Should medical staffs pay physicians for performing peer review?

Whether medical staff members should be paid for serving on the medical staff quality or peer review committee is a question that will never die. For years, medical staffs have been grappling with questions such as the following:

• The chief of staff, department chairs, and vice chairs receive a stipend. Should other medical staff members also receive a stipend for serving on a committee?
• Should only committees that require members to review material before a meeting be compensated?
• Should we pay a flat fee across the board or should the pay reflect the physician’s specialty?
• Should we pay a stipend even if other hospitals in the area do not?

As physicians had less time to devote to medical staff responsibilities, the burden falls unequally on some more than others. In the past, physicians saw serving on committees as a duty, and compensation was unheard of. In many medical staff cultures, even today, physicians who are paid for non-clinical work, such as case management physician advisors or medical directors, are viewed as being in administration’s pocket. 
So what is the right course? My response to this question should not be construed as either advocating or not advocating for physician payment. I will, however, offer some ideas on how to approach the issue. There are really four decisions you must make to address this issue:

Should you pay? There is nothing illegal about paying physicians, as long as you pay fair market value. The real issue is what does you medical staff think about physicians getting paid for serving on committees? If your culture would react negatively, you need to either work to change that culture or abandon the issue. The best place to discuss this question is at your medical executive committee meeting, not at the committee that potentially would be paid.

Who should get paid? Most medical staffs focus on individuals who go above and beyond, rather than those who simply show up at the meeting and don’t contribute much. Attending a committee meeting is a physician’s responsibility as a member of a self governing medical staff. But for those who go above and beyond, defining their responsibilities will help the medical staff develop a fair compensation mechanism. This may be based on the time spent on tasks or on the tasks that are accomplished. The medical staff can pay physicians for meeting attendance if the meeting requires preparation ahead of time. The medical staff may wish to exclude physician leaders who already get paid. For example, if the medical director’s responsibility is to review physician care, you may wish to exclude him or her from additional payment for quality work.

Who should pay? When it comes to paying medical staff members for attending meetings, the hospital is typically the source of the funds. Sometimes, the hospital may provide the medical staff with a lump sum of funds to pay physicians for various activities and let the medical staff determine the distribution. Another option is for the medical staff to provide some or all of the funds from medical staff dues. These two approaches work particularly well if the medical staff culture is suspicious of physicians who receive funds from administration. Whatever payment mechanism the medical staff uses, the medical staff, administration, and the board need to be in consensus.
 
How much should you pay? The legal issue here is based on the Stark law for inurnment. The medical staff should establish an administrative hourly rate for physicians and apply it equally to all physicians, regardless of specialty. Then the medical staff must establish a method to determine how to quantify the actual work done. It can be either through requiring physicians to track their time spent reviewing cases or by establishing a general per-case rate.

Robert Marder, MD, CMSL, is vice president of The Greeley Company, a division of HCPro, Inc. in Danvers, MA.