The Physician Employment Contract Handbook, Second Edition : A Guide to Structuring Equitable Arrangements

202 Pages·2011·1.54 MB·English

by  Todd

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Business Law, Medical Business Administration
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Responsible medical schools would make the [first edition] a required
text. Prudent physicians would keep their copy and refer to it as necessary
throughout their careers. This book is that important … Take the lessons T
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provided in this book to heart …
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—From the foreword by Gary D. Wimsett, Jr., Attorney and Counselor at Law,
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Gainesville, Florida h
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No matter which way you look at it, whether you own your own practice, i
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become part of a large physician group, or become an employee of a hospital, ia
you will be signing an employment contract of some sort. Revised and updated, n

The Physician Employment Contract Handbook, Second Edition: A Guide to E
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Structuring Equitable Arrangements provides sample physician employment
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contracts and explains how each contract works.
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The new edition includes increased information on the latest managed care m
entities and a review of basic concepts in fraud and abuse, corporate practice
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of medicine, and antitrust concerns. The author discusses the various legal and n
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compliance issues related to physician employment, such as anti-self-referral
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and anti-kickback issues, and examines how to resolve disputes through
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arbitration or mediation. The author also outlines the pros and cons of various n
partnership arrangements. t
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After you have finished this book, you will be able to ask meaningful questions t

