As was discussed in Blog I in this series, enhanced physician integration
is essential for the future success of any hospital or health system in
existence today. In addition, Blog II articulated both the historical
and present reasons why this integration is so hard to achieve. Because
integration is both essential and hard to achieve, we must answer the
question – What are the key strategies to achieve successful physician
integration?
First, physician leaders must be identified that have the competencies
or can develop the competencies to foster strong and meaningful integration
strategies. Such physicians are often seen in the organization as informal
leaders, often providing capable leadership required for care teams on
the nursing units, in the Operating Suite, and in the critical care areas,
including the emergency dept. Because of strong interpersonal skills,
they are often also the most popular as judged by the nursing and ancillary
staff, and likewise often have the highest patients satisfaction scores.
Because of these qualities, these physicians are regularly appointed to
or elected to medical staff leadership roles by their peers, often rising
to the Chief of Staff position.
Once physicians leaders are identified, they must be given formal opportunities
to participate in hospital programs, thereby beginning the alignment so
critical for developing their ownership and accountability for the clinical
outcomes, including both aspects of the value equation – quality
over cost. Such opportunities can be organized under the follow three areas:
1. Operational Teams, Task Forces, or Committees
a. Revenue Enhancement
b. Supply Chain Management
c. Clinical Technology Capital Expenditures
d. Labor Costs
e. Day-to-day management decisions in the clinical areas
f. Care Management Programs
2. Executive Roles
a. Program Director
b. Department Chair
c. Product Line Leadership
d. Medical Staff Executive Team
e. Chief or Assistant Chief Medical Officer
3. Governance
a. Medical Staff Committees
b. Board Committees
c. Board Director
d. Participant in Strategic Planning Retreats
In addition to these opportunities for enhancing physician integration,
there are other options for aligning incentives and enhancing collaborative
efforts between the doctors and the hospital. These often require legal
contractual agreements and include:
1. Employment, including primary care, specialists, and hospitalists
2. Joint ventures, often seen with ambulatory surgery centers and interventional
clinic programs
3. Professional Service Agreements, routinely in place for anesthesia,
pathology, radiology, and emergency services.
4. Co-Management of Service Lines
5. Integrated delivery models as are being formulated in ACO arrangements
a. Clinical Institutes
b. Medical Services Organizations (MSOs)
c. Physician Hospital Organization (PHO)
d. Patient Centered Medical Homes
e. Hospitals at Home
Although the previous opportunities identified can more easily work for
employed or contracted physicians, they must be offered also to the independent
practitioners. This is often the largest group of providers in hospital
and health systems today and they must therefore integrated not only with
the hospital, but also with their peers who have chosen the employment
or contracted route. One way of uniting this “mixed model”
of physicians who are credentialed in the hospital is by asking them to
develop, implement, and support a Physician Compact. These non legal documents
clearly articulate what the hospital will provide for the physicians and
in return what is expected by the hospital from the physicians. Most physicians
can be unified under the quality agenda, and a few systems are bring together
the employed, contracted, and independent practitioners under a system-wide
Medical Society . Through this organization, the health system often offers
informational techno logy support to the doctors’ offices, as well
as, ongoing physician education programs, including regular regulatory
updates, particularly those surrounding coding and billing.
Yes, it is abundantly clear that there are many and varied strategies of
integrating the various categories of physicians with hospitals. But physicians,
in order to be successful if they undertake these opportunities, must
have the competencies necessary to fulfill the integrative roles and responsibilities.
That being the case, in Blog IV of this series we will explore the final
question we posed several weeks ago – How do physicians acquire
the necessary leadership competencies to embrace successful integration?