Part A

[musom]

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So I am a APCP community practice guy in a small rural town, currently an employeed physician. My contract is going up for renewal/renegotiation soon. I post a question to those either employeed or independent groups: Should I be using medicare Part A in my bargaining power for my salary? The current payer rate is about 40% medicare. I've been in conversations before where independent groups negotiate a portion of the part A that the hospital is collecting on their behalf....be either hourly rate, number of beds (number of beds x $500), relative compensation equivalent....

Any thoughts. Should I be fighting to get some portion of Part A included in my salary?

 

[BU Pathology]

Yes, CAP has information on their website about the rationale, and the legal justification, for asking that a portion of your compensation be paid. Part A payments are bundled payments to the hospital which includes a portion of the professional lab oversight.

 

[AZpath]

Time spent in support of the institution and its lab is an important portion of your salary ( Part A medicare).
Our part A compensation is based on a estimate of time spent for MC and Medicaid patients times an hourly rate. These costs are built into the DRG part A payment to the institution.

We bill the clinical component on commercial insurance patients. Often hospitals don't bother with this.
This is unfortunate since they net less money and therefore may not pay a good salary as a result.
Don't let them base your compensation on net collections. They often under code and under collect.

 

[musom]

So pardon my confusion...but theoretically is Part A compensation to a Pathologist the equivalent as to receiving a stipend for medical directorship? Are these one and the same?

For example....I'm a solo practicing pathologist that receives payment for my clinical lab medical directorship duties, say 20k, so is that considered my allotment for Part A? Or should I be asking for an allotment from Part A on top of my medical directorship stipend?

 

[BU Pathology]

You should change the language of your institution. Stipend suggests that you are a student receiving payments so that you can study. What you are actually receiving as the medical director is payment for your professional services.

If your hospital is paying 10% of your compensation (salary, fringe and bonus) and you spend 10% of your time as the medical director of the labs then it is a fair arrangement. If you spend more than 10% of your time engaged in these professional activities, and can document the time spent, then it would be appropriate to renegotiate your compensation.

CAP has excellent resources on this issue, just to restate the point.

 

[musom]

Point taken. And thank you for restating the point, I have reviewed the CAP Part A Compensation documents that are available online. A more direct answer would be greatly appreciated.

 

[BU Pathology]

A direct answer cannot be provided without a review of your contract, formula for determining compensation, etc.

If the hospital tells you that they are providing certain dollars for you being the medical director, then those funds are probably coming from part A payments to the hospital.

 

[musom]

That's as much of a direct answer as I would've expected. And that was my assumption, too. At the very least I can try to negotiate a strong medical directorship fee. And when it comes down to it, I'm a rock star, I deserve it.

 

[Over9000]

That's as much of a direct answer as I would've expected. And that was my assumption, too. At the very least I can try to negotiate a strong medical directorship fee. And when it comes down to it, I'm a rock star, I deserve it.

Love the attitude. Every pathologist should be like this.

 

[univlad]

Are you an employee of the hospital or an employee a group contracted with the hospital?

 

[musom]

I am one of 12 physicians in a small community hospital which are individually employeed. In its current state, is working out well for me. But only the future will tell....

 

[coroner]

I like your spunk, but you have to realize you have zero leverage when trying to renegotiate your contract. You are dealing with admin types and their name of the game is cost-cuttting. Those who are physician-friendly and generously dole out the dollars are quickly shown the door by the board of directors.

I know of Part A’s as high as 20K/mo. for a solo pathologist in an 85 bed hospital to three-man groups in a 200 bed hospital who get nothing. The latter has a CEO who tells them to swallow a nice, tall glass of STFU or the hospital won’t renew their contract, so they begrudgingly concede to keep their jobs. Is it fair: No. Is that the way medical economics operate particularly in our field: You better believe it.

The key thing you mentioned in your past conversations about Part A negotiations was that they took place with independent groups. They have a little bit more leverage when it comes to this matter vs employed-types. Because of this, in your negotiations, the hospital will likely pull the stunt that whatever they get reimbursed for Part A and calculate per pathologist is already built into your contract. Also, you’re in a 12-man group, so the hospital will likely fear the slippery slope that you might be twittering with your colleagues and if one gets a bump in their contract for a revised “Part A per FTE” section in their contract, then everybody will be clamoring for it.

