7 Options for Physicians Wary of Employment

Kenneth J. Terry, MA


January 13, 2016

In This Article

Harder and Harder to Go It Alone

Whether you want to do that may depend on the financial stability of your practice and on how much you prize your autonomy. But as value-based reimbursement expands, small practices will find it increasingly difficult to go it alone, the experts point out. If they don't want to fall into the hospital orbit, they'll have to form a certain kind of physician organization. However, they can still do business with the hospital.

"Affiliations [with hospitals] are worth considering, but it doesn't mean you have to give up your autonomy to link with like-minded physicians," says Alice Gosfield, a veteran healthcare attorney based in Philadelphia. "Clinical integration is the sine qua non for all physicians, no matter what environment they're living in—whether they're employed, or in an independent practice association (IPA) or a mega group, or in a clinically integrated network."

Medical Directorships

One way in which hospitals try to align doctors with them is by offering them medical directorships. Fewer of these part-time posts are available than in the past, Kennedy says, because hospitals tend to fill them with employed doctors as they build integrated delivery systems. "That model is still out there, but it's not anything that will help you survive."

Nevertheless, some medical directorships can pay well, Zetter points out. He cites a physician who recently took such a post in a mental health facility where he also provides services. He'll make an additional $50,000 a year in revenue for performing medical director duties 4-8 hours a week.

There are also new types of medical directorships, LaPenna notes. He has seen some healthcare organizations pay independent practitioners extra to be "transition doctors" who help handle the transitions of patients from the hospital to home or skilled nursing facilities to prevent readmissions. Other physicians are being recruited by some hospitals to do telemedicine in their spare time, he says.

Comanagement Agreements

The comanagement of hospital service lines or ambulatory surgery centers owned by hospitals is mainly an opportunity for specialists such orthopedists, cardiologists, and urologists, the experts say.

A comanagement agreement, which usually covers multiple practices in the same specialty, sets up a separate legal entity with joint hospital and physician governance. Incentives based on quality metrics are paid to the individual doctors. But if the goal is to standardize the use of certain devices or implants, the incentive would go to the participants as a group and be divided among them, explains attorney Bruce Johnson, Esq, a partner in the Denver law firm of Polsinelli Shughart PC.

Comanagement gets physicians more involved in hospital activities; less commonly, it extends to the outpatient side, Gosfield notes. "It represents a way for physicians to help the hospital, align what they're doing, and get more money that's not CPT money."

To comply with Medicare regulations, the reimbursement can't be based on length of stay or for referring patients to the hospital, she points out. But hospitals can reward doctors for getting better results and increasing efficiency, usually by meeting a set of predetermined targets.

"One of the principal values of a comanagement agreement is that it focuses the physicians' and the hospital's attention on things like OR efficiency and cath lab efficiency," explains Johnson. "The hospital can get its doctors looking at device costs and certain aspects of quality, such as surgical infection rates. The win for doctors is that they can get some money out of it, although typically the money is less than what anyone wants."


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