7 Options for Physicians Wary of Employment

Kenneth J. Terry, MA


January 13, 2016

In This Article

Captive PCs

In CPM states, hospitals use captive professional corporations (PCs) so they don't have to employ physicians directly. By placing the ownership of the practice in a PC controlled by the hospital, captive PCs can also give doctors the feeling that they're still owners rather than employees, LaPenna notes.

The captive PC has another benefit, Gosfield says, even in non-CPM states. Physicians in a captive PC can bill for nurse practitioners or physician assistants on an "incident to" basis because both they and the nonphysician clinicians work for the same PC. They can't do that if they work directly for the hospital.

In addition, they can get credit for services that nonphysician practitioners bill under their own provider numbers at 85% of the Medicare rate. While neither this nor the "incident to" is fee-for-service income to doctors, it can be factored into the doctors' compensation through the captive PC, she says.

Non-hospital-Related Opportunities

Physicians' nonemployment opportunities are by no means limited to those offered by hospitals. Some physicians organize clinically integrated IPAs and MSOs with their colleagues, and groups of small practices have formed many of the more than 600 accountable care organizations (ACOs). Bundled payments are another new opportunity for IPAs, although most of those arrangements do involve hospitals.

Clinically integrated networks can contract directly with employers, Gosfield says. These direct contracts may involve bundled payments or enhanced care management, rather than capitation or global risk, she adds.

LaPenna advises physicians to look for an IPA or a physician-hospital organization that will enable them to negotiate higher rates or participate in new value-based payment models. But they must manage their patients in ways that align with these emerging payment structures, he adds. "So the changing reimbursement landscape in their local area gives them a signal on how to behave."

Many clinically integrated IPAs are being formed, he notes, "but we're not sure how many will be successful because they're newly formed and on the bleeding edge of this technology." Among other things, IPA members have to find a way to exchange information among their disparate EHRs, and so far, "interoperability has been an absolute failure," he points out.


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