Obstetrical care is comprised of the provision of antepartum care, delivery, and postpartum care. When a single physician or practice provides all the services, it is billed as a global OB package using a global OB code. However, given today’s use of laborists, more and more community physicians taking less call, as well as the integration of advanced practice providers, obstetrical care is often provided by more than one provider or practice. So, how do you compensate a laborist or a community physician for delivering the patient of another physician or group? The challenge is how to equitably allocate the services that are otherwise bundled within the global OB case rate.
When isolating the delivery as a service performed by a different physician, there are a few methods for allocating the reimbursement. Some methods rely on a flat fee to pay the delivering physician. Others may split the collections that come through the door. Things can become more complicated in a shared model where the physicians share not only the delivery, but the overall care of the patient during the maternity period.
Take for instance, Ms. Jones who comes into her OB’s office to initiate prenatal care. During the course of her pregnancy, she could see any of the providers within the practice for prenatal visits, the delivery, and/or any post-partum follow-up care. The compliance concern for our clients pertains to the need to appropriately give credit to each physician for the services that they personally perform. For one such client, we created a model for allocating all the components of the global OB case rate such that the shared model could be easily administered and where the resultant compensation would be within Fair Market Value (FMV).
The shared model allocates both WRVUs and professional collections based on the number of prenatal office visits, the delivery, as well as the inpatient/outpatient postpartum visits. In doing so, our client was assured that their physicians were credited with the services that they personally performed and that they were not providing an undue benefit that could result in a compliance concern.
This example is for a single group practice. However, as you consider these global obstetrical services, you will need to consider the impact of community physicians and/or laborist groups performing a portion of the global services and how that impacts the FMV for various potential economic arrangements, including but not limited to, the employment agreements with the employed practice, call agreements with the community physicians, and/or OB laborist coverage agreements with the hospital.
By Rob Holland, Director
For access to a recent slide presentation on OB hospitalist credit under professional services agreements, click here.