That being said to answer you original question, if you should be fighting, I would. However, your odds of success may have more to do with if you play golf with the CEO, are a member of the same country club as the board of directors, or kids go to the same private school rather than your reputation amongst clinicians or Pathology brilliance. So don’t get your hopes up whether you’re a rock star or not. But hey, keep rockin…

 

[yaah]

The more the hospital asks you to do, the more part A that is. Committees, tumor boards, whatever. Keep track of your time and use that in negotiation. Lab directorship by a qualified physician is required by CMS. There are things that can be delegated that they don't "have" to pay you for, but if they are taking advantage of that that should be leverage for you. I am not at all surprised to see the doom and gloomers and the "take what they give you, take the scraps" comments as per usual. I have no doubt there are some hospitals like that out there, looking for the absolute lowest possible cost so long as there is a minimum of quality. And there are also hospitals that give you anything you want. But most are somewhere in the middle. "leverage" is gained by doing a good job, proving your worth and respectability in day to day affairs, such that if you leave it won't just be the lab that complains.

 

[pathstudent]

Yes we are entitled to Part A. Our hospital has us do timing studies where we document how much time we spend on Part A activities and then they multiply that times 90 an hour which they say is the value stated in the federal register for what a pathologist Lab Director is worth.

It is difficult if not impossible to document all the time you spend doing part A activity. It is like adding up infinitesimals in calculus. I think we should be paid for every hour we are here. Does the CFO have to document what she is doing every second to justify her pay? Just because I am signing out surgicals am I not still clin lab medical director?


If I went down there and said I wanted x dollars for medical director fees and started showing them articles from CAP and such, they would get very annoyed with me quickly. Moreover there are companies like Quest who lobby them to take over this whole operation and a small part of their pitch is that they don't need medical director fees.

 

[ygdrasil]

I've heard that Part A payments for lab services in a critical access hospital is itemized, not part of the DRG, but my google-fu has failed to come up with a schedule of payments. Any ideas?

 

[stickyshift]

Something like $130/hour for each documented hour of Part A work.

 

[AZpath]

Critical access hospitals get 101% of their costs from CME.
It is not a DRG system.
They itemize every cost possible hospital cost and charge it to feds.

 

[AZpath]

Sorry CMS. CAHs don't have fee schedule from most services. The charge costs to CMS. Lab director fees are likely itemized as physicians services.

 

[Napoleon1801]

This is a good read from a lawyer that deals with pathology business related topics.

http://www.executivewarcollege.com/wp-content/uploads/All-Handouts.pdf

Can a Hospital Refuse to Pay Pathologists for Their Professional Components of Clinical Pathology Services for the Hospital’s Medicare Patients?

By refusing to pay adequate Part A compensation to pathologists, hospitals and their individual administrators and trustees may violate the anti-kickback law, thereby subjecting themselves to criminal and civil penalties.

 

[deleted314957]

This is a good read from a lawyer that deals with pathology business related topics.

http://www.executivewarcollege.com/wp-content/uploads/All-Handouts.pdf

Can a Hospital Refuse to Pay Pathologists for Their Professional Components of Clinical Pathology Services for the Hospital’s Medicare Patients?

By refusing to pay adequate Part A compensation to pathologists, hospitals and their individual administrators and trustees may violate the anti-kickback law, thereby subjecting themselves to criminal and civil penalties.

This is a nice review of the PC of CP history. It is very important to note, in all
the IG and other agency and legal comments and interpretations, the constant use of words such
as "may", "could possibly", "caution against", etc. There is a general lack of "shall", "will", "is", etc.
That nuance has been brazenly pointed out to me by hospital administrators and their lawyers.
THEY DON'T CARE.
Go ahead and sue Monster Mega hospital Corp after you have lost your contract and are in the bread
line.

This is not the good old days. Pathologists are a commodity in abundance.

But it is an excellent review.