Physician Services Model Comparison

SCP Health Thought Leadership

November 14, 2024

Resources

The complexity of the No Surprises Act (NSA), payor responses, and regulatory changes has made it very difficult for previously successful models to be financially viable, leaving health system executives with no choice but to evaluate their options. Delivering high-quality care in a cost-effective way is the highest priority when identifying the most effective care delivery models with the needed flexibility and expertise in staffing, coding, documentation, and managing revenue cycle.

Below is a chart to help compare the different types of physician service models.

Hospital

Pros

Cons

Hospital Employed Programs

Physicians, NPs, and PAs: directly employed by the hospital or hospital’s medical group.

Recruiting, credentialing revenue cycle, documentation, and coding done within the health system or through health system partners.

Clinicians are loyal to hospital and patients
High-degree of patent trust with community clinicians
Clinicians are in alignment with hospital strategy
Positive clinical outcomes
Local staffing control

Overall program cost/revenue collection
Recruiting challenges
Compensations models without productivity/performance targets
Lack of schedule flexibility to match volume changes
Lack of expertise to manage and navigate NSA, reimbursement changes, etc.
Modern care delivery models leveraging clinical integration and virtual care

National Outsourced Clinical Services

Physicians, NPs, and PAs: work locally, employed by vendor.

Professional recruiting, credentialing, revenue cycle, documentation, and coding are done by vendor through either direct services or third-party arrangements.

Robust, nationwide quality and outcomes management
Clinicians are loyal to hospital and patients
Clinicians are in alignment with hospital strategy
Expert staffing and resource management
AI and tech support for operational optimization
Balanced compensation models include quality, performance, and efficiency
Scalable recruiting and revenue cycle to maximize financial results
Deep domain expertise
Optimized overall program cost
Coding and documentation expertise
Positive clinical outcomes
Modern care delivery models leveraging clinical integration and virtual care

Local clinicians can be seen as outsourced
Variable financial stability among vendors
Vendor KPIs can take precedence over hospital strategy
Potential for staffing only vs strategic partnership
Variability among vendors

Co-resourced

Physicians, NPs, and PAs are directly employed by the hospital or hospital’s medical group, with the possibility to leaseback the group for headcount and managed care contracting reasons.

Recruiting, credentialing, rev cycle, documentation and coding all done at scale by vendor as part of management solution.

Clinicians are loyal to hospital
High-degree of patient trust with community clinicians
Alignment of physician group to hospital strategy
Leverages best of employed programs and vendor programs
Expert staffing and resource management
Possible artificial intelligence and tech support for operational optimization
Optimized overall program costs
Coding and documentation expertise
Positive clinical outcomes

Clinicians are loyal to hospital
High-degree of patient trust with community clinicians
Alignment of physician group to hospital strategy
Leverages best of employed programs and vendor programs
Expert staffing and resource management
Possible artificial intelligence and tech support for operational optimization
Optimized overall program costs
Coding and documentation expertise
Positive clinical outcomes

Local or regional physician group providing services

Physicians, NPs, and PAs are employed by a local or regional physician group.

Physician group provides recruiting, credentialing, revenue cycle, and documentation either directly or via third party arrangement.

High-degree of patient trust with community clinicians
Alignment of physician group to hospital strategy
Positive clinical outcomes
Local staffing control and resource management
Shared resources in the community

Limited insights of NSA and its regulatory impact on collections
Higher sensitivity to changes in market/ reimbursement
Limited scale and negotiation power with payers
Limited revenue collection expertise
Standard care delivery models - limited to no use of tele services and modernized approaches

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A physician-led team of clinical specialists in emergency, hospital, and critical care medicine, supporting local clinical practices with national resources to deliver high-quality patient care in the communities we serve.