Own the whole contract to provide all orthopaedic trauma care if possible, not just individual contracting (negotiate as a corporate entity).
Expect multiple long meetings with administration. Process may take 6-12 months for contracts lasting only 2-3 years. Longer contracts (i.e. 5 years) are more common. Consider adding provision for extensions to existing negotiated contract so entire process does not need repeating in two years. The physician is at a disadvantage, as they are negotiating not with other physicians but with professional negotiators (administrators), who continuously negotiate with multiple groups/departments/specialties.
Provisions for unfunded patients: hospital to pay at a negotiated rate (e.g. Medicare). Some contracts require a yearly cap (e.g. $100 - 200K).
Stipend versus other models to generate 'salary'
Hospitalist/Sugicalist model=hospital employee=salary
Occurrence or Contact fees (can effectively increase stipend without being visible to FMV surveyors)
Each trip to the ED for a consult generates a fee
Stipends are part of the hospital Fair Market Value (FMV)
Hospitals legally need to use FMV as a guideline
Doing your own research, not just relying on their FMV
The trauma service brings revenue to the hospital (1).
Does your case load justify demand? Obtain this information from hospital billing to determine the number of operative and nonoperative cases/admissions.
OR time daily, either preferred access (shared but with priority access) or protected access, needed for long-term sustainability. If hospital not willing, negotiate a trial period where, if used less than an agreed percentage (i.e. 60-70%), this time can be reduced. If used more, time can be added.
Access C-arm/other technologies with available tech.
Trauma Service to provide inpatient care.
CME Education Stipend
This is an alternative to bringing the patients to the physician's private clinic.
All patients are seen, not just unfunded/underfunded.
This gives the hospital a reason to keep the trauma clinic. Significant fees generated for the hospital in diagnostic radiology (XR/CT/MRI) and returns to the OR for follow-up procedures. Revenue is positive for the hospital (2).
Justified based upon hours required to manage the service, create protocols for improved trauma care, and perform community outreach (presentations to community non-trauma hospitals).
Options for employment, through hospital, where hospital bills/collects, or a 'stipend/budget' given for individual/group to employ PA, assuming risk but potential benefit of charges/efficiency.
OR nurse liaison to mesh with OR, Ortho MD, Ortho PA, and trauma general surgeons/hospitalists to improve efficiency of case flow through the OR, workup/studies on patients, implants for cases, etc. This nurse is ideally one who has been an experienced OR nurse. Nurse starts earlier in the day than the traditional OR nurse, monitors progress of surgical patients for that day, and organizes the progress for the day based upon who is ready for surgery. Being an OR nurse, they understand what cancels surgery and keeps patients from getting to the OR.
Do not be greedy. Be realistic in expectations for pay.
Implants (negotiate savings to be at least in part returned to trauma service through education and capital equipment purchases).
Hip Fracture Service (for those with combined ER/trauma coverage): Work with hospitalist service to explore reduction in length of stay, other financial benefits to an integrated service line.
(1) Orthopaedic Traumatology: The Hospital Side of the Ledger, Defining the Financial Relationship Between Physicians and Hospitals. April 2008 - Volume 22 - Issue 4 - pp 221-226.
(2) Getting Paid for Taking ER Calls: Who Pays, and How Much is Fair? MGMA Connexion, Vol. 6, Issue 7, August 2006.