The following table offers a summary of what might be expected in terms of the time and steps required in developing and implementing an MSO after a commitment has been received from interested parties.

Time Activity Comments
Week One Health system commitment.

Advertisement for positions.

Preliminary announcement to medical staff.

Consulting group provides staff for assistance or practice support.
Week Two Physician liaison staff consulted regarding role definition.

Physical space is committed.
Phone, stationery and office incidentals contracted or purchased.

Hospital\consulting group joint venture contracts developed. Contracts are executed.

Liaison staff and consultants map out strategy for specific services.

Protocols developed for practice assistance and practice evaluation.

Target practices identified.

Week three A corporation is formed, the office becomes functional, banking and financial functions are defined.

Definitive material forwarded to the medical staff.

Interviews for permanent positions begin.

Interviews (recruiting) begin for the target practitioners.

Plan completed for hospital based liaison office, medical staff recruiting, MSO interrelationship.

Protocols and standards in place for practice support functions.

Hospital\MSO communication processes defined.

Contracts (hospital\MSO) under review.

Initial reception functions maintained by the consultative group.

Week four Offers are made to one FTE consultant and one FTE technical-clerical staff person.

Analysis begins on transition of captive billing functions (hospital based groups and clinics).

Contracts are signed with the consultative group and a line of credit is established for initial operations.

Contract form development begins for the customer base; i.e. the target practices.

Consulting staff review the target practices to test the protocols for intake and the practice review and intake process.

The initial target practices are reviewed and recommendations are available for review by the MSO steering committee (hospital administrative representatives and consultants).

A formal organization chart is ready for the review of the initial medical staff representatives on the physician advisory panel.

Week five Commitment is made to the target practices, the physician advisory panel is formed. Business plans are developed for each participating practitioner.

Planning for general medical staff educational programs is initiated with the hospital based physician liaison office.

Computer system RFP is developed for the billing and hospital communication linkage. RFP’s distributed to the potential vendors.

Initial meeting of the physician advisory group is held. General governance issues are discussed.

Hospital steering committee meets to review initial business plan, medical staff response, composition of target practice group.

If the steering committee endorsement is forthcoming, the project is launched. This is a key stage in the commitment and development process and it is potentially an irreversible step.

Week six Contracts are signed with the target practices. The physician advisory board is formally appointed.

First consultative FTE starts, technical-clerical staff starts. Orientation begins using the target practice information as a base of reference.

The MSO is in business.

Technical-clerical, reception functions are turned over to the on site staff.

Orientation of consultative staff begins.

Week seven Target practices are integrated into a co-op structure with management functions performed by the MSO staff (back up by the consulting group).

Practice personnel are informed of the changes, and they are evaluated relative to their possible contribution to the MSO generally and the specific practices.

Reorganization (after evaluation) of billing, registration, collection, purchasing functions is initiated.

Timeline is developed for the incorporation of the hospital based billing activity into the MSO.

Orientation continues on all levels.

The physician advisory panel becomes more active in monitoring activities and proposed solutions. Essentially, they are used for the creation of support and the development of consensus.

The steering committee continues to meet, primarily to assure the MSO is operating in support of the hospital’s overall medical staff development goals.

Week eight Computer RFP’s are received, reviewed and site visits are scheduled, if necessary.

Contract purchasing processes are integrated into the client practices.

Follow-up material is distributed to the medical staff stressing (hopefully) the initial success of the pilot activity and announcing new “products” for individual practice involvement. These might include educational seminars, practice analysis services, compliance review services (CLIA, OSHA, etc.).

Orientation continues.

At this stage, initial integration of the practices is taking place with the emphasis on the service quality to the charter members. The committee structure is continuing to develop and “practice” decisions are being made at the physician advisory panel level so that the doctors can gain a comfort level with the process and the new relationships which are being formed.

Week nine Additional technical-clerical position is started.

Contract is awarded to a computer vendor. Planning process initiated to reorganize billing, collection processes into one integrated system.

A personnel audit is conducted to determine the feasibility of reorganizing certain elements of the practice staff into the MSO. This might start with billing and collection and eventually could include all practice staff.

Practice bookkeeping, financial reporting functions, internal controls, registration, record keeping and charge slip functions are in the process of review and standardization.

Orientation of all parties continues.

Emphasis begins to shift from the target physician group (assuming there is high satisfaction) to a group which might comprise the next tier of service.

The physician advisory panel should now be concentrating on cost savings related to staff coordination and internal practice cost efficiencies.

Week ten Contract finalized with the computer vendor. Formal commitment, contract execution.

Collection processes are centralized. If possible, other central coordination is attempted such as payroll, electronic claims transmittal, account reconciliation, claims follow up, etc.

Exploration can begin on such issues as medical malpractice coverage, benefits redesign, pension reorganization, etc.

Vendor groups might be incorporated at this stage after a “make or buy” analysis is completed to determine the feasibility of developing core services. At this stage, there would be sufficient critical mass to assure favorable customer status for most services.

Boards continue to meet. Orientation and consolidation continues. By this time, some staff cross training (practice to practice) should have occurred, at least on a limited basis.

Week eleven Additional consultative staff member is added.

Each practice is now ready to develop a plan for growth, expansion (or consolidation). This planning process is initiated by the consulting staff and individual doctors.

Practice processes are retooled to accommodate the computer conversion. Existing equipment is evaluated for conversion or disposal. Specific timelines are developed for each practice to be incorporated into the new system.

Physician advisory panel concentrates on the near term coordination of billing, registration, collection functions. Long-term planning discussions focus on direct contracting, HMO coordination, product development, etc.

The consultative staff and the MSO group concentrates on cost efficiencies (related to personnel savings), billing conversion problems and the incorporation of additional practices.

Week twelve Training begins for staff on the new computer system. Site visits are made to existing installations.

One additional staff person is recruited with specific orientation to the computer system under consideration.

Initial efforts in the conversion process focus on hospital departments. Hopefully, at this stage, at least one prototype system can be operational, being tested in tandem with existing systems to assure accuracy and to allow a local training site to be organized.

Physician advisory group continues deliberation on long term goals.

Progress report is prepared emphasizing new services (computer) to the medical staff.

Hospital steering committee develops plan for shift of hospital based physician billing functions to the MSO.

Week thirteen Practice conversions continue. Training continues. Critical evaluation stage is approaching. The physician group should begin to develop (or reflect upon) comparisons related to “before and after” comparisons of the MSO experience.

Hospital group considers potential for outside sales and/or additional products and/or expansion to other components of the medical staff.

Week fourteen All practices either operational or well under way in the conversion process.

Staff planning is focused upon taking the computer and billing functions to full capacity and in integrating hospital linkage functions for scheduling, patient reports, etc.

Medical group does an initial evaluation. Pilot phase is closed.

Long-term commitment to the medical advisory group is reviewed and defined.

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