Building Physician Support for Trauma Care

Best Practices in Community Hospitals

Greg Bishop, President

Bishop+ Associates

June 2004

Building Physician Support for Trauma Care

Best Practices in Community Hospitals

Problems, Factors & Principles

Improving Trauma Medical Staff Value

Cost-Effective Trauma Physician Support

Arriving At Fair Trauma Physician Compensation

Specialty Issues & Market Norms

Problems, Factors & Principles

Problematic Physician Structures

Multiple Contributing Factors

Principles For Proceeding

Problematic Physician Structures

Fragile, Complex Structures

Serious Shortages, Few In Pipeline

Costs, Closures, Weak & Unstable Structures

Balkans of Hospital/Physician Relations

16 Trauma Center Specialists24/7 Availability

Multiple Contributing Factors

Increasing Burden of Uninsured Patients

Incompatibility with Private Practice

Undesirable Lifestyle Due to Trauma Call;

Reductions in Resident Support

Outpatient Surgery/Specialty Hospital Trends

Increasing Physician Sub-Specialization

Multiple Contributing Factors

Malpractice Market Turmoil

Physician Payment Penalizes Trauma

Managed Care Escapes Paying its Share

Demise of Community ED Call Panels

EMTALA Changes Encourage Dumping

Principles For Proceeding

Value, Not Cost Is Key Issue

Strengthen Structure For Decades

Pursue Opportunities For Ideal Solutions

Leadership Is Essential

Patient Care Is A Core Physician Value

Impact On Hospital Physician Relations

Improving Value In Trauma CareStrengthening Trauma Program

Quality of Care; Responsiveness

Maintaining Verification Status

QA, CME, Protocols

Cost effectiveness; Reduced LOS

Community Outreach & Injury Prevention

Public Advocate for Optimal Trauma Care

Improving Value In Trauma CareStrengthening Hospital

Surgical Critical Care Program

Ortho & Neuro Centers of Excellence

Orthopedic Hospitalist Model

Hospital/Physician Relations

ED/OR/ICU Issues

Trauma Center Halo Effect

Framework For Cost Effective Trauma Physician Support

Effective Structure

Hospital Support

Optimal Franchise

Trauma Physician Compensation

Dealing With Leverage

Effective Structure

Strong Trauma Medical Leadership

Strong Trauma Service

Make Trauma Call Less Burdensome Only Call in Specialty When Needed

Have Patient Ready When Specialist Arrives

Don’t Make Specialists Wait for Diagnostic Results

Implement Tiered Call System; Facial Fracture Panels

Hospital Support

OR Block Time

ED Throughput

Physician Assistants

Nurse Practitioners

Other

Optimize Franchise

Trauma/SICU/Surgery

Hospital Based Orthopedic Program

Establishment of Centers of Excellence

Halo Effect for both Physicians and Hospital

Trauma Physician Compensation

Trauma Medical Director Compensation

Payment on Uninsured Patients

Call Stipends; In-house call versus on-call

Response Fees/Complex Schemes

Consolidated Trauma Physician Billing Support

Net Annual Hospital Cost (NAHC)

Dealing With Leverage

Balkans Revisited

Stark Provides Constraint

Do Not Form A Cartel

Compliance Is A Serious Issue

Arriving At Fair Compensation

Key Payment Factors

Employment vs. Contracting

Data and Market Norms

Process is Key

Key Payment Factors

Lack of Residency

Volume of Uninsured

Role versus Value Provided

In-House Call versus On-Call

Trauma Volume +/-

Employment vs. Contracting

Contract With Group For Service/Employment Of Trauma Specialist

Hospital Employment of Surgeons

Contract with Individual Surgeons

Data & Market Norms

Data Sources

Comparison to Salary Data

Specialty Outliers

Payment on Uninsured

Dealing With Leverage

Balkans Revisited

Stark Provides Constraint

Do Not Form A Cartel

Compliance Is A Serious Issue

Process Is Key

Do Not Ignore Requests

Effective Hospital Leadership

Benchmark Trauma Financial Performance

Solicit Specialty Input

Address Non-Financial Issues

Define Fair Level of Compensation

Specialty Issues & Market Norms

Trauma Surgery

Neurosurgery

Orthopedic Surgery

Plastic Surgery

Low Volume Specialties

Hospital Based Specialties

Trauma Surgery

Key Issues: Core of Trauma Center Highest impact specialty Frontline and patient care manager roles Franchise Value

Market Norms Most Trauma Surgeons within Community Hospitals

Receive Hospital Support In-House Call $1000-$2500 per day On-Call $500-$1500 per day

Neurosurgery

Key Issues: High impact specialty due to shortage Quick response time to surgery required Relatively small professional fee franchise Relatively poor payer mix

Market Norms About 40% of Neurosurgeons In Community Hospitals

Receive Support $500-$2,500 per day

Orthopedic Surgery

Key Issues: High volume trauma specialty Sub-specialization making surgeons uncomfortable with trauma Need To Reduce Number of Surgeons Taking Trauma Call Large professional fee franchise

Market Norms 30% Orthopedic Surgeons In Community Hospitals Receive

Hospital Support $500-$2,000 per day

Plastic Surgery

Key Issues: Small volume specialty; ED call issues Call structure is critical for this specialty Declining number of surgeons taking call High paying, busy private practices (Cosmetic Surgery)

Market Norms 10-15% Plastic Surgeons In Community Hospitals Receive

Hospital Support $250-$1,000 per day

Low Volume Specialists

Key Issues: Focus on Trauma Service making their life easier Can be most difficult issue Combined with ED call issues

Market Norms Few are Compensated in Community Hospital Setting No Real Market Norms Payment on Uninsured Patients

Hospital Based Specialists

Trauma is Part of Their Hospital Franchise

Few Payment Examples

In house Anesthesia is exception

Trauma Center Of The Future

The emerging Hospitalist Model

Carved out Trauma Physician Billing

Trauma Specific CPT Codes and RVU’s

Unfallkrankenhaus Lorenz Bohler