One party appears to be missing at the negotiating table as physicians and hospitals enter employment talks: Medicare, or rather, how and how much Medicare will pay providers a few years from now.

The shift by cardiologists from private practice to employed models has entered phase two, with many of those groups now renegotiating or preparing to renegotiate contracts. Our cover story looks at how the process changes between a first and second round, and ways to improve chances of a favorable deal.

Hopefully, by the time renegotiations come around both parties have established good will and good faith. But right now, they also have a good deal of angst.

Hospitals are being squeezed by payers, although critics might argue that reflects a correction in an industry that historically made lots of money. Many analyses show hospitals have cut costs to compensate. Other analyses also reveal a recent downturn in some physician pay, and cardiologists are no exception.

Today’s negotiations and renegotiations may be more about minimizing risk than maximizing gain. Neither party wants to enter an agreement that later proves to be unsustainable. Making even a three-year projection under scenarios such as readmission penalties, bundled payments or accountable care organizations must be a challenge.

The negotiation table can be a place where both sides can voice their concerns and share strategies for coping amid uncertainty. Both cardiologists and hospitals have more to offer each other than mere services and pay. We’re talking smart people here.    

Best-case scenario is a contract that benefits both parties. Hospitals and hospital systems that support and value their physicians in return should get doctors and staff who work efficiently to improve patient care. Physicians who contribute to their hospital or system’s mission should be rewarded with equitable compensation and recognition.

Can it be done? We’ll see soon enough.