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PhysicianEmployment
Issues
Presented by Kirk Doan
KIRK DOAN –HEALTH LAW EXPERIENCE
General Counsel -- Metropolitan Medical Society ofGreater Kansas City
Board Member -- Missouri Medical Political ActionCommittee
Member -- Metropolitan Medical Society Alliance --Legislative Liaison
Member -- State Government Relations Committee --Metropolitan Medical Society
Partner -- Health Care Practice Group of StinsonLeonard Street LLP
President, KC Society of Healthcare Attorneys
PHYSICIAN EMPLOYMENTAGREEMENTS
Introduction
o Hospital employed physician
o Private group employed physician
o PC/LLC owner/employed physician
Contract issues to be addressed
Relationship to other agreements
o Revenue guaranty agreement
o Shareholder agreement
CORPORATE FORMALITIES
Who is the employer
Has contract been authorized
Who signs for the employer
Is the employer a substantial entity
Fee splitting
Corporate practice of medicine
PHYSICIAN QUALIFICATIONS
What licenses and privileges are required
When must they be obtained
When do you start and risk of delay
Medicare exclusion or suspension
Effect of staff membership on covenant
Board eligibility or certification
Managed care/insurance agreements
TERM OF THE AGREEMENT
Date legally binding and start date
Evergreen provision for renewal
Escalators and passage of time
Termination versus expiration
Locum Tenens as damages
Partnership consideration timeline
Terms of buyout - Shareholders’ agreement
PRACTICE LOCATION
Where will you work and reassignment
Effect on family
Effect on covenant not to compete
Is your consent required
WHAT EARNINGS BELONGTO THE GROUP
Honorariums and consulting
Inventions and books
Moonlighting
Hospital staff positions
Call payments
PATIENT ASSIGNMENT
Effect on compensation and bonus
Equitable allocation of new patients
Helps to build your practice
ADMINISTRATIVE TIMECOMMITMENTS/CALL/ROUNDS
35-40 Clinical hours per week
Limit administrative duties
Staff positions
Call assignment
Rounds at hospital
Immigration minimums
INCORPORATED POLICIES ANDPROCEDURES
Employee handbook
Employer rules and regulations
Hospital rules and regulations
Medical staff by-laws
Request copies or password to website
MEDICAL RECORDS
Timely preparation
Copies for your administrative, regulatoryor litigation purposes
HIPAA -- business associate rules
Record retention and access
Ownership of records
SPECIAL EQUIPMENT
Cellphone, pager, PDA, dictation
Revenue generating equipment
Automobiles
Computers and EMR
Ancillary staff -- duty to consult
Physician extenders and collaborativepractice agreements
Special equipment for practice
COMPENSATION
Formula or set amount
Guarantee and/or Bonus
Audit rights
Realistic - MGMA Data, WRVU analysis
Forfeiture of bonus on early departure
Stark II caps on total compensation
C-Corp dividend vs. compensation issue
REVENUE GUARANTY AGREEMENT
Between hospital andrecruit/group
Indemnification by groups
1099 income
Termination for cause
Terms of payback
Stipends during residency
MALPRACTICE INSURANCE
Amount
Who pays for the tail, conditions topayment
Evidence of prior coverage or nosecoverage
Moonlighting
Extra-ordinary premiums
Indemnify for harassment, etc.
FRINGE BENEFITS
Copies of all plandescriptions
Effect of vesting schedule
COBRA rights
Publications
Medical Staff dues
Society dues
VACATION AND CME
Amount
CME count againstvacation
Vacation -- use it orloose it?
CME allowance
Sick leave
SIGNING BONUS, MOVINGEXPENSES, ETC.
Signing bonus
Moving expenses
House hunting trips
Recruiting fee
Repayment obligations
Loans and stipends
If loan, 1099 income upon forgiveness
FOR-CAUSE/NOT-FOR-CAUSETERMINATION
Definition
Objective criteria and right to cure
Effect on pay and benefits
Effect on malpractice tail or competitioncovenants
Notice period for not-for-cause
Liquidated damages for training expenses
Automatic termination of hospital privileges
Arbitration
COVENANT NOT TO COMPETE
Radius
Duration
Ownership
Enforceability
Relation to hospital,clinic locations
J-1 Visa Waivers
Part of practicepurchase
Consideration
Buy-out formulas
Liquidateddamages
ASSIGNMENT OF CONTRACT
Who do you work for
Consent required
EXECUTION
Copies
E-signatures
Amendments
