Being a physician transaction attorney is never boring because the more regulations, guidelines, and laws change, the more questions everyone has. But it’s more than just getting a question answered and being compliant. Physicians feel overwhelmed and out of control, and the risks facing their practice are real. This contributes to burnout and apathy, as it is difficult enough to keep up with the changing landscape of clinical medicine. Now you need to become a specialist in finance, employment and law? It’s a lot.
So, as a health care attorney who has been doing this for over twenty years, I wanted to give you the top four questions I hear and how I can help you in these areas.
The first and largest area relates to contract negotiations. Do I really have room to negotiate this agreement? Can I get out of non-competes and other harsh conditions? Am I just a pawn in the system or do I have actual leverage?
My answer to that is simple: You absolutely have room for negotiation. But you have to find your leverage. Always think like your employer and try to find a way to differentiate yourself from your peers and use this leverage to your advantage. And remember – some things have specific state law rules (like non-competes), so have a lawyer review it before you sign. Once the ink is dry and you’ve signed the agreement, there’s no going back. But please, whatever you do, make sure there is a back door to the agreement without many strings attached. You should be able to leave any job with a certain period of notice.
The second area I get asked about all the time is how, with all the regulations out there, can a physician feel secure in the world of compliance. I get it—between billing and coding, privacy laws, and Medicare regulations—there’s a lot to keep up with. My biggest tip is to put together a compliance plan. This is required by the Affordable Care Act (ACA), but many doctors still don’t have a solid compliance plan. Make sure it contains the seven required elements of the Office of the Inspector General and actually use it! Encourage your employees to report problems when they see them instead of fearing that they will have problems. Assign compliance duties to a staff member and provide them with the resources to track moving targets and at least issue red flags that you can follow up on. Education is key.
Next, I am always asked about labor law issues. Educate yourself on whether you need to hire key staff as a contractor or as an employee, and have a basic work manual that outlines the rules of your practice. Don’t let employee problems pile up and fester, thinking they’ll fix themselves. Listen to your staff and if there is a problem, see if you can resolve it early and quickly before it escalates out of control. And make sure you have a non-retaliation policy so that if someone does report something in good faith, he or she isn’t penalized. And consider whether you want someone to be an at-will employee, where they can be fired at any time, and whether you want them to be bound by an employment agreement.
Even though this law has been around for over two decades, I get questions about HIPAA on a daily basis. Yes, people are still confused about what records can be made available and to whom. What if someone dies? What about mental health notes? This really is an area where it pays to have a quick chat with your lawyer. But the foundations can be made within the walls of your practice. Instead of subscribing to some useless training, you have your employees perform during their time off to tick a box, have a very solid speaker come in every few years, and really train on that topic. And remember – it’s not just privacy that’s an issue, security is too. Do you perform robust security audits? Do you even know if your data is properly backed up in the event of a cyber attack? And please monitor the sharing of protected health information over telephones, general mail and text messages.
Health care is full of complexities, and it often takes a team of people to help you navigate the waters. But you’re likely to ask your attorney fewer questions by knowing you have a voice in contract negotiations, developing a compliance plan, considering your employee relations, and brushing up on HIPAA. And this will ultimately save you money and allow you to focus more on treating patients.
Amanda Hill is a healthcare attorney.
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