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Nudging Physicians Toward Accountability

Gienna Shaw, for HealthLeaders Media, January 11, 2012

This article appears in the December 2011 issue of HealthLeaders magazine.

Ellis M. Knight, MD, MBA, went into medicine as an idealist. And, added the senior vice president of ambulatory services at Palmetto Health in Columbia, SC, he still is.

But about five years ago he began to question whether his practice of medicine was measuring up to the expectations, desires, and motivations he had when he entered medical school.

The answer: not so much. It was “crushing,” he said at the HealthLeaders Media Rounds event, The Real Value of ACOs, hosted by Norton Healthcare in Louisville, KY.

“I went into a career in medicine because I wanted to help people, [but] a lot of what I was doing every day wasn’t helping people. I was doing a lot of stuff, seeing a lot of patients, putting people through a lot of tests and procedures, a lot of stays in the hospital, but when you asked at the end of the day how much good I did for people today, what did all this activity result in? My honest assessment was not as much as I’d like.”

Knight thought the answer to this lacking might lie in a system of accountable care. To his surprise, he discovered many of his colleagues felt the same way. In the summer of 2009, Knight sent an e-mail to physician colleagues and asked them what they thought about starting an ACO. The positive response was overwhelming. Ultimately there were well over 100 physicians on the e-mail chain.

The Palmetto Health Quality Collaborative was created in 2010 to align the acute care hospital system with the medical staff and community physicians to improve the quality and coordination of care. All physicians who are members in good standing with Palmetto Health are eligible to participate—including employed, contract, and community physicians.

“Integration at several levels is something that we worked on a lot at Palmetto Health Collaborative,” Knight said.

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