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[olaf]

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Hi all

My group gets approached about new work frequently and we have been seeing a trend. Here is an excerpt from a letter of interest where they talk about the two possible arrangements that they would entertain.


1. *The surgery center would enter into a consulting & services agreement with the anesthesia group for a fixed monthly fee. *The anesthesia group would be responsible for managing, billing, and collecting for all anesthesia services. *The surgery center would employ the anesthesia providers.
*
2. *The surgery center would offer the anesthesia group a fixed daily payment for coverage, which would be intended to assure the center has complete coverage and reduce for the anesthesia group all financial risk related to the provision of services including credit risk that is associated with billing and collecting for anesthesia services. *
The anesthesia group would still be required to bill and collect for all anesthesia services, and the providers would not be employed by the surgery center.

...............

This is in NYC and wondering if others are seeing this elsewhere. I know there are tons of lawyers involved but it still seems like a kickback.

 

[pgg]

I know there are tons of lawyers involved but it still seems like a kickback.

Sounds like a common/typical hospital subsidy arrangement? I'm no expert though.

 

[imfrankie]

"The surgery center would offer the anesthesia group a fixed daily payment for coverage"

You bet. Some of my buddies at SDN and I will cover your center. Our rates are flexible:

Prepaid plan $/day = ($250/hr)X(#of ORs)X(hours you're open/day)X(5 days/week)

 

[countingdays]

Sounds like a common/typical hospital subsidy arrangement? I'm no expert though.

Not if the billing goes to the surgery center and the fixed rate is less than billing receipts. Sounds like a kickback.

 

[olaf]

So the way they set this up is that the surgicenter collects all the billing using the rates we have contracted with insurance companies. Typically they want half the billing. So they want to give us 1.5k and they collect 3k from our billing. Lawyers are heavily involved so it's not quite that simple. If we don't take it there are lines of groups that will take it. Is this happening anywhere else?

 

[BLADEMDA]

So the way they set this up is that the surgicenter collects all the billing using the rates we have contracted with insurance companies. Typically they want half the billing. So they want to give us 1.5k and they collect 3k from our billing. Lawyers are heavily involved so it's not quite that simple. If we don't take it there are lines of groups that will take it. Is this happening anywhere else?

Yes. It's becoming more the norm than the the exception. I recommend you analyze the numbers and if you think it is a fair deal take it. You can haggle for a bit more but the owners of the ASC are in the driver's seat

 

[countingdays]

Yes. It's becoming more the norm than the the exception. I recommend you analyze the numbers and if you think it is a fair deal take it. You can haggle for a bit more but the owners of the ASC are in the driver's seat

Or don't take it and sue whoever does.

 

[BLADEMDA]

Or don't take it and sue whoever does.

Good luck with the whistleblower lawsuit. There are already at least a few suits over this exact issue. No rulings yet on the legality. However, if the ASC structures it right they are able to profit from anesthesia while paying the providers a fee. The lawyers ave to use the correct wording in the agreement but I believe it is legal and doesn't violate the Stark provision/law.

http://en.wikipedia.org/wiki/Stark_Law

 

[countingdays]

Good luck with the whistleblower lawsuit. There are already at least a few suits over this exact issue. No rulings yet on the legality. However, if the ASC structures it right they are able to profit from anesthesia while paying the providers a fee. The lawyers ave to use the correct wording in the agreement but I believe it is legal and doesn't violate the Stark provision/law.

http://en.wikipedia.org/wiki/Stark_Law

If the offer is below fair market value, then you could probably sue successfully.

 

[saratoga733]

"If the offer is below fair market value, then you could probably sue successfully."

Which begs the question... what is fair market value??

 

[ASA6]

It doesnt beg the question, because that is not the correct use of that phrase.

 

[sevoflurane]

"If the offer is below fair market value, then you could probably sue successfully."

Which begs the question... what is fair market value??

It depends on case load/complexity, # of ORs running past 3:00pm, how many md's are required to be on call to cover cases, etc.

For 30k you can hire an outside agency to do a comprehensive review and they can get you their estimate of fair market value. If you go this route, do not use the companies hired by the ASC. It needs to be an I dependent institution w/ no ties to the ASC.

$45-55 per unit is a reasonable end point