Physician Compensation Management Process Health Ethics Trust Central Region Certification Intensive Course
August 6, 2013 1
Premier Health • • • • • •
Local system Not owned by a large corporation Primarily centralized management Big Board Compliance & Audit Committee Sole Compliance Officer aka individual heroics 2
What’s your goal? • Do you know your endpoint? • Do you have support from management? • Do you have a sponsor? • Have you identified an issue – what’s your “burning platform”? • Can you demonstrate savings? 3
How to start… • What do you already have in place?
(current state assessment) – Is there a committee that can do the reviews? – Existing review process – per Corporate Compliance policy for physician contract review – Engaged internal executive committee (CCC) – Focus – Anti-kickback and Stark in internal CCC meeting – Dedicated CEO asking the right questions – Very supportive in-house counsel – Very persistent compliance officer 4
What’s next? Where do we have gaps? • What is the goal of the CEO’s request? – Design a physician compensation review process – that meets (to the best of our ability) the IRS rebuttable presumption – for executive compensation.
• What are the standards of the IRS rebuttable presumption? • What would the process look like if we reviewed 100% of the contracts? • How do you make that manageable? • Who approves the contracts? Who has the authority? • What’s the appetite of the governing body?
Filling the Gaps • Selection process on the contracts that should be reviewed • • • •
Outside counsel Tax expert Define “insider” Think of a funnel…..
• Detailed review with key stakeholders • What do they understand, what don’t they understand?
• Determine approval authority – no matter how painful • Better educate the internal committee (CCC) • Educate the Board on their new function • Ongoing education with each contract presented for review 6
Final Product • Board approved process and delegated authority for approval • Education of the Board required
• “How to” notebook • • • • • •
Executive Summary Statutory Overview, flowchart Defined terms Defined benchmarks Specific guidelines for each type of contract Everything we could thing of related to a physician contract
• Consistent reference to process when introducing a contract for review • Support and reinforcement from in-house counsel and operations • Overall willingness of senior management to understand and participate in the process • Willingness of Board to be educated, conduct the review and ask questions • Support from System Leadership – new step in our review process
Ongoing Review Does the process work? What have we missed? What needs changing? • Internal with in-house counsel & compliance • Compliance Tracking • Report two times per year to CCC • Report two times per year to Compliance & Audit
• Corporate Compliance Committee-minutes, denoting approval/ conditions • Compliance & Audit Committee-minutes, denoting approval/ conditions • “Big” Board by way of C&A minutes • Ongoing education regarding settlements with physician arrangements • Discussion about a review process of another hospital or system • Review and sign off by outside counsel • Request review by Internal Audit 8
Words of Advice • OVER communicate the “proposed” process • Meet with everyone that will listen—even those that won’t
• Who gets to vote? • It’s best for them, it’s best for the process
• A non-compliance champion • Go slowly but keep moving – “Successive Approximation” • Constant presentation of settlements – start your burning platform • Compensation consultant 9
Dianne Dieterle Judge, MS Ed, JD System VP, Chief Compliance & Enterprise Risk Officer Premier Health 110 North Main St. Suite 930 Dayton, OH 45402 email@example.com 937.499.9794 10