"CMGs (contract management groups) can provide a valuable community service by operating a better emergency department (ED), recruiting better physicians and providing patient quality management programs," says Robert Broida, M.D., an emergency physician and consultant for ED Quality Solutions Inc., Cleveland. "It's the board of directors' responsibility to ensure that quality of care is upheld. They hold the ball in their hands."

It comes down to hospitals taking the initiative to manage their CMG relationships, says George Molzen, M.D., immediate past president of the American College of Emergency Physicians (ACEP). Before hiring a CMG, the board needs to be specific about their expectations and include those expectations in their contract. A CMG should add value to the hospital relative to patient care, staffing and assistance in achieving a hospital ED's goals and objectives.

If you have concerns, ask to speak to three to five hospitals where that CMG has lost a contract. This may provide insight into potential problems.

The following is a list of provisions recommended by the ACEP and the American Academy of Emergency Physicians that should be included in a CMG contract with a hospital and/or physician group:

• The provisional period should not exceed one year. Physicians should be allowed due process.
• A defined mechanism should be included that regularly and automatically provides all emergency physicians details of their professional charges and collections.
• An additional mechanism is needed that regularly and automatically provides all full partners with the total charges and collections for the CMG, and the distribution of all income, including all management and operational expenses such as coding/billing/collection, professional liability insurance, nonphysician employee salaries and physician administrative stipends.
• Physicians should be provided details of the CMG's governance process, including the method of electing leaders and new partners, appointing medical directors and administrators and revising the board's bylaws.
• Physicians should not be required to agree to post-contractual restrictive covenants.
• The CMG should be wholly owned by practicing physicians.