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Comanagement Agreements between Hospitals and Practices are Common

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The days of complete and total physician autonomy have mostly come to an end. As integrated care delivery systems are being established, hospitals have a vested interest in acquiring or aligning with local physician practices. And because it’s so hard to be an autonomous physician, many private practices are reciprocating that interest.

Hospital-practice partnerships are simply a fact of the marketplace. However, this fact often takes many forms depending on the job, and not all of those forms are necessarily unfavorable to physicians.

For example, Kenneth J. Terry, MA, reports over at Medscape, some practices have a comanagement agreement with the local hospital.

According to Terry, “The comanagement of hospital service lines or ambulatory surgery centers owned by hospitals is mainly an opportunity for specialists such [as] orthopedists, cardiologists, and urologists… A comanagement agreement, which usually covers multiple practices in the same specialty, sets up a separate legal entity with joint hospital and physician governance. Incentives based on quality metrics are paid to the individual doctors.”

“But if the goal is to standardize the use of certain devices or implants, the incentive would go to the participants as a group and be divided among them,” attorney Bruce Johnson, Esq., of Denver-based Polsinelli Shughart PC, told Medscape.

Healthcare attorney Alice Gosfield said comanagement agreements are “a way for physicians to help the hospital, align what they’re doing, and get more money that’s not CPT money.” It “gets physicians more involved in hospital activities; less commonly, it extends to the outpatient side.”

Most of the time, hospitals will establish “a set of predetermined targets” for rewarding doctors with exceptional outcomes, Terry reports. This is mainly because Medicare regulations forbid physician reimbursements for increasing patient referrals and reducing length of stays under a comanagement agreement.

According to Johnson, “One of the principal values of a comanagement agreement is that it focuses the physicians' and the hospital's attention on things like OR efficiency and cath-lab efficiency. The hospital can get its doctors looking at device costs and certain aspects of quality, such as surgical infection rates. The win for doctors is that they can get some money out of it, although typically the money is less than what anyone wants.”

As physicians who are looking for jobs, how do you feel about comanagement agreements? Would you accept a position with a practice that had such an agreement with a local hospital? From your perspective, what are the pros and cons behind these agreements?

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