1. 2006 Medical Group Forum Group Practice Operating Issues Session II C

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

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

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

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

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

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

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

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

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

11. Operating Systems ► Practice Management System ► Electronic Health Record

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

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

14. Corp vs Care Center Functions ► Accountability ► Control ► Power

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

16. 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

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

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

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

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

21. 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