Catholic Health Initiatives is a faith-based system that includes 73 hospitals and operates in 19 states. Here Stephen L. Moore, MD, senior vice president and CMO at the Denver-based health system, makes eight points about hospital-physician integration.
1. CHI is busy acquiring practices. In the past three years Catholic Health Initiatives has gone from 425 employed physicians to more than 1,500. Two of its organizations have 350 employed physicians each. The system aims to double the number of employed physicians in the next 2-3 years and reach a level of more than 3,000 providers, including some non-physicians.
2. Integration has been a long-term trend. Physician integration is a well-known strategy for CHI and many other healthcare organizations. "Nationally, the trend toward physician integration is not all that new," Dr. Moore says. "In the past 15-20 years hospitals have been solidifying their physician referral base, in some cases aligning with an IDN health plan." Lately, however, hospitals have seen more specialists wanting to discuss employment.
3. Physicians, hospitals driven closer together. Decreasing reimbursements are, by necessity, driving hospitals and physicians closer together. "We are seeing a perfect storm," Dr. Moore says. "Both hospitals and physicians have experienced major changes in payments, with drastic decreases predicted to hit within the next 3 years and continuing through 2020." Recently, cardiologists and oncologists in particular have been seeing large cutbacks in payments for office-based procedures.
4. CHI is progressing with alignment. Healthcare reform will likely increase incentives for physician-hospital alignment, but with no regulations out yet, the impact of reform is "still a little cloudy," Dr. Moore says. While CHI waits for more specifics, the system is creating centers of physician alignment. "We are looking for care that is much more efficient, more protocol-driven," he says. "As partners, we will need to drive variations in quality and outcomes out of the organization."
5. Payment transition is awkward. Hospitals and physicians are transitioning to completely different payment arrangements that call for coordinated care and place less emphasis on the per-unit price. "Hospitals are in an extremely schizophrenic position right now," Dr. Moore says. "They have one foot in the current payment model and the other in the next model." Hospitals will be shifting to systems that emphasize population health and disease management.
6. Old "governance" model needs updating. Hospitals and physicians have related to each other through a "governance" model, created 100 years ago for credentialing and peer review. Because patients are sicker, care is more complex and physicians need to cooperate more closely with hospitals, this model alone will not address the new provider relationships necessary for care delivery.
7. Hospitals and physicians need a team approach. "You need a team approach in which the doctor works with other providers," Dr. Moore says. One example of this is the multidisciplinary approach Johns Hopkins Hospital developed for its ICU. "Physicians, as leaders of the team, will play a guiding role as they transition from the more traditional model of 'captain of the ship,' " he says.
8. Alternatives to employment. In addition to employment, hospitals are pushing for other arrangements such as co-management opportunities for current established practitioners on the medical staff who can manage leadership roles at hospitals. "Within our contracts with hospital-based specialists, we're looking at increasing operational roles as medical directors and others through co-management and other agreements that better align our mutual goals," Dr. Moore says.
Find out more about Catholic Health Initiatives.
1. CHI is busy acquiring practices. In the past three years Catholic Health Initiatives has gone from 425 employed physicians to more than 1,500. Two of its organizations have 350 employed physicians each. The system aims to double the number of employed physicians in the next 2-3 years and reach a level of more than 3,000 providers, including some non-physicians.
2. Integration has been a long-term trend. Physician integration is a well-known strategy for CHI and many other healthcare organizations. "Nationally, the trend toward physician integration is not all that new," Dr. Moore says. "In the past 15-20 years hospitals have been solidifying their physician referral base, in some cases aligning with an IDN health plan." Lately, however, hospitals have seen more specialists wanting to discuss employment.
3. Physicians, hospitals driven closer together. Decreasing reimbursements are, by necessity, driving hospitals and physicians closer together. "We are seeing a perfect storm," Dr. Moore says. "Both hospitals and physicians have experienced major changes in payments, with drastic decreases predicted to hit within the next 3 years and continuing through 2020." Recently, cardiologists and oncologists in particular have been seeing large cutbacks in payments for office-based procedures.
4. CHI is progressing with alignment. Healthcare reform will likely increase incentives for physician-hospital alignment, but with no regulations out yet, the impact of reform is "still a little cloudy," Dr. Moore says. While CHI waits for more specifics, the system is creating centers of physician alignment. "We are looking for care that is much more efficient, more protocol-driven," he says. "As partners, we will need to drive variations in quality and outcomes out of the organization."
5. Payment transition is awkward. Hospitals and physicians are transitioning to completely different payment arrangements that call for coordinated care and place less emphasis on the per-unit price. "Hospitals are in an extremely schizophrenic position right now," Dr. Moore says. "They have one foot in the current payment model and the other in the next model." Hospitals will be shifting to systems that emphasize population health and disease management.
6. Old "governance" model needs updating. Hospitals and physicians have related to each other through a "governance" model, created 100 years ago for credentialing and peer review. Because patients are sicker, care is more complex and physicians need to cooperate more closely with hospitals, this model alone will not address the new provider relationships necessary for care delivery.
7. Hospitals and physicians need a team approach. "You need a team approach in which the doctor works with other providers," Dr. Moore says. One example of this is the multidisciplinary approach Johns Hopkins Hospital developed for its ICU. "Physicians, as leaders of the team, will play a guiding role as they transition from the more traditional model of 'captain of the ship,' " he says.
8. Alternatives to employment. In addition to employment, hospitals are pushing for other arrangements such as co-management opportunities for current established practitioners on the medical staff who can manage leadership roles at hospitals. "Within our contracts with hospital-based specialists, we're looking at increasing operational roles as medical directors and others through co-management and other agreements that better align our mutual goals," Dr. Moore says.
Find out more about Catholic Health Initiatives.