If physicians have essentially been small business owners, hospitals have been their workshop.
Before our eyes, they are cobbling together a new business relationship ”“ with caring the focus.
Hospitals and physicians traditionally have been paid for the volume of care they provide, and little had been done to change that. Now the Affordable Care Act focuses on population health and has a payment model that rewards quality and cost savings, while providing incentives for electronic patient information sharing.
While no one knows what the final details of health reform will look like, the change from volume- to value-based payment will change the system of care. Improving population health and quality outcomes requires alignment between providers, especially the physician and the hospital. Traditionally independent of each other, these two groups of providers find themselves facing a new world and a new way of working together to deliver care.
There are many models that are being developed across health care in the United States to bring hospitals and physicians closer together. However, the most common of these models include the employment of physicians by hospitals.
Employment is not a desired option for every physician, but for those who find it an attractive model, there are many opportunities.
Physicians, hospitals ”“ and patients
The independent practice of medicine today can present many challenges to a physician. The increasing cost of the practice, overhead along with decreasing reimbursement, investment requirements in information technology and quality reporting requirements make small, single-specialty practices difficult to maintain.
Employment by a health system or hospital provides the small medical practice or independent physician economies of scale, giving them access to information technology systems and providing management services that will enable the physician to focus on the care of their patients. For hospitals, the employment of physicians is an opportunity to align incentives and develop a continuum of care for the patients.
Clearly, the patient is the most important component in examining a hospital/physician employment model. Today we see significant increases in chronic illness such as diabetes and heart failure. The employment model allows for systems to be implemented between the hospital and the physician”™s office that will better monitor the patient and coordinate their care. This care coordination will ensure that the patient gets the appropriate care in the best setting to treat and manage their symptoms. These care management systems are proven to improve outcomes and decrease cost.
The challenge
While hospital/physician employment may on the surface seem easy, it is not. Physicians have been trained to be independent small business owners. The hospital has been the workshop for the physician and in some cases the trust between the two has not been strong. However, both parties realize that they have to change and that change requires each to give up some independence, change their focus and look at building a relationship that puts the patient and their needs above all others.
This is certainly achievable. There are many places across our country where change is happening and it is benefiting the communities the hospital and physicians serve.
This is an exciting time to be part of the health-care system. While we cannot predict what will happen with reform, hospitals and physicians are partnering through different models to create systems that will improve care across a continuum for their patients. Together hospitals and physicians are changing the health care landscape and improving the way we work together to deliver care.
Susan L. Davis is CEO of St. Vincent”™s Medical Center in Bridgeport and St. Vincent”™s Health Services. She can be reached at sdavis@stvincents.org.
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