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?