After the patients have settled in with their new physicians, physician compensation must be sorted out. For smaller practices, a plan for compensation should be included in agreements about covering for one another. Usually, the money follows the patient, with business insurance making up shortages. “Our group has a production-based model of physician payment,” said Long. “If you don’t produce, you don’t get paid more than a base salary. For those doctors and midlevel providers who had to work harder, they saw the benefits.”
Dividing up call is often one of the more contentious issues to address. Few providers volunteer to take call, and working out these issues in advance of a need can be important in keeping the partners, at the least, not unhappy. “We are the only ENTs in our area, so we had to adjust call,” said Easly. “If all of my providers did not cooperate, it could have gotten ugly.”
Permanent disability, another facet of the coverage agreement for single or small groups, has to be addressed. For larger practices, buy/sell agreements that are already likely in place should be reviewed to make sure they define the moment when a disability becomes permanent and triggers the provision. “An agreement defining when the buy/sell parts of the partnership or corporation structure come into play [is] important to have in place ahead of time,” said Dr. Bryant. “This ensures all members agree [how to handle] the situation should it arise.”
Although most of the focus is on the physicians, office staff plays an important role that shouldn’t be underestimated. The staff needs to be kept abreast of what is happening, which can be as stressful for them as the providers. Unaddressed staffing concerns only add to the problems already being tackled by management.
“What is often overlooked is [the fact that] when staff is fearful and uncertain about their future, you need to address these issues, good news or bad,” said Long. “People jump ship if the reassurance is not there that the doctors and management are handling things. Decide ahead of time that you will be keeping the staff informed, especially as things change.”
Kurt Ullman is a freelance medical writer based in Indiana.