2021

Evan R. Goldfischer, MD, MBA, FACS, urologist and Director of the Research Department at Premier Medical Group in Poughkeepsie, New York, discusses hospital service line agreements and the process of negotiating beneficial pay for call contracts. He begins by explaining physician health system alignment and how alignment can look different depending on how much autonomy a physician desires. Dr. Goldfischer explains that hospitals want to partner with urologists because they need urologic specialization for a wide variety of patients and do not know how to effectively manage service lines, and that urologists should desire partnership because it reduces the incentive for internal urology departments and gives urologists the opportunity to improve the condition of their practice. He also states that there is a great deal of benefit to patients due to access to well-trained and educated specialists. Dr. Goldfischer also describes how call coverage and quality improvement service arrangements function to benefit a hospital, and outlines the call coverage responsibilities, including 24/7 coverage 365 days a year, unassigned inpatients, daily rounds, and more. He then details call coverage compensation in terms of flat fee coverage. Dr. Goldfischer explains the variables involved in deciding flat fees such as extent of burden, extent of treatment, fair market value, and probability of providing uncompensated care. He details quality based payment strategies and how to collect evidence on the positive changes a physician has made as part of a hospital as a way to prove value. Dr. Goldfischer concludes by stating that physicians understand their specialty and should be compensated for achieving higher quality work and lower costs.