Regardless of the structure, in most instances the faculty physician's entire practice occurs within the scope of a specific academic practice. To understand why a faculty practice plan may not be considered a group practice, and thus may not fit into an existing or proposed exception, it is necessary to appreciate the various legal structures of faculty practice plans, the many organizational models found within academic practices, and the reasons behind funds transfers in academic practices. The legal structures of faculty practice plans can be broadly categorized as departmental, federated, or a multispecialty group. Faculty physicians in departmental plans refer to each other as well as to physicians who are outside the faculty practice plan. Referrals in a federated plan are similar to those in a departmental plan, where they may be either to other faculty physicians or to physicians outside the plan.
Referrals are to physicians within the group practice.
In all cases, each faculty practice plan functions within an academic practice. To fully appreciate the complexities of referrals that can occur in this type of setting, and the potential for violations of the physician self-referral regulations, it is necessary to understand the organizational models of academic practices. A clear explanation of the complexity and variety of models found within academic settings is found in the attached the paper Organizational Models of Medical School Relationships to the Clinical Enterprise that was published in the journal Academic Medicine in November 1996. It represents the most current thinking about the structures in an academic setting. Some of these structures may pass muster under the proposed rule, but many of them may not.