Having presented a general overview in our initial blog entitled “Physician
Integration: A Critical Success", it is now time for us to reflect
on the first question in our four part series:
Why is physician integration so critical for present and future success?”
It is becoming increasingly clear today that a successful and sustainable
hospital or health system will be one that can prove, by clearly defined
and appropriate metrics, that they are delivering high quality and safe
care, while simultaneously reducing costs and improving accessibility.
These goals and their achievement must be imbedded into the health system’s
strategic goals and operational performance. Although the accountability
for the monitoring of the successful implementation of these goals is
done by the Board of Trustees and the Management Team, the ability to
achieve these goals is, in reality, predominately dependent on the physicians’
practice styles.
Physicians drive the quality and safety of the clinical outcomes in concert
with the nurses and other members of the care team. To enhance quality
they must actively participate in the care institution’s care management
processes, supporting the utilization of evidenced-based medical treatment
protocols. In addition, they must support population and preventive medicine
programs, move appropriate services to efficient and safe outpatient areas,
and lead in the designing of pathways of care that improve accessibility
and level of service satisfaction for patients and their families.
As important as they are to quality improvement, the physicians are also
a critical driver of the cost of the various healthcare processes and
treatment plans. Doctors write the orders, utilize supplies, determine
the level of support staff utilized, and demand the latest and safest
clinical technologies. Hence, the Value Equation – Quality over
Costs - is driven significantly by physicians. Therefore, the degree of
integration of the practices, protocols and processes of the physicians
associated with the hospital or health system, whether employed, contracted,
or credentialed as independent practitioners, with those of the hospital
or health system will parallel the degree of present and future success
for both. They must eventually agree that “we are all in this together
and, as such, will win or lose together”.
Having been a physician for 46 years and having the opportunity to work
in numerous leadership roles with physicians of all types and specialties,
I know that physicians desire the best clinical outcomes for their patients.
Physicians know that this requires the best nurses, ancillary caregivers,
and support staff. They recognize that treatment plans driven by evidence-based
medical protocols result in best practices and cost-efficient care. And
they also know that excellent care is a necessity, not a luxury, for all
they serve.
In the end, it is critical that the Board of Trustees, the Executive Leaders,
the Management Teams, the physicians, and all other employees have the
same vision, strategies and operational goals. By being fully integrated
into the plans to achieve these goals, the physicians will position the
health system for the best chance at future success. By uniting their
voices with the Board, C-Suite, Directors, and Managers, physicians will
enhance the team’s ability to rapidly address the complex challenges
in today’s health care environment, driving toward successful solutions.
Now, better understanding the critical nature of physician integration
today, we would suggest that it will become more important as the future
unfolds. Why?
1. Because the pressure to decrease costs will significantly accelerate
due to declining reimbursements both from the private and governmental
payers, thus increasing operational losses from the supply and labor costs;
2. Much more clinical input will be required to select appropriate technologies
that will be effective in supporting the value equation;
3. Significant physician input and support will be required to grow care
management processes, population health approaches, and preventive medicine
programs; and,
4. With the ever growing aging population, physicians will be needed to
develop and support medical homes, hospital-at-home, and robust end-of-life programs.
Physician integration is critical in assuring that health care has the
potential to meet the ultimate objective of high quality, low cost, affordable
care. But, it has also been shown over and over again, in hospital after
hospital, that physician integration is hard to achieve. How can this
be done in an easier fashion? This question will be addressed in the next
Blog in this series.