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Line it up! Getting Physician Alignment Straight Isn't Easy

Karen Minich-Pourshadi, for HealthLeaders Media, June 28, 2010

I've always found the expression, "You shouldn't let the inmates run the asylum" amusing. It has so many applications, not the least of which applies to quality patient care and hospital-physician alignment. Let me throw in a disclaimer here, I'm not calling patients mentally handicapped nor hospitals mental facilities—but what I'd like you to think about is the idea that in some way or another your patients really should be running your hospital and by doing so you will end up with better hospital-physician alignment.

With the American Hospital Association reporting in late 2009 that 74% of hospital CEOs are being approached more frequently by physicians seeking employment, the recession coupled with healthcare reform is ushering in a rebirth of the 1980s physician employment boom-but this time around everyone is wiser. All providers-hospitals, physicians, and payers-recognize that they must work together to position themselves for bundled, performance-based payments for care delