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Ties That Bind

Rick Johnson, for HealthLeaders News, October 18, 2007
Healthcare CEOs are sure spending a lot of time and energy on physician relations nowadays. That's the word from industry insiders at last week's Top Leadership Teams in Healthcare Conference.The topic of hospital-physician alignment permeated the conference's panel discussions. From the perspective of hospital leaders, here are three of the top physician-relations issues of the day:
  • Emergency call coverage
  • Physician employment
  • EMR technology that tethers physicians and hospitals

Although these concerns are intertwined, I'll take up each separately in PhysicianLeaders, starting today with ED call coverage. If you polled hospital CEOs nationwide, payments to physicians for call coverage would be a top-five issue, said Richard Salluzzo, MD, president and CEO of Wellmont Health System. And Wellmont's chief medical officer, Anthony Oliva, DO, agrees.

"This is a huge problem for hospitals, and we have to start focusing on how we're going to move forward," said Oliva, during a physician relations panel discussion. "This has become a recruitment issue that hospitals are using against hospitals. This is one of the biggest issues we're facing in our ability to care for our communities--especially providing care to our sickest patients at their sickest times."

Salluzzo outlined a few of the strategies that Wellmont has initiated to ensure call coverage, including:

  1. Employing hospitalists so that patients can get transferred quickly from the ED
  2. Expanding employment of orthopedic-, neuro- and cardio-traumatologists in the ED
  3. Developing formal patient-transfer relationships between smaller and larger hospitals

"Small hospitals are not going to be able to force surgeons and orthopedists to work nights and weekends," said Salluzzo.

Chris Van Gorder, CEO of Scripps Health in San Diego, said he doesn't know of any organization in his market that is not paying physicians for emergency room coverage. "Today we spend roughly $15 million a year," he said. Van Gorder shared a story about how Scripps avoided escalating a conflict with its physicians over paying for ED call coverage by sharing its operational information. He said that his relationship with the medical staff was feisty at times when they requested more money. But rather than dictate to doctors what Scripps was willing to pay, Van Gorder invited them to research the issue through a joint physician-management task force.

Van Gorder and his leadership team realized that the physicians in his region had legitimate burdens. But at the time, Scripps was losing money as a system. The physicians were seeking about $4 million more for coverage, which the system had earmarked for nursing staff raises. "I told them, 'If you believe we need to spend another $4 million to keep the medical staff satisfied and keep our emergency room open I will do that. But I am not going to not be able to give that raise to the nurses, and I'm going to tell them that I had to give that money to you because you demanded it.'" Rather than denying the nurses a raise, the physicians formed a task force with management and studied the issue for about two months. In the end they recommended increasing call coverage payment by $2 million and giving $2 million to the nursing staff.

Of course, one of the underlying issues with the call-coverage dilemma is the looming physician shortage crisis. For more information on that topic, check out my colleague John Commins' cover story, Will There Be Enough Doctors?, in this month's HealthLeaders magazine.

In future issues of PhysicianLeaders, I will share what hospital administrators had to say about the growing trend of physician employment and proving EMR technology to medical staff. In just a couple of weeks, I'm off to Philadelphia to attend the annual MGMA conference. I hope to see some of you there, but if I don't I'll be sure to give you my thoughts on the conference and insights from speakers and attendees.


Rick Johnson is a senior editor with HealthLeaders Media. He can be reached at rjohnson@healthleadersmedia.com.

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