At the Becker's Hospital Review Annual Meeting on May 18, Robert Wilson, managing director of Health Care Advisory Services, Naya Kehayes, MPH, managing principal and CEO of Eveia Health Consulting and Management, and Mickey Bilbrey, vice president of eastern operations for Quorum Health Resources, discussed the best ideas for physician-hospital integration.
Here are some key questions and responses from the panel, which was moderated by Scott Becker, JD, CPA, partner with McGuireWoods in Chicago.
Question: How do you measure the success of a physician integration strategy?
Robert Wilson: Obviously, financial performance is a measure you'd use. From what I've seen, the losses at a physician group level are unsustainable in most cases. We can talk about what losses really mean, but in most cases, the losses at a practice level are dragging down the performance of a hospital where it's unsustainable for a health system.
Naya Kehayes: We typically will come into a situation in two scenarios: the first is with physicians of a surgery center, and hospitals are upset they're pulling all the volume out of the hospital. There is lots of attention around aligning with those physicians so [the hospital] can integrate the physicians into the hospital and have access to a component of the value stream they're losing. The second situation in which we have involvement is when there is already a joint venture with the hospital, and there we're looking at the strategies of how to increase the hospital's operating margin while presenting cost savings to the payor.
Mickey Bilbrey: Aside from the financial issues, one of the markers we're looking at at the 150 hospitals we manage...we see the whole issue of hospital-physician relationships as reducing practice variation in the clinical world. If you look at our hospitals, it's not just about employing physicians from the financial perspective but long-term goal of reducing practice variation. If we can achieve that, we can increase overall performance of practice and the hospital.
Q: How many of the hospitals you've worked with have moved towards employment?
MB: Often times we've found if you don't employ, you have no depth. The strategy of employment addresses the need of capacity and access to medical services. That's probably one of the overriding drivers of why hospitals have moved towards that employment model. How do you try to reduce practice variation when everyone isn't employed? Most hospitals are spending a great deal of time on the IT side and getting employed and non-employed physicians into a more consistent model with the use of IT.
Q: What are some things you can change to increase physician alignment?
RW: It should work around the seamless delivery of care across a continuum. A lot of the organizations I work with get stuck at that intermediate step. There is employment with a small "e," and employment with a big "E." The employment with a big E is not only employment on a piece of paper, but it means you bring them into the tent and closer into decision-making and governance as if they have an ownership stake in the ultimate success of the system.
Q: Are the problems more related to a lack of leadership or mishandling of basic responsibilities?
RW: All of the above. Those blocking and tackling things probably aren't working because leadership isn't supporting them. It's really all about culture. How I define culture is that attitude of ownership, where physicians have an emotional stake in the operations.
Q: What are some examples of the best hospital-physician programs?
NK: I do think that when a hospital is really...if they're employed physicians and they continue to integrate them into the system as when they were not employed — they continue to structure their compensation around quality initiatives, I think that's really critical to their success and to have the physicians feel involved, not like they're just "employed." Historically, hospital leadership has not really engaged them to working with them in a joint ventured effort. I think that's absolutely critical. That's where they exceed in having the most successful hospital-physician relationship.
Physician-Hospital Joint Ventures: How to Prevent Failure
12 Tips for Successful Hospital-Physician Joint Ventures
Here are some key questions and responses from the panel, which was moderated by Scott Becker, JD, CPA, partner with McGuireWoods in Chicago.
Question: How do you measure the success of a physician integration strategy?
Robert Wilson: Obviously, financial performance is a measure you'd use. From what I've seen, the losses at a physician group level are unsustainable in most cases. We can talk about what losses really mean, but in most cases, the losses at a practice level are dragging down the performance of a hospital where it's unsustainable for a health system.
Naya Kehayes: We typically will come into a situation in two scenarios: the first is with physicians of a surgery center, and hospitals are upset they're pulling all the volume out of the hospital. There is lots of attention around aligning with those physicians so [the hospital] can integrate the physicians into the hospital and have access to a component of the value stream they're losing. The second situation in which we have involvement is when there is already a joint venture with the hospital, and there we're looking at the strategies of how to increase the hospital's operating margin while presenting cost savings to the payor.
Mickey Bilbrey: Aside from the financial issues, one of the markers we're looking at at the 150 hospitals we manage...we see the whole issue of hospital-physician relationships as reducing practice variation in the clinical world. If you look at our hospitals, it's not just about employing physicians from the financial perspective but long-term goal of reducing practice variation. If we can achieve that, we can increase overall performance of practice and the hospital.
Q: How many of the hospitals you've worked with have moved towards employment?
MB: Often times we've found if you don't employ, you have no depth. The strategy of employment addresses the need of capacity and access to medical services. That's probably one of the overriding drivers of why hospitals have moved towards that employment model. How do you try to reduce practice variation when everyone isn't employed? Most hospitals are spending a great deal of time on the IT side and getting employed and non-employed physicians into a more consistent model with the use of IT.
Q: What are some things you can change to increase physician alignment?
RW: It should work around the seamless delivery of care across a continuum. A lot of the organizations I work with get stuck at that intermediate step. There is employment with a small "e," and employment with a big "E." The employment with a big E is not only employment on a piece of paper, but it means you bring them into the tent and closer into decision-making and governance as if they have an ownership stake in the ultimate success of the system.
Q: Are the problems more related to a lack of leadership or mishandling of basic responsibilities?
RW: All of the above. Those blocking and tackling things probably aren't working because leadership isn't supporting them. It's really all about culture. How I define culture is that attitude of ownership, where physicians have an emotional stake in the operations.
Q: What are some examples of the best hospital-physician programs?
NK: I do think that when a hospital is really...if they're employed physicians and they continue to integrate them into the system as when they were not employed — they continue to structure their compensation around quality initiatives, I think that's really critical to their success and to have the physicians feel involved, not like they're just "employed." Historically, hospital leadership has not really engaged them to working with them in a joint ventured effort. I think that's absolutely critical. That's where they exceed in having the most successful hospital-physician relationship.
More Articles on Hospital-Physician Relationships:
4 Trends and Best Practices of Service Line Co-Management RelationshipsPhysician-Hospital Joint Ventures: How to Prevent Failure
12 Tips for Successful Hospital-Physician Joint Ventures