What an MSO Does Not Do: Where the Line Sits Between the Business and the Medicine
The single most common reason a PC and MSO structure is challenged is drift: the management company starting to make decisions that belong to the physician. Here is the line, decision by decision.
Key Highlights
- The physician-owned practice has sole authority over diagnosis and the treatment plan, and sets and approves clinical protocols and the standard of care.
- The practice decides hiring and firing of clinicians and approves compensation amounts. The MSO sources candidates and runs payroll.
- The practice owns medical records and approves the patient fee schedule. The MSO hosts records under a BAA and models and collects.
- The MSO owns technology, real estate, marketing and non-clinical HR, with the practice consulted.
Why the Line Matters
Corporate-practice rules exist to keep medical judgment with licensed physicians. A management company that tells clinicians what to prescribe, how long a visit should be, or whom to hire for clinical reasons is practicing medicine through its contract, whatever the paperwork says. The structure holds only if the practice makes the clinical decisions in fact, and regulators look for evidence of that.
What Belongs to the Physician-Owned Practice
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What Belongs to the Management Company
Technology, real estate, marketing and non-clinical HR belong to the management company, with the practice consulted. So do payment processing operations and the day-to-day running of the schedule inside the clinical limits the practice sets. The management company can supply data, defaults and scheduling infrastructure. The clinician decides care.
Signs the Line Has Moved
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Keeping It Clean
Write the division of authority into the management agreement, keep board minutes that record clinical decisions as the practice's own, make the physician owner a real participant, and review the arrangement on a schedule. If a situation is unclear, the safe answer is that the decision belongs to the licensed clinician. General information, not legal advice.
Disclaimer
This article is general educational information, not legal advice. Requirements vary by state and by the facts of a clinic's structure, so confirm specifics with health care regulatory counsel.
MedGrid MSO provides management services to independently owned practices; it does not practise medicine and does not direct clinical decisions. Requirements vary by state and by service, and change over time — nothing on this page is legal or medical advice. Talk to us or your own counsel before making a structural decision for your clinic.