Physician integration can lay the groundwork for population health readiness. However, integrating service lines for a children's hospital, especially one that is part of a larger academic health system, poses its own challenges, according to Steven G. Docimo, MD, CMO, vice president of children's subspecialty services and professor in the division of pediatric urology at the Children's Hospital of Pittsburgh of UPMC.
The University of Pittsburgh School of Medicine has put forth a proposal for an integrated pediatric service line, Dr. Docimo said at the Becker's Hospital Review 6th Annual Meeting in Chicago May 8.
"We need to be more tightly integrated than we already are to improve costs and manage our population in West Pennsylvania," he said. "I'm not convinced that value-based care will happen in pediatrics, so we want to make sure fee-for-service is still thriving," Dr. Docimo said.
UPMC is in a period of reorganization, driven by external market factors, reimbursement changes and, in part, by the ongoing battle with local payer Highmark, according to Dr. Docimo.
"The hospital division and clinical division are working together, and that's creating a little bit of tension, but we think overall it's a positive move," he said.
It's an interesting time for Children's. The pediatric service line is still growing while the rest of the health system is in a phase of contraction and trying to rapidly decrease expenses.
Creating an integrated pediatric service line at UPMC requires negotiations with 13 different departments in pediatrics, according to Dr. Docimo. At the level of the system's physician group, University of Pittsburgh Physicians, only pediatrics is a department, while all pediatric specialties are all subdivisions of specialty departments, according to Dr. Docimo. For example, pediatric surgical divisions report to surgery at Children's and to their respective departments within UPP.
The integration Dr. Docimo said he is hoping for is not currently reflected in the organization of subspecialty divisions. The siloed nature of service lines is difficult to manage as is, he said.
To continue to improve, Children's wants to streamline its service lines to make it easier to implement strategic initiatives, which are difficult to put into place under the current structure because negotiations must be made with 13 different department chairs.
Integration will also help create a stronger network of pediatricians. Children's Hospital doesn't compete for patients with other organizations, Dr. Docimo said. Instead, they compete for talent with all other major children's hospitals around the country. "There is a limited talent pool and we need to be able to pull those people in and make them feel value," he said.
Once integrated, Dr. Docimo hopes to group pediatric physicians into incentive pools, so surgeons are incentivized around the same goals, instead of department-based goals. Currently, all of the departments have not achieved alignment around incentives and compensation, he said. He'd also like to centralize managerial and support staff, achieve efficiency in utilization, reduce redundancy and create multidisciplinary pathways.
"Integration is essential to be a world-class institution, compete for complex patients and manage the population of healthy children," Dr. Docimo said.