Kathryn Howe Ruscitto, currently executive vice president of 430-bed St. Joseph’s Hospital Health Center in Syracuse, N.Y., will become president and CEO of the hospital on Jan 1. Here she describes seven ways for hospitals to align with physicians, based on her experiences at St. Joseph's.
1. Develop your big picture. First, Ms. Ruscitto says, the hospital needs to ask, "What kind of system are we trying to create?" Due to a large home care operation at St. Joseph's, "we have more inpatient business than outpatient business," she says. This puts St. Joseph's on the road to an accountable care organization, but the hospital is holding off on plans for an ACO until more details are available.
2. Employ some physicians. Many physicians, even larger groups, are seeking hospital employment. St. Joseph’s expects to have 120 employed physicians out of a staff of 400 active physicians by the middle of 2011. Having started by employing hospitalists, ob-gyns and infectious disease physicians, the hospital recently acquired North Medical, the largest private primary care practice in the area, with 50 physicians and 30 midlevels. The acquisition took a year to complete, mainly due to legal considerations, such as meeting Stark requirements.
3. Involve physicians in governance. Many physicians on staff will stay independent, which requires other forms of alignment, such as involving them in governance. The ad hoc coordinating council at St. Joseph's, made up of physicians, participates in hospital decision-making and is separate from the hospital medical staff. The hospital recently put the new governance structure to the test when compiling its new five-year strategic plan, a massive effort that involved five teams, with physicians on each team. The work started with focus groups of medical staff. "Now that we've got the engagement piece correct, the other steps should flow naturally," Ms. Ruscitto says.
4. Give voice to younger physicians. Younger physicians are essential to the future strength of the institution, therefore they need a place at the table. The ad hoc coordinating council includes early, mid- and late-career physicians. "Young physicians have an entirely different approach than a physician who is about to retire," Ms. Ruscitto says. "They are more interested in employment and don't want the headaches of private practice."
5. Provide actionable information. "Physicians have busy schedules and do not have the time to sift through raw data," Ms. Ruscitto says. Hospital staff research topics and present actionable information to physicians serving on committees, as they do for board members.
6. Set up templates of care. Coordinated care requires the creation of best practices that enhance quality and lower costs. The hospital is developing "templates of care," best practices for physicians that are being formulated by a committee of physicians. St. Joseph's recently hired a director of informatics, who is a cardiologist with 30 years experience, to head the committee. The committee will develop hundreds of such templates.
7. Improve IT systems. "We have been developing an IT system and processes to improve quality of care," Ms. Ruscitto says. "Everything is in place except CPOE and that should start up shortly." The hospital is participating in its regional health information organization to enable data-sharing. St. Joseph is adding 23 IT staff to deal with its expanding IT functions.
Find out more about St. Joseph’s Hospital Health Center.
1. Develop your big picture. First, Ms. Ruscitto says, the hospital needs to ask, "What kind of system are we trying to create?" Due to a large home care operation at St. Joseph's, "we have more inpatient business than outpatient business," she says. This puts St. Joseph's on the road to an accountable care organization, but the hospital is holding off on plans for an ACO until more details are available.
2. Employ some physicians. Many physicians, even larger groups, are seeking hospital employment. St. Joseph’s expects to have 120 employed physicians out of a staff of 400 active physicians by the middle of 2011. Having started by employing hospitalists, ob-gyns and infectious disease physicians, the hospital recently acquired North Medical, the largest private primary care practice in the area, with 50 physicians and 30 midlevels. The acquisition took a year to complete, mainly due to legal considerations, such as meeting Stark requirements.
3. Involve physicians in governance. Many physicians on staff will stay independent, which requires other forms of alignment, such as involving them in governance. The ad hoc coordinating council at St. Joseph's, made up of physicians, participates in hospital decision-making and is separate from the hospital medical staff. The hospital recently put the new governance structure to the test when compiling its new five-year strategic plan, a massive effort that involved five teams, with physicians on each team. The work started with focus groups of medical staff. "Now that we've got the engagement piece correct, the other steps should flow naturally," Ms. Ruscitto says.
4. Give voice to younger physicians. Younger physicians are essential to the future strength of the institution, therefore they need a place at the table. The ad hoc coordinating council includes early, mid- and late-career physicians. "Young physicians have an entirely different approach than a physician who is about to retire," Ms. Ruscitto says. "They are more interested in employment and don't want the headaches of private practice."
5. Provide actionable information. "Physicians have busy schedules and do not have the time to sift through raw data," Ms. Ruscitto says. Hospital staff research topics and present actionable information to physicians serving on committees, as they do for board members.
6. Set up templates of care. Coordinated care requires the creation of best practices that enhance quality and lower costs. The hospital is developing "templates of care," best practices for physicians that are being formulated by a committee of physicians. St. Joseph's recently hired a director of informatics, who is a cardiologist with 30 years experience, to head the committee. The committee will develop hundreds of such templates.
7. Improve IT systems. "We have been developing an IT system and processes to improve quality of care," Ms. Ruscitto says. "Everything is in place except CPOE and that should start up shortly." The hospital is participating in its regional health information organization to enable data-sharing. St. Joseph is adding 23 IT staff to deal with its expanding IT functions.
Find out more about St. Joseph’s Hospital Health Center.