Getting to the Heart of Cardiology Alignment
This article appears in the January 2012 issue of HealthLeaders magazine.
Like the rhythm of the beating heart, there is the steady drumbeat of knocking on the hospital's doors.
It's those cardiologists.
With declining reimbursements and eroding practice income, cardiologists are increasingly seeking hospital employment, prompting health systems to consider an array of possibilities for physician alignment.
Most hospital systems are using the standard employment model as they bring physicians into their systems, but others are using comanagement or other paradigms, such as professional services or business enterprise systems, for invigorated cardiology programs. In the process, they are improving internal committee oversight and management structures, and influencing changes within group practices.
"Physicians are sitting alongside the administrative team at all levels of the heart institute," says Lisa Shannon, COO of Spectrum Health's Grand Rapids, MI, hospitals. "So many times an administrator is unable to move things forward to change quality or decrease costs unless it is physician-led." Spectrum Health has employed, integrated physicians, and also those who are not salaried within the system. Physicians who aren't employed are included in the committee structure, says Shannon, noting, "We certainly have room and need their input."
As the nation moves toward value-based purchasing, hospitals are evaluating systems such as bundling for episodes of care, which is shown to improve efficiencies, according to Nancy Harrison, director of the acute care episode project for the 681-licensed-bed Hillcrest Medical Center in Tulsa, OK, which is part of Ardent Health Services, a Nashville-based system that owns nine acute care hospitals and one rehabilitation hospital with a total of 1,731 licensed beds.
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Healthcare leaders are considering prospects for new payment systems, for value-based efficiencies, and possible accountable care organization structures, says Tim Attebery, system vice president for cardiovascular services for the Wellmont Health System in Kingsport, TN.
"We want a seat at the table as we talk to physicians and physicians are coming together; they may be in several ACOs," says Attebery. "Cardiology and heart disease is the No. 1 subspecialty of any population."
Roger Noble, RN, director of cardiovascular services for FirstHealth Moore Regional Hospital in Pinehurst, NC, says the 395-licensed-bed hospital is evaluating several employment models to hire cardiologists, who are now under contract with the hospital. One of the models being considered is an integrated plan, such as a professional services agreement in which a hospital or health system operates a physician clinic and contracts with an independent group to provide professional services.
The hospital, part of FirstHealth of the Carolinas, a private, not-for-profit system with 582 licensed beds, may decide to diversify its employment models and not just stick with one, Noble says.
"Because of our geographic location, we have a market lock that allows us to do something we maybe wouldn't be able to do in an overly competitive environment," Noble says.
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