of legal and accounting counsel, do a preliminary review and analysis of the H
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agreement offered, and even compare a prospective employer’s contract to other
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standard agreements without endangering confidentiality agreements. You will
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be able to design standard text, saving time and money on legal fees by having b
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counsel review and add the final touches to contract drafts instead of starting
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from scratch. With proper planning and a clear understanding of both short-
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and long-term objectives, you can move into the future and take advantage of
opportunities in the current healthcare revolution. S
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K10674 E
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ISBN: 978-1-4398-91030106-04 itio
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9 781439 813164
www.productivitypress.com
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The Physician
Employment
Contract Handbook
Second Edition
A Guide to Structuring
Equitable Arrangements
Maria K. Todd
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2011 by Taylor & Francis Group, LLC
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Version Date: 20110726
International Standard Book Number-13: 978-1-4398-9540-5 (eBook - PDF)
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Contents
Foreword....................................................................................................................xi
Preface......................................................................................................................xv
Acknowledgments...................................................................................................xvii
About.the.Author.....................................................................................................xix
Chapter 1 Introduction...........................................................................................1
Occupational.Options.for.Physicians....................................................1
Managed.Care.Implications..................................................................1
Hospital-Owned.Management.Services.Organization.(MSO)..............3
Group.Practice.without.Walls/Clinic.without.Walls/Integrated.
Health.Systems......................................................................................3
Open.Physician.Hospital.Organization.(PHO)......................................4
Closed.Physician.Hospital.Organization...............................................4
Physician.Practice.Management.Arrangement.....................................5
Equity.Management.Services.Organization..........................................5
Foundation.Model.................................................................................6
Staff.Model............................................................................................9
Conclusion.............................................................................................9
Chapter 2 Working.with.Search.Firms................................................................11
Preemployment.Issues.........................................................................11
Curriculum.Vitae:.Dos.and.Don’ts.................................................12
Do.Not.Do.This!.............................................................................12
The.Physician.Recruitment.Process....................................................13
The.Screening.Process........................................................................13
The.Interview.Process.........................................................................13
Submitting.Your.CV.to.Search.Firms.................................................14
Working.with.a.Physician.Recruiter:.A.Checklist..............................17
Negotiating.a.Contract.with.an.Employer...........................................18
Chapter 3 An.Introduction.to.the.Group.Practice.Environment..........................19
Setting.Your.Expectations...................................................................22
Chapter 4 Medicare.and.Medicaid.Antikickback.Concerns,.Fraud.and.
Abuse.Concerns..................................................................................25
Problems.with.Fraud.Control..............................................................25
iii
iv Contents
Laws.Governing.Healthcare.Fraud.....................................................26
What.Do.You.Do.When.You.Learn.That.a.Colleague.or.
Employer.Is.Corrupt?..........................................................................28
Causing.the.Submission.of.a.False.Claim...........................................28
Damages.under.the.False.Claims.Act.................................................28
Qui.Tam.(Whistleblower).Provisions.of.the.False.Claims.Act...........28
Resources............................................................................................34
Chapter 5 Antitrust.Concerns.for.Physicians.......................................................35
Antitrust.Laws.in.General...................................................................35
Antitrust.Enforcement.........................................................................36
Conspiracy.in.Restraint.of.Trade........................................................37
Chapter 6 Medicare.Physician.Incentive.Plan.Requirements..............................39
Physician.Incentive.Plan.Regulation.Questions.and.Answers............40
Glossary...............................................................................................52
Where.to.Find.More.Information........................................................53
Healthcare.Reform.and.Physician.Incentives......................................53
Conclusion...........................................................................................54
Chapter 7 Corporate.Practice.of.Medicine..........................................................57
Walk-In.Retail.Clinics.and.Medical.Marijuana.Clinics......................58
Chapter 8 Contract.Law.Basics............................................................................65
Incorporation.of.Exhibits.and.Attachments........................................66
Standards.of.Care................................................................................66
Exclusion.of.Other.Statements............................................................67
Contract.of.Record..............................................................................67
Express.or.Implied.Contracts..............................................................67
Quasi-Contracts...................................................................................67
Definiteness.........................................................................................68
Other.Types.of.Contracts....................................................................69
Termination.of.an.Offer......................................................................70
Duress.Issues.......................................................................................70
Interpretation.of.Contracts..................................................................70
Assignments........................................................................................71
Delegation.of.Duties............................................................................71
Discharge.of.Contracts........................................................................72
Bankruptcy..........................................................................................73
Breach.of.Contract..............................................................................74
Liquidated.Damages............................................................................74
Contents v
Chapter 9 A.Checklist.for.Managed.Care.Agreements.as.They.Apply.to.
the.Employed.Physician......................................................................75
Sample.Wording..................................................................................76
Chapter 10 Alternative.Dispute.Resolution.(ADR)................................................79
Glossary.of.Dispute.Resolution.Terms................................................79
Advantages.of.Alternative.Dispute.Resolution...................................80
Speed..............................................................................................81
Choice.and.Expertise.of.Impartial.Neutrals...................................81
Informality.and.Flexibility.............................................................81
Privacy............................................................................................82
Economy.........................................................................................82
Finality...........................................................................................82
Who.Are.the.Neutrals?........................................................................82
Who.Uses.Alternative.Dispute.Resolution?........................................82
High-Level.Comparison.and.Contrast:.Arbitration.and......
Mediation............................................................................................83
Arbitration.and.the.Law......................................................................84
Practicalities.of.Arbitration.and.Mediation.........................................85
Focus.on.Mediation.............................................................................86
Types.of.Disputes.Resolved.by.Mediation.....................................86
Mediation.Neutrals.........................................................................86
Scheduling.a.Mediation..................................................................86
Stages.of.Mediation........................................................................86
The.Agreement.to.Mediate........................................................86
Selection.of.the.Mediator...........................................................87
Preparation.for.the.Mediation.Session.......................................88
The.Mediation.Conference.............................................................88
The.Settlement...........................................................................89
Administrative.Fees...................................................................89
Mediation.Deposits....................................................................89
Mediation.Deposit.Refunds.......................................................90
Stages.of.Arbitration...........................................................................90
The.Agreement.to.Arbitrate...........................................................90
Standard.Arbitration.Clause...........................................................90
Typical.Dispute.Resolution.Language.in.Employment....
Agreements.........................................................................................92
Chapter 11 Physician.Employment.Contracts........................................................93
Compensation.and.Benefits.................................................................94
Other.Major.Considerations...........................................................95
General.Contract.Terms......................................................................96
The.Real.Key.to.Success.....................................................................96
vi Contents
Chapter 12 Where.Money.Comes.from.in.Order.to.Pay.You................................97
Managed.Care.Participation.for.the.Newcomer..................................97
Health.Maintenance.Organizations.(HMOs)......................................97
HMO.Provider.Contracts................................................................98
Point-of-Service.Products.in.HMOs...............................................98
Transferring.Risk.to.Providers.in.the.HMO.Setting......................98
Preferred.Provider.Organizations.(PPOs)...........................................99
Third-Party.Administrators..........................................................100
Silent.PPOs...................................................................................101
Exclusive.Provider.Organizations.(EPOs)........................................102
Independent.Practice.Associations.(IPAs)........................................102
Physician.Hospital.Organizations.(PHOs)........................................102
Management.Services.Organizations.(MSOs)..................................102
Conclusion.........................................................................................103
Chapter 13 Employed.Physicians.in.the.Hospital-Sponsored.Practice................105
What.to.Expect.from.the.Contractor.................................................107
Compensation....................................................................................108
Grievances.........................................................................................109
Noncompete.Clauses.........................................................................109
Chapter 14 Full.Partnership.Arrangements.........................................................111
Duration.of.Partnership.....................................................................111
Partner.Disability.Benefits................................................................112
Chapter 15 Medical.Director.Positions................................................................119
Chapter 16 Concierge.Medicine:.Contracting.with.the.New.Employer.of.
Physicians—Consumers....................................................................123
Concierge.Practice.Fee.Agreements.................................................124
Online.Services.................................................................................126
Appendix 1: Full Partnership Agreement .........................................................129
Appendix 2: Full-Time Faculty Member—University Medical
Corporation ..........................................................................................................143
Appendix 3: Physician Employment Agreement ..............................................149
Appendix 4: Independent Contractor Agreement ............................................157
Appendix 5: Medical Director Employment Agreement .................................165
Appendix 6: New Medical Group Employment Agreement ............................171
Contents vii
Appendix 7: Sample Concierge Medicine Practice Membership
Agreement .............................................................................................................179

