ERS 4/10/2014

Tee It Forward: When Should You Move Up a Tee

Box?

Developing a Strategy For Limited and Senior

Partnership Options Within a Radiology Group

Michael Brown, MDVice-President, Managing Partner

Carolina Radiology Associates, LLCMyrtle Beach, SC

A 2012 survey of TEE IT FORWARD participants found that:

• 56 percent played faster• 56 percent are likely to play golf more often• 83 percent hit more-lofted clubs into greens

• 85 percent had more fun• 93 percent will TEE IT FORWARD again

Evolution of Golf Technology

ADVANCES MAKE THE GAME EASIER

BALL:

WOUND BALATA

SOLID CORE SURLYN

MULTIATERIAL

MULTICORE

IMPROVED FITTING

DRIVERS:

PERSIMMON

STEEL

TITANIUM

COMPOSITE

ADJUSTABLE

TIM

E

Evolution of RadiologyRADIOGRAPHY

FLUORO/BARIUM

CT

MRI

CTA/MRA

PET/MOLECULAR IMAGING

CT AND MR PERFUSION

DUAL SOURCE CT

TIM

E

INCREASING:

VOLUME, TECH SAVVY,

PRODUCTIVITY,

DEMANDSADVANCES MAKE RADIOLOGY

HARDER

RATIONALE FOR SENIOR/LIMITED POLICIES

• Reward for years of service• Allow for better lifestyle

• Can build in “rights” to purchase addt’l time off

• Must have defined value for time off as a group

policy

• Must consider limits to preserve remaining FTEs

time off• Allow for transition into new areas of interest

• Difficulty in maintaining skill set/acquiring new skills• CTA, procedures, etc.

• Enable recruitment in revenue neutral environment• Accomplished through financial “give backs”

RATIONALE FOR SENIOR/LIMITED POLICIES

• Long term strategic planning• Allow for transition/training of leadership

positions• Allows for evaluation on impact of new hires

• Financially

• Vacation

• Call

• Develop exit strategy for retiring Radiologists• Ready paperwork and documents• No surprises – if you have done your

homework!

HOW DO YOU DEVELOP THESE POLICIES?1. Determine what constitutes an FTE in your

practice• Weekday rotations

• Procedures

• Advanced imaging

• Subspecialty training• Weekend rotations• Evening and nighttime coverage• Ancillary services/administration

• Managerial board

• Medical directorship

• Hospital committees

• Internal committee/subcommittee participation

HOW DO YOU DEVELOP THESE POLICIES?1. Determine what constitutes an FTE in your practice

• Must assign a “relative value” to each facet• Should be based on average FTE reimbursement

• Tabulate as percentages, not absolute dollar values• Preserves integrity of policy in case of

decreased group revenue

• Must balance financial penalties/“give backs”:• Ensure adequate reimbursement to remaining FTEs

for addt’l workload

• If too punitive, will dissuade participation by eligible partners

HOW DO YOU DEVELOP THESE POLICIES?2. Determine entry criteria

• Age?• Years of service• Irrevocable once entered, unless defined conditions are

met

3. Limit participation in these tracks• Absolute number of senior/limited partners?• Percentage of group allowed to be on these policies?• Vote of FTEs to allow entry, without hard cap on

numbers?• Requires OA with strong language, defined majority

interest.

4. Define duration of senior and limited partnerships• Timeline until mandatory partnership resignation?• Promise of employment upon resignation of

partnership?• Retention of voting privileges for senior/limited

partners?• Participation in administrative activities?

HOW DO YOU DEVELOP THESE POLICIES?

INPUT IS NEEDED FROM ALL MEMBERS OF THE GROUP

IF ALL PARTIES GIVE A LITTLE, YOU CAN DEVELOP A WORKABLE COMPROMISE

WHAT ISSUES CAN YOU ANTICIPATE?• Payments due to member when resigning• Cash reserve distribution• Equity in building or equipment

• Need appraisal• Adjustment of notes, mortgages

• Timeline for payments

• Continuation of benefits• Medical• Dental• Some state medical associations allow

continued participation with ongoing membership

WHAT ISSUES CAN YOU ANTICIPATE?• Malpractice coverage

• Will resigning member remain as employee?• If not, will they be pursuing other Radiology work?• If claims made policy in place, is tail coverage needed?

• Some carriers forgive tail depending on years of membership

• Who pays tail coverage?

