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BEST PRACTICES

机译：最佳做法

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START WITH THESE QUESTIONSThere are many legal concerns regarding antitrust whenever doctors come together. I’ve seen doctors spend substantial legal fees just to get an entity operational; I’ve also seen situations in which no real benefits materialize that the independent practitioners didn’t already possess. To help clients answer the questions listed above, I always ask a few questions of my own to help understand if there is any value to be gained in these types of relationships.What are the payers demanding in your market area? In more densely populated areas, practices already experience demands from payers in terms of reporting requirements and the desire to enter into capitated contracts. Capitated contracts are those in which practices receive a flat dollar amount per insured member per month regardless of the quantity of provided services. In exchange for sharing the risk with the payer, the organization has exclusive rights to those “captured lives” insured by the payer. It is essential that you assess your market and the number of lives that the payers will control to gain a clear understanding of the importance of being able to contract with each payer. If it appears payer activities may limit your access to patients, assess your practice by looking at its strengths, weaknesses, opportunities and threats (a SWOT analysis) from the payers’ perspectives. Below is a look at what payer’s want and several related questions to consider.Payers want you to prove value. Do you have strong reporting platforms that provide good data detailing the cost-effective management of patients?Payers want satisfied members. What do your patient satisfaction surveys indicate?Payers want the full spectrum of eye-care services. Do you provide that in your practice?Payers want geographic coverage and easy access for their members. Given their membership, do your practice locations meet their needs?Why do you want to form/participate in this type of organization? If you have any glaring weaknesses in your SWOT analysis, such as limited eye-care services, you may want some type of network affiliation to meet payer demands. Beyond payer contracting desires, many practices are considering an MSO to help share expenses with area practices that have similar values and are facing the same challenges. Practices that face major expenses to upgrade IT systems might find it helpful to pool resources with others to make the best investment possible. Also, a desire to outsource increasingly complex functions (such as human resources) might make an MSO attractive.How likely is it that national networks will help you retain access to patients? When considering a solicitation from a national network, find out how long the organization has been in business and scrutinize its track record for negotiating contracts. Historically, national networks have gained little traction because payers are regulated by states and are driven by local relationships (primarily with hospitals). Presently, health care is locally and regionally driven.Is there a demand from your referral sources? When Meaningful Use was being implemented, I worked with an ophthalmic practice that wanted to develop an MSO with a focus on computer systems and billing for optometric practices. The owners believed that optometrists would want their electronic practice management and health records system. But a quick survey helped us determine that we were trying to solve a problem that didn’t exist for the optometrists; those practices already had systems that worked for them. A little research prevented us from putting together an infrastructure and company that would not have had any customers. On the other hand, optometrists might be interested in an integrated network organization if it could help get them onto payer panels where they have previously been denied access.
机译：从这些问题开始每当医生走到一起时，都会有许多关于反托拉斯的法律问题。我见过医生为了使实体运作而花费大量的法律费用;我还看到过这样的情况，独立从业人员还没有拥有真正的好处。为了帮助客户回答上述问题，我总是会提出一些自己的问题，以帮助您了解在这种类型的关系中是否有任何价值。付款人在您所在的市场领域要求什么？在人口稠密的地区，实践已经经历了付款人对报告要求和签订人头合同的渴望。有条件合同是指无论提供多少服务，执业医师每个受保成员每月均获得固定金额的合同。作为与付款人分担风险的交换，组织对付款人投保的那些“被俘获的生命”拥有专有权。必须评估您的市场和付款人将控制的寿命，以清楚地了解与每个付款人签约的重要性。如果看似付款人的活动可能会限制您与患者的联系，请从付款人的角度查看其做法，劣势，机会和威胁（SWOT分析）以评估您的做法。以下是付款人的需求以及需要考虑的几个相关问题。付款人希望您证明自己的价值。您是否拥有强大的报告平台，可以提供详细的数据来详细描述患者的成本效益管理？付款人需要满意的会员。您的患者满意度调查表明什么？付款人需要全方位的眼保健服务。您是否在实践中提供了这些？付款人希望其会员可以覆盖地理区域，并易于访问。根据他们的成员资格，您的执业地点是否满足他们的需求？为什么要组建/参与这种类型的组织？如果您在SWOT分析中存在任何明显的缺点，例如有限的眼保健服务，则可能需要某种类型的网络从属关系来满足付款人的要求。除了付款人订立合同的愿望外，许多实践还在考虑采用MSO来帮助与具有相似价值和面临相同挑战的区域实践分担费用。升级IT系统要面对大量费用的实践可能会发现与他人共享资源以进行最佳投资可能会有所帮助。此外，将日益复杂的功能（如人力资源）外包的愿望可能会使MSO更具吸引力。国家网络有多大可能帮助您保持与患者的联系？在考虑通过国家网络进行招标时，请找出该组织开展业务已有多长时间，并仔细检查其谈判合同的往绩。从历史上看，国家网络几乎没有什么吸引力，因为付款人受州监管，并受地方关系（主要是与医院的关系）的驱动。目前，医疗保健是由地方和区域驱动的，您的推荐来源是否有需求？当实施“有意义的使用”时，我与眼科部门合作，希望开发一种MSO，重点是计算机系统和验光业务的计费。业主认为，验光师需要他们的电子执业管理和健康记录系统。但是快速调查帮助我们确定了我们正在尝试解决验光师所不存在的问题;这些实践已经拥有适合他们的系统。一项小的研究阻止了我们将没有客户的基础架构和公司整合在一起。另一方面，验光师可能会对集成网络组织感兴趣，如果它可以帮助他们进入以前拒绝访问的付款人面板。

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