2006 Medical Group Forum Group Practice Operating Issues Session II C

2006 Medical Group 2006 Medical Group ForumForum

Group PracticeGroup Practice

Operating IssuesOperating Issues

Session II CSession II C

Pre-Agreement IssuesPre-Agreement Issues

Pre-”Go-Live” IssuesPre-”Go-Live” Issues

Operating IssuesOperating Issues

Pre-Agreement IssuesPre-Agreement Issues

►Structure of GroupStructure of Group

►StrategyStrategy

►Dispute ResolutionDispute Resolution

►Corporate Support ServicesCorporate Support Services

Structure of GroupStructure of Group

►Board of Managers/DirectorsBoard of Managers/Directors

►Executive Committee/CEOExecutive Committee/CEO

►Chief Operating OfficerChief Operating Officer

►Central Decision Making SchemaCentral Decision Making Schema

StrategyStrategy

►Payer ContractsPayer Contracts

►Ancillary ServicesAncillary Services

►Pay for Hospital ServicesPay for Hospital Services

►ExpansionExpansion

Dispute ResolutionDispute Resolution

►State (Office) versus Federal (Corp)State (Office) versus Federal (Corp)

► Individual (Physician) versus GroupIndividual (Physician) versus Group

Central Support ServicesCentral Support Services

►Malpractice InsuranceMalpractice Insurance►Strategic AdviceStrategic Advice►Legal SupportLegal Support►Accounting ServicesAccounting Services►Corporate ServicesCorporate Services

Pre-”Go-Live” IssuesPre-”Go-Live” Issues

►Corporate ServicesCorporate Services

►Location of Corporate OfficeLocation of Corporate Office

►Operating SystemsOperating Systems

►$$ Issues$$ Issues

Corporate ServicesCorporate Services

►Contract NegotiationsContract Negotiations

►Claims Submission and Receipt PostingClaims Submission and Receipt Posting

►Human ResourcesHuman Resources

►AccountingAccounting

Location of Corporate OfficeLocation of Corporate Office

►GeographyGeography

►Electrical PowerElectrical Power

►Phone/Data LinesPhone/Data Lines

►StaffingStaffing

Operating SystemsOperating Systems

►Practice Management SystemPractice Management System

►Electronic Health RecordElectronic Health Record

Dollar IssuesDollar Issues

►Corporate FeeCorporate Fee RateRate TimingTiming

►$$ Get Where $$ Belong$$ Get Where $$ Belong Received by Corporate officeReceived by Corporate office Delivered to Care Center/OfficeDelivered to Care Center/Office

Operating IssuesOperating Issues

►Delineation: Corp vs Care Center Delineation: Corp vs Care Center FunctionsFunctions

►Development of Best PracticesDevelopment of Best Practices

►Consolidation of Core ServicesConsolidation of Core Services

►Transition of New MembersTransition of New Members

Corp vs Care Center Corp vs Care Center FunctionsFunctions

►AccountabilityAccountability

►ControlControl

►PowerPower

Accountability IssuesAccountability Issues

►Define Corp v CC Responsibility onDefine Corp v CC Responsibility on Billing and ?Collecting?Billing and ?Collecting? Management of Info SystemManagement of Info System Accounting/Finance Accounting/Finance Human Resources ServicesHuman Resources Services Other Intersecting FunctionsOther Intersecting Functions

Control IssuesControl Issues

►Define Corp v CC Responsibility on:Define Corp v CC Responsibility on: Employing and Terminating EmployeesEmploying and Terminating Employees Money Earned v Money DeliveredMoney Earned v Money Delivered Master Files in Information SystemMaster Files in Information System Accounting StandardsAccounting Standards Other Intersecting FunctionsOther Intersecting Functions

Power IssuesPower Issues

►Define Relative Power of CC v Corp on:Define Relative Power of CC v Corp on:

Procedural IssuesProcedural Issues

Strategic IssuesStrategic Issues

AutonomyAutonomy

Best PracticesBest Practices

►Find Best Practices Through:Find Best Practices Through: Information SystemInformation System Communication Between CC’sCommunication Between CC’s Discussions with PayersDiscussions with Payers

Consolidation of Core Consolidation of Core ServicesServices

►BankingBanking►AccountingAccounting►Malpractice InsuranceMalpractice Insurance►Claims Submission/Posting to Claims Submission/Posting to

CollectingCollecting►CredentialingCredentialing►Employee ManagementEmployee Management►PurchasingPurchasing

Transition of New MembersTransition of New Members

►Add New Members toAdd New Members to PayersPayers Information SystemsInformation Systems BankingBanking Liability Insurance – General and MedicalLiability Insurance – General and Medical Operations in GeneralOperations in General

OutcomeOutcome

►Trade Surmountable Issues for:Trade Surmountable Issues for: Power of Negotiation with PayersPower of Negotiation with Payers Power of Negotiation with Malpractice Power of Negotiation with Malpractice

CarriersCarriers Critical Mass for Developing AncillariesCritical Mass for Developing Ancillaries Ability to Influence the Bigger PictureAbility to Influence the Bigger Picture And More to ComeAnd More to Come