• If revenues drop for the practice,• Senior/limited partner may owe monies to group at

bonus distribution interval• Depends on group payment structure• Timeframe for payment

• Group practice changes• “Outs” for senior/limited partner should

call/weekend/weekday staffing changes occur• May not affect timeline until retirement, just change in

financial penalties

WHAT ISSUES CAN YOU ANTICIPATE?• Retirement plan participation• During senior/limited partnership, and

depending on amount of financial penalty/“give back”, partner may not be able to fully fund 401k/profit sharing plans

• Will retiring partner be allowed to continue to have holdings in retirement plans after resignation?• Should be specified in OA/policy/401k management

agreement• May be possible depending on plan balance• Group should have a policy that all sign outlining

what happens to plan in case of death/divorce/etc.

My Experience…

• Joined Carolina Radiology in 2005

• Earned partnership in 2008

• Elected Managing Partner in 2009

• Elected Vice-President 2011

• Carolina Radiology is a multi-specialty Radiology Practice in Myrtle Beach, SC• Serve 5 hospital systems• Cover our own call 24/7• Teleradiology arm of practice for in-office

imaging, urgent care centers

My Experience…

• In 2009, • 16 full partners, • 1 employee, • 1 Senior Partner

• Senior Partner at that time had no timeline for withdrawal, limited penalties for decreased participation in call, and convoluted structure for purchasing additional time off.

• Review of FTE requirements led to shift valuation of: FTE

M-F 8-5 60%

EVENINGS/NIGHTS

20%

WEEKEND 8-5 20%

My Experience…

• Based on hours worked by FTE• Limited partner eligibility at 15 years of service• Senior Partner eligibility at 20 years of service

• Limited partner • Automatically converts to Senior Partner status

after 5 years• May convert earlier if 20 years of service met

prior to 5 years.

• Senior partner • Required to resign partnership 5 years after

entering Senior Partner status.• Continuation as employee TBD by partnership,

NOT guaranteed.

My Experience…

• Partnership votes on any request for change in status• 75% required interest per OA

• 1 year notice required for any request to change partnership status

• Both limited and senior status irrevocable once entered

• Retain partner voting privileges, but may no longer serve in managerial roles.

My Experience…

• Senior partner has RIGHT to purchase additional vacation • Must continue to work at least half time• Pays pre-established rate for time off

• Limited partner DOES NOT have this right.

• Financial penalties are tied to facet of practice that ltd/senior partner opts out of:

FTE SENIOR LIMITED

M-F 8-5 60% 60% 50%

EVENINGS/NIGHTS

20% 20% 25%

WEEKEND 8-5 20% 20% 25%

Thanks for your attention,

Mike Brown

MBrown@CarolinaRadiology.com

References

Retirement: It's Not About the Finances!by John J. CronanJournal of the American College of Radiology (Vol.6, Issue 4)http://www.jacr.org/article/S1546-1440%2808%2900621-2/abstract?source=aemf

Retirement Issues for Radiologists, Part 2: Consensus Statement on Retirement and Preretirement Issues by the Commission on Human Resources of the ACRby Jay A. Harolds, John J. Cronan, Beverly G. Coleman, Edward I. BluthJournal of the American College of Radiology (Vol.10, Issue 5)http://www.jacr.org/article/S1546-1440%2812%2900666-7/abstract?source=aemf

Retirement Issues for Radiologists and the Radiology Practice, Part 1: A Report of the ACR Commission on Human Resources, Subcommittee on Retirementby John J. Cronan, Beverly G. Coleman, Jay A. Harolds, Edward I. BluthJournal of the American College of Radiology (Vol.10, Issue 2)http://www.jacr.org/article/S1546-1440%2812%2900584-4/abstract?source=aemf

Health Issues and the Practicing Radiologist: Defining Concepts and Developing Recommendations for Leave Options and Policiesby Marta E. Heilbrun, Claire E. Bender, Hang B. Truong, Edward I. BluthJournal of the American College of Radiology (Vol.10, Issue 9)http://www.jacr.org/article/S1546-1440%2813%2900282-2/abstract?source=aemf

Challenges Facing the Mature Radiologist: A Guideby Paul H. Ellenbogen, Lawrence R. Muroff, Barry D. PressmanJournal of the American College of Radiology (Vol.6, Issue 6)http://www.jacr.org/article/S1546-1440%2808%2900637-6/abstract?source=aemf

Radiology job sharing: Improving quality of life and maximizing resources for radiology groupsby John Lewis FloydJournal of the American College of Radiology (Vol.1, Issue 10)http://www.jacr.org/article/S1546-1440%2804%2900230-3/abstract?source=aemf

Practice Governance 101, v. 2013by David F. HayesJournal of the American College of Radiology (Vol.10, Issue 3)http://www.jacr.org/article/S1546-1440%2812%2900437-1/abstract?source=aemf