Synergy - September/October 2012 - 11

• Is the contract still current, or has it expired? You would be surprised how many contracts have expiration dates and no automatic renewals. • Does the contract reference the existence of other contracts with this physician or the maintenance of a master list of all such contracts? (This is a federal requirement.) You may be the only one who has a handle on the fact that Dr. X has four different contracts with the hospital.

such as incorporating recruitment incentives (e.g., moving expenses, repayment of student loans) into the agreement rather than having a separate contract. You should ask the following questions1 of employment contracts: • Does the contract require appointment to the medical staff with privileges? What if the physician will be using a hospitalist? • Does the contract require sharing of peer review information? Will this destroy the privilege? • Does the contract take into consideration time spent on medical staff activities (e.g., department chair, credentials committee chair, officer)? • Does the contract require that matters be referred to human resources rather than to the medical staff? Is this appropriate? • Who is responsible for credentialing the physician for managed care plans? • Is the amount of required professional liability insurance consistent with the medical staff bylaws requirements?

You should ask the following questions of medical director agreements: • What is the difference between the duties of the medical director and the department chair? Are they the same? Do they overlap? • Must the physician keep time sheets? Who is responsible for giving them to the physician? Who is responsible for making sure they are turned in? • Who maintains documents generated by the medical director? Should any of these documents be peer review protected? • Does the physician have any medical staff committee responsibilities? • Does the physician have any reporting obligations to medical staff leaders?

Recruitment Agreements
Although an MSP may not be involved in the negotiation of a recruitment agreement, there are certain elements that need to be incorporated into the agreement to ensure a smooth transition. You should ask the following questions of recruitment agreements: • Is there a provision requiring the physician to submit an application for appointment/privileges sufficiently in advance of the start date so the application can be processed and approved (or rejected)? • Should the medical staff office coordinate with someone in administration if problems develop with the application? Can these problems be discussed consistent with your state’s peer review statute? • Does the agreement obligate the physician to be a Medicare/Medicaid provider? Should it? • Does the agreement obligate the sharing of any information between the hospital, the physician and/or the physician’s employer (which often is an entity other than the hospital)? Can you do this without violating the peer review privilege?

Exclusive Services Agreements/ Professional Service Agreements
These exclusive services agreements are no longer just for the traditional hospital-based services of radiology, pathology, anesthesia and emergency medicine. Today, these

Although an MSP may not be involved in the negotiation of a recruitment agreement, there are certain elements that need to be incorporated into the agreement to ensure a smooth transition.
• Does termination of the contract result in automatic termination of appointment/ privileges (or vice versa)? agreements may be for any number of services to include open heart surgery, cardiac catheterization, sleep disorders, nuclear medicine and hospitalists. And this proliferation can create problems. You should ask the following questions of exclusive services agreements: • Do the privilege sets match up to the exclusive services being provided? • Do the exclusive provisions preclude physicians with the same privileges from being able to continue to practice? Who will notify them of this? • Is the exclusivity language too broad? For example, does a contract for anesthesia
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Medical Director Agreements
Back in the “good ol’ days,” medical director agreements were very common and not necessarily viewed with great scrutiny. Today, they are one of the first documents that will be subject to an audit. The contract must have defined, needed services and a compensation arrangement that meets fair market value. The scope of those services will vary depending upon the roles of your medical staff leaders as provided for in your medical staff governing documents.
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Employment Contracts
Interestingly enough, employment contracts are the one arrangement between a physician and a healthcare entity that do not have to be reduced to writing. Having said this, it is extremely rare to find a physician who is employed “at will.” This is due to a number of factors, including remuneration, scope of services, termination provisions and possible noncompetition clauses. In addition, the employment contract may include terms that need to be in writing,

Several of these questions also apply to the recruitment agreement and vice versa.

September /Oct Ober 2012 SYNERGY

Synergy - September/October 2012

Table of Contents for the Digital Edition of Synergy - September/October 2012