If you are a small doctor, it is not always easy to figure out how to provide coverage. What works best for one facility may not always work well for another, especially in rural areas where the nearest hospital or clinic may be hours away. It is important that you carefully review your doctor’s options to protect your bottom line and the morale of your employees, while ensuring that your patients have access to the care they need. Here are five ways to plan coverage by doctors and the pros and cons of each.
1. No alternative coverage
In some cases, providing alternative coverage may not work, but should generally only be used for short-term absence from doctors. This option can be attractive as it saves money to a hospital or clinic if you don’t have to pay for a replacement to come in.
However, this approach should be used with caution because there are many disadvantages of not providing coverage. Consider the case of a busy doctor who has had no replacement for a week, says Brock Slabach, senior VP of the National Rural Health Association and former head of hospital. “If the waiting time is usually ten minutes and now two and a half hours, you can lose patients to other facilities because of this business interruption,” he says.
If a doctor who is regularly available for unplanned surgery – such as a surgeon – is not available, this can burden other health care providers who rely on the presence of this surgical protection in their facility.
If you don’t provide alternative coverage, revenue will decrease because you won’t be able to charge for services that you don’t provide. “If you generate a certain turnover for a provider and the doctor is now two or three weeks away, there can be a gap in turnover,” says Slabach.
2. Use existing facility staff
Many facilities will attempt to meet medical care needs internally by requiring existing staff to admit additional patients or to work additional shifts. There is a reason why this is a commonly used option. The existing staff is already qualified, insured and knows how the hospital works. You are probably also familiar with the patient population. Since they are always on site, they can also ensure better continuity of care. Billing is also easier because they are already employed in the hospital and registered with the payers.
If the coverage you need is expected, e.g. For example, during a vacation, “simply analyze your personnel pattern and adjust your existing employees,” says Slabach.
However, pulling the cover from the inside can also lead to burnout by the doctor, especially if this happens frequently. “When everyone is usually pretty busy, you just add more volume, which would make it very stressful,” says Slabach. “There is also a difference that depends on the length of time. Is that for a week or four months? Most people can survive a week, but if you are looking for months, you have to look at things in terms of service quality. “
3. Share doctors with another facility
For hospitals that are not too far from another facility, sharing doctors can provide the necessary coverage. This type of agreement can be formally organized by the two hospitals, or a doctor in one facility can choose to work as an independent contractor in the other.
In any case, the fact that they’re already licensed in the state and have misconduct coverage is less of a concern, says Slabach. “The other advantage is that they are familiar with the patients in this region,” he says. “They can provide a more culturally appropriate context for the care of the population they will serve.”
However, this type of reporting can be difficult because existing doctors’ schedules have to be bypassed. “Maybe you need someone for three weeks, but they can only last one week, so we would have to mix and match something,” says Slabach.
How the doctors are paid – and where the revenue they bring goes – depends on the agreement your facility makes with the doctor or your facility. “If you do this as an independent contractor, apart from your current employer, it would be between the hospital and the practitioner,” says Slabach.
“When the contract is signed with the other hospital, you have an agreement with them and this is drawn up between the organizations. In general, most practitioners do not want to be responsible for billing and collecting services in another facility, so they give their billing rights to the facility they work for. “
4. Bring a Locum Tenens doctor with you
In many facilities, a Locum Tenens doctor is called in when coverage is required. This can be an excellent way to ensure that patients are seen by a qualified doctor.
Locums contracts can be short or long term, making them a convenient option for vacation insurance or to fill out while hiring a new permanent doctor. This option ensures that patients have uninterrupted access to care and current staff do not feel the burden of having to perform additional tasks.
“I needed someone to cover my midwifery program for the weekend,” says Slabach. Finding a local doctor who is insured for a few days can be difficult. He had to take out insurance against misconduct and only prove himself on duty for a few days.
With a Locums doctor, the Locums agency helps with certification and usually offers insurance against misconduct. Payment is also relatively easy, with an agreed contract billed through the facility. “You pay them the amount per day or per hour and then enter everything you collect beyond the contract,” says Slabach. If you enroll the Locums doctor with your payers, the income from billing the procedures performed by a Locum Tenens doctor will usually exceed the cost of paying for the Locums.
5. Use doctors from local medical groups
If you prefer to seek medical care on site, you can connect with groups of doctors who have hospital rights. This can work well for easy-to-fill specialties, especially if you have personal contacts in the area.
“As a hospital administrator, I occasionally let resident doctors work for me in the emergency room or work in a clinic for a few days,” says Slabach. “It was my personal Rolodex from people I knew could come when I needed it.”
This strategy can help ensure coverage for short periods of time and ensures that patients always have access to care. It also solves the problem of taking out insurance and testing. However, it is not the best solution for longer-term coverage needs, as providers are already maintaining full-time employment elsewhere.
Service billing can also be difficult and is usually not a unified model. In some cases, the doctor can be paid at a certain rate and the hospital gathers all the revenue from the services provided. In other cases, the medical group can arrange for generated income to be retained and diverted from your sources of income.
Planning for medical care
Regardless of whether you need coverage for a doctor on vacation in three months, or suddenly need to leave a doctor for another opportunity, it’s important to have a well-defined plan and be ready to act quickly. Each of these alternatives to medical care may be appropriate for your facility, depending on the circumstances.
“You have to look at the fourfold goal,” says Slabach. “In addition to trying to exceed costs, lower costs, get better results, improve patient experience, and keep doctors happy.”
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