Foreword
Responsible.medical.schools.would.make.the.Physician Employment Contract
Handbook.a.required.text..Prudent.physicians.would.keep.their.copy.and.refer.to.
it.as.necessary.throughout.their.careers..This.book.is.that.important..The.practice.
of.medicine.and.the.business.of.practice.are.two.distinct.disciplines..Mastery.of.the.
former.and.neglect.of.the.latter.nearly.guarantee.an.unhappy.and.unfulfilling.profes-
sional.life.in.medicine.
For.many.new.physicians,.their.first.employment.agreement.is.a.near-mystical.
document.representing.the.end.of.many.years.of.grueling.medical.education.and.the.
beginning.of.their.careers.as.doctors.and.healers..As.many.new.physicians.begin.
their.careers.with.significant.medical.school.debts.to.repay,.the.employment.contract.
also.represents.a.means.to.repay.these.debts.and.to.lay.the.foundation.for.a.successful.
career..More.experienced.physicians,.too,.often.view.employment.agreements.sim-
ply.as.a.means.to.an.end..This.view,.while.understandable,.can.be.perilous..Todd’s.
book.provides.anecdotal.evidence.of.misunderstood.or.casually.reviewed.employ-
ment.agreements.that.have.gone.terribly.wrong..It.does.not.have.to.be.this.way.
Over.the.course.of.my.legal.career,.I.have.had.the.opportunity.to.review,.draft,.and.
negotiate.literally.thousands.of.contracts..Some.of.the.most.sophisticated,.complex,.
and.therefore.often-litigated.agreements.are.related.to.the.business.of.healthcare..
Physician.employment.agreements,.of.course,.fall.within.this.group..As.the.business.
of.healthcare.grows.more.complex.daily,.physician.employment.contracts.are.par-
ticularly.susceptible.to.misunderstanding.because.physician.education.and.training.
prepare.one.to.treat.patients—not.to.skillfully.negotiate.an.employment.agreement.
necessarily.laden.with.federal.and.state.laws,.rules,.and.regulations.directed.to.the.
many.legal.aspects.of.practicing.medicine.in.the.United.States.
This.is.not.to.suggest.that.physician.employers,.be.they.hospitals,.managed.care.
organizations,.or.other.physicians.in.private.practice.settings,.are.intent.on.exploiting.
their.colleagues.or.leveraging.their.bargaining.position.to.extract.unfair.concessions.
from.the.unwary.or.ill.informed..Of.course,.some.employers.do.take.advantage.of.
their.experience.and.access.to.expert.legal.resources.when.developing.and.nego-
tiating.physician.contracts..The.employer’s.legal.counsel.typically.drafts.employ-
ment.agreements,.and.employers.typically.have.much.more.experience.dealing.with.
employment.agreements..The.agreement’s.“default”.provisions.will.almost.certainly.
favor.the.employer,.and.the.general.tenor.of.the.agreement.will.be.tilted.in.the.
employer’s.favor.in.almost.every.instance..However,.you.can.and.should.take.steps.
to.shift.this.balance.of.power.in.your.favor.
In.my.experience,.the.biggest.mistake.many.physicians.make.is.presuming.these.
agreements.are.nonnegotiable..Notwithstanding.an.employer’s.seemingly.superior.
negotiation.position.with.respect.to.physician.employment.agreements,.the.careful.
physician.would.do.well.to.approach.every.employment.agreement.as.an.opportu-
nity.to.clarify.critical.issues.dealing.with.day-to-day.practice.expectations,.long-
ix