What legal risks are present when entering a health care contract

InAMA reorganizes as the national organization of state and local associations. Membership increases from about 8, physicians in to 70, in -- half the physicians in the country.

What legal risks are present when entering a health care contract

Bundled contracts take many forms but generally pay an entity a fixed or capitated amount in return for a set of services surrounding an episode of care.

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In this structure, healthcare providers accept financial risk, and as a result, should enter into bundled contracts cautiously. As a result, quality and cost management of these patients will be much more complex, and innovative care strategies will need to be developed, he says.

In response, hospitals should review the following four types of considerations before entering into a bundled pricing contract. Financial considerations Because providers take on risk in a bundled contract, financial considerations are probably the most important set of considerations hospitals needs to examine before entering into such a contract.

As part of examining the financial impact of a bundled contract, hospitals should: Understand the direct and indirect costs for the entire bundled pricing episode. Identify frequency of outliers and associated costs for these cases.

Develop risk mitigation strategies and terms for outliers. James Reilly, managing partner at TRG Health Care Solutions says that hospitals can mitigate outlier risks by including a provision in the contract to exclude certain outliers from the bundled payment or develop a reinsurance or risk pool for these cases.

Contracts that include exclusionary provisions might define an "outlier" as a patient that exceeds a pre-determined total length of stay, a certain total of charges or who has a set number or type of co-morbidities, says Mr.

Identify what costs can be lowered with the help of your physicians.

What legal risks are present when entering a health care contract

After getting a complete picture of current costs, hospitals should begin to estimate how much these costs might be lowered by physicians. This includes cost savings from standardizing equipment or implants as well as cost savings from providing more coordinated care. Once physicians are engaged, hospitals must commit to transparently sharing its costs with physicians as a way to drive their behavior, says Mr.

Quantify market share potential. Finally, hospitals should determine how many more admissions they should expect from entering into a bundled contract and how that is expected to translate into revenue increases.

Medical staff considerations Because physicians are essentially the key drivers of the cost of care, hospitals must engage them in any bundled payment initiatives.

Hospitals with a medical staff that is resistant to bundled pricing must view this as a major challenge to success and will need to enact steps to bring them on board.

What legal risks are present when entering a health care contract

Communicate with medical staff regarding risks and rewards of bundled pricing. Rewards should include incentive programs that reward physicians for improving efficiency and better coordinating care, says Mr.

Educate physicians on what is included in a "bundled fee.OSHA's Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers provide the agency's recommendations for reducing the risk of workplace violence to workers in healthcare, including home healthcare, and in social services.

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A series of conversations, involving patients, lawyers, ethicists, economists, policy-makers, informaticians and clinicians must begin now. Because providers take on risk in a bundled contract, financial considerations are probably the most important set of considerations hospitals needs to examine before entering into such a contract.

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