AMDA’s Model Medical Director agreement; changes for an evolving role.

  • Risk Management: Rich Feifer, Tony Burgess and Rajeev Kumar
    • Physicians are not named in lawsuits very often
    • How would physicians be available for consultation in defense of claims
    • Recommendation is to keep this vague – physician usually sheltered as part of QA meetings
    • Dr. Vicky Walker has language for indemnification clause
  • Handing on call hours – Karl Steinberg/Rajeev Kumar
    • Flat stipend for being available 24/7 on call.
    • additional hours spent in admin role at fair market value
    • On call should be for administrative issues - at least need to separate your administrative and clinical responsibilities
    • Medical director tag does require back up for clinical reasons
    • Medical directors are called even if they are only performing administrative roles
    • Medical director role in emergency situations – should have some language in the agreement
    • Stipend for on-call makes sense since people know what they want to make and they ‘bill up’ to it
  • Employed vs “Traditional” Medical Directors – Tom Haithcoat/Karl Steinberg
    • More and more employed medical directors
    • How are typical geriatrician contracts structured and could some of that be incorporated
      • Base + productivity-based salary 
  • Should there be some continued education and certification built in?
    • There may be issues in rural areas and areas where it is difficult to recruit medical directors
  • iSNP considerations
  • Should there be essential vs suggested duties and optional sections to agreement- checkbox style.
  • Biggest changes in the contract have been around alternative payment models –
  • Relationship building with acute care side; face of the organization
  • Peer review; medical staff functions, recruitment of consultants.
  • Attending Physician Agreement – is that a separate project? Update to the roles and responsibilities of attending physician.
  • Sample agreement but not contract
  • Potentially Avoidable Utilization – role of the medical director
  • Standard contract and then other considerations for value-based medicine
  • Timesheet type document of what you have been doing to help facilities to meet their quality metrics
  • Rewarding for outcome driven care; gain sharing with waiver of Stark/anti kick back statutes. Refer to comments made to CMS RFI.
  • Adding sexual orientation under discrimination discussion- Dr Karl Steinberg