions for documentation
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• The report should include: • Service and specialty
• Physician (plus record number, if you use a contract
management system
• Market benchmarks
• Negotiated rate
• Anniversary date
Can I Use Market Data to
Establish FMV?
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Things to consider
• Is there market data available?
• How complex is the agreement?
• Is it a high value agreement (like a hospital-based
service)?
• Are you dealing with exceptional conditions?
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Using Market Data
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Tips for Integrating Market Data into
Your Physician Contracting Program
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Use the most recent, relevant data
possible
• Use at least one data source that is up-to-date (note:
must be at least three months old to publish)
• Consider integrating data from multiple sources, if
robust data is available
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Make sure the sample size is large
• Beware different definitions of “provider”
• More data=better data
• At the same time, compare like with like
• Diversity is important
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Stay consistent
• Use the same data sources yearly for consistency in
your compliance program
• Apply market data benchmarks equally across
contracts
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Keep written record of how a payment
decision was reached, particularly
difficult ones
• Paying for a service not commonly compensated?
Keep detailed records of the negotiation process and
the circumstances that resulted in payment.
• Are you paying above the 75th or the 90th percentile
for a service? Document why a higher than normal
rate was negotiated.
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We want to hear from you!
www.mdranger.com
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Allison Pullins
Director
650-692-8873
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