2006 Medical Group Forum Group Practice Operating Issues Session II C.

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Presentation transcript:

2006 Medical Group Forum Group Practice Operating Issues Session II C

Pre-Agreement Issues Pre-”Go-Live” Issues Operating Issues

Pre-Agreement Issues ► Structure of Group ► Strategy ► Dispute Resolution ► Corporate Support Services

Structure of Group ► Board of Managers/Directors ► Executive Committee/CEO ► Chief Operating Officer ► Central Decision Making Schema

Strategy ► Payer Contracts ► Ancillary Services ► Pay for Hospital Services ► Expansion

Dispute Resolution ► State (Office) versus Federal (Corp) ► Individual (Physician) versus Group

Central Support Services ► Malpractice Insurance ► Strategic Advice ► Legal Support ► Accounting Services ► Corporate Services

Pre-”Go-Live” Issues ► Corporate Services ► Location of Corporate Office ► Operating Systems ► $$ Issues

Corporate Services ► Contract Negotiations ► Claims Submission and Receipt Posting ► Human Resources ► Accounting

Location of Corporate Office ► Geography ► Electrical Power ► Phone/Data Lines ► Staffing

Operating Systems ► Practice Management System ► Electronic Health Record

Dollar Issues ► Corporate Fee  Rate  Timing ► $$ Get Where $$ Belong  Received by Corporate office  Delivered to Care Center/Office

Operating Issues ► Delineation: Corp vs Care Center Functions ► Development of Best Practices ► Consolidation of Core Services ► Transition of New Members

Corp vs Care Center Functions ► Accountability ► Control ► Power

Accountability Issues ► Define Corp v CC Responsibility on  Billing and ?Collecting?  Management of Info System  Accounting/Finance  Human Resources Services  Other Intersecting Functions

Control Issues ► Define Corp v CC Responsibility on:  Employing and Terminating Employees  Money Earned v Money Delivered  Master Files in Information System  Accounting Standards  Other Intersecting Functions

Power Issues ► Define Relative Power of CC v Corp on:  Procedural Issues  Strategic Issues  Autonomy

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

Consolidation of Core Services ► Banking ► Accounting ► Malpractice Insurance ► Claims Submission/Posting to Collecting ► Credentialing ► Employee Management ► Purchasing

Transition of New Members ► Add New Members to  Payers  Information Systems  Banking  Liability Insurance – General and Medical  Operations in General

Outcome ► Trade Surmountable Issues for:  Power of Negotiation with Payers  Power of Negotiation with Malpractice Carriers  Critical Mass for Developing Ancillaries  Ability to Influence the Bigger Picture  And More to Come