Finally, we found that the terms of the co-management agreement should be negotiated by a small group of physicians authorized to speak for the entire panel. If the largest group of physicians does not choose its representatives on the original steering committee, the negotiated contractual terms may be rejected by the broader group. Many are aware that the health sector is moving from a simple service pricing model to one that rewards both hospitals and physicians on the basis of quality. First, however, reimbursement remains based on the service charge, as the characteristics of future repayment paradigms are significantly uncertain. However, such a refund will clearly be based on factors that will be affected by participants who will provide better quality services, at lower cost and with increased efficiency. To facilitate these changes, one model currently in use is the Clinical Co-Management Agreement (CCMA). As with other analyses where patients` net product is used as a variable, the FMV definition of a management agreement can be significantly influenced by the Payor mix of the service line. For example, when a co-management agreement is developed for a service line with a high percentage of poor payers, the hospital and its assessment firm should consider certain adjustments to “normalize” the negative effects of bad payers on the determination of the fmV area.  In addition, it is customary for an valuation firm`s analysis to also be based on a cost estimate and that such an approach is not based on net revenues for its application, an “average” of the resulting fluctuation margins of both approaches will help mitigate the effects of a high mix of poor payers.
The growing popularity of co-management arrangements, coupled with the unique dynamics of each hospital, has led to greater variations in structure and application. In addition, problems related to the allocation of time between different schemes may arise if the employment regime is time-based (p. B. team coverage), as opposed to productivity.  In these cases, the mechanisms for monitoring and documenting the performance of the required tasks should be integrated into the structure of at least one of the devices.  Regardless of this, the hospital and its assessment office must consider the “totality” of the potential compensation, including the possibility that the physician has engaged too much in a basket of tasks that are not feasible.