Flexibility with Future Reform, Contract Negotiations Key to Career Success

MIAMI BEACH, FLA.—While payment and health care reform seem inevitable in the coming years, physicians need not think of themselves as the losers in this situation, nor hospitals and payers as the winners, according to Pamela S. Douglas, MD.

“Payment reform is a strategy to control unsustainable health care costs, but it is also an opportunity to change and align incentives … to affect a positive change,” Douglas, of the Duke Clinical Research Institute, Durham, N.C., said at TCT 2012.

Douglas laid out a structure as to how physicians can thrive under future reform. Some of the opportunities include increased payments for uncovered or currently undercompensated services, the excess revenue that might be generated from higher-quality care; a greater flexibility to be able to tailor care to individual patient needs; and the rewards for reducing health care costs.

Some of the more daunting challenges physicians will face may involve inadequate reimbursements for new services or bundled payments, penalties for unmeasured quality efforts, higher implementation costs and a lack of data to accurately establish prices, according to Douglas.

Increased accountability

In order to thrive in the new payment environment, Douglas said that physicians will need to focus on quality improvement.  “Regulators and payers are driving accountability now,” Douglas said. “We and our colleagues will drive quality accountability in the future.”

An example of this change can be found in Accountable Care Organizations, she said. 

In addition, physicians will need to more stringently implement guidelines and standards.

“Volume will no longer be the only quality metric or the only trigger for reimbursement,” she said.

Lastly, defining patient value and fulfilling patient satisfaction will become more important. Physicians and associated staff need to view current policies and procedures from the patient’s perspective, she said. Availability and responsiveness on the part of the entire staff is critical.

Douglas also stressed the need to measure and respond to patient satisfaction: “Own your data,” she said.

Pearls for employment negotiations

As they complete their fellowships, cardiologists are highly trained for performing in a clinical setting, but are often unprepared for what lies ahead in relation to the business of being a doctor—how payers work, how to navigate through complex coding issues, how to work within a private practice and how to keep patients, partners and referring doctors happy. In another presentation at TCT 2012, Thomas Tu, MD, of the Louisville Cardiology Medical Group, Louisville, Ky., offered suggestions to physicians on the essentials of employment contract negotiations. “A good contracting process will set the stage for a smooth transition to a new job,” Tu said. “Being armed with knowledge will make the process smoother and give you a better chance to get what you want.”

First, Tu suggests that fellows find a job that they like in the type of practice that suits them, and save salary discussions for the end of the interview process. On an interview, he advises candidates to ask questions about workload, where referrals come from, how the group makes decisions and who is in charge. With regard to salary, Tu encouraged fellows to not only come armed with research regarding what the market will bear, but also with an understanding of the many revenue streams through which their income will derive.

He also stressed other often overlooked considerations beyond salary when creating an employment contract.

“In my experience, what we argue about the most in our practice, even more than money, is vacation schedule and the call schedule,” Tu said.

Finally, he strongly recommended consulting a local lawyer in the final phase of discussions, in which a job candidate may have to address everything from non-compete agreements to more complex state-specific legal issues that lie closer to home. Ultimately, Tu advised physicians that, when it comes to negotiating, there is nothing wrong with asking for what you want. “Just be prepared to be told ‘no,’” he said.