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How the Dynamics of Physician Alignment Are Changing

Michael Zeis, for HealthLeaders Media, September 13, 2013

Population health and accountable care models continue to gain traction as the industry shifts away from the traditional fee-for-service provider payment structure.

This article appears in the September issue of HealthLeaders magazine.

The 2013 Physician-Hospital Alignment Survey demonstrates that healthcare organizations are recasting their priorities to meet the expected requirements of industry reform. And, as the annual HealthLeaders Media survey reveals, not only are there changes in emphasis regarding employment models, but also there is increased pursuit of collaborative relationships and at-risk payment models. Leaders are showing increasing interest in undertaking initiatives in population health and accountable care models.

Looking at population served

Maximizing admissions has been a long-standing objective of hospital-physician alignment efforts. As the healthcare industry shifts away from fee-for-service, more treatment will take place in outpatient and ambulatory environments and the patient mix will change in those settings as well as at acute care hospitals.


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Leaders at hospitals and health systems will probably rely more on their specialists, which will make it important to offer a targeted set of specialty services and to have a primary care network with sufficient coverage to provide the necessary referrals.

Pamela Stoyanoff, executive vice president and chief operating officer for Methodist Health System, which operates five hospitals and 1,161 licensed beds in the Dallas area, summarizes the classic approach to building referrals: "You have to shore up referrals, and physicians in your primary care network are the ones who are giving specialists their referrals. I think that's one reason so many health systems are buying big physician primary care practices."

Motivating physicians to participate in quality and safety initiatives is included among the top three physician alignment objectives by 73%, more than any other objective. But nearly half of respondents (47%) say one of the top three objectives behind their physician alignment strategy is to maximize the patient population served, which doesn't necessarily mean maximizing admissions.

"We've done a lot of things to try to improve access to care, which gets patients the right care at the right place at the right time, " says Scott Nygaard, MD, chief medical officer at physician services for Lee Memorial Health System in Fort Myers, Fla., which serves Lee County through four acute care hospitals. "We're trying to create a better delivery system."

Is fee-for-service sustainable?

Alignment discussions are taking on a flavor of collaboration or mutual accountability, fostered by doubts on the part of many in acute care settings about whether the fee-for-service business model is sustainable.

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