The Coronavirus disease 2019 (“COVID-19”) crisis has been a pandemic the world has not seen in our lifetimes. Although health systems continue to be challenged with the flood of patients or preparing for a surge, it is important for health systems to actively understand how compensation and contracting can support these efforts. While it patient care comes first, organizations should truly focus on creating that system of support to avoid any compliance issues or situations in which providers do not feel supported. This article is going to focus on an organization’s potential approach to the COVID-19 crisis from a compensation and contracting perspective.
Implementation of Governance Process
One of the first issues faced by our organization was the need to ensure we could move quickly while still maintaining a governance process for approving provider compensation. Our previous process involved multiple committees and stakeholders. Unfortunately, this process, while well-intended, is not effective in a crisis situation. Because of these we worked with several leaders and the system Board to address this issue.
Our proposed approach was to create an emergency subcommittee composed of members of our normal compensation committee. This reduced the number of individuals from 13 to 5. The subcommittee is composed of an operational leader, compensation leader, and three provider leaders. The intent was to create a group that could meet quickly, virtually, and address any compensation and/or contracting issues. Second, any approvals coming from this subcommittee would be considered approved so long as the approvals receive electronic approval from the General Counsel, the Chief Financial Officer, and the Chief Human Resources Officer. A report would be made of all activities and our Board would have access to that report at all times.
Compensation Planning Phases
Our emergency subcommittee worked together to focus on the creation of planning phases. Those phases include a Pre-Surge Phase, a Surge Phase, and a Post-Surge Phase. In the Pre-Surge Phase our focus was on how to ensure our provider workforce was supported but also productive. The decreases in elective procedures and shutting down of units/offices made productivity a key issue.
Pre-Surge Phase
In this phase we focused on stability and keeping providers busy. First, we required all specialties to submit a redeployment plan. The goal was to document how all groups will maintain their FTE during this time. Most included virtual health as a major component and many included training/backup planning for any type of patient surge. Second, for shift based specialties that were experiencing decreased need for shifts, those specialties were told to ensure they evenly spread out shifts (avoiding one person from taking all of the shifts) and allow individuals to work up to their FTE but not more. Finally, with any individuals or specialties unable to fulfill their entire FTE, those cases would get sent to the leadership of the group and leaders would develop additional duties.
In this phase, the compensation for all providers will remain the same so long as the individual is meeting their FTE and providing the same level of hours they were before. We made this decision not to maintain income but to change the reconciliation period. For example, if during this phase someone is deficient 1,000 wRVUs, in a future period they must produce 1,000 wRVUs before they can receive additional compensation under a production model. This avoids double payment risks. The same is true for shift based specialties. If they are working less hours, we will pay them consistent with their previous compensation but if they are deficient 200 hours, that will need to be made up. Once again, this avoids overpayment of any type as it merely changes our reconciliation period to a future date. The date is unknown right now.
Future Phases
We are actively discussing the future phases now but organizations should spend as much time planning now as it will avoid confusion later. One major initiative has been to create emergency template contracts to streamline the contracting process. In addition, we have focused on trying to ensure there are quick turnaround times with any requests. These are difficult times but providing strategic support to your health system could be just what is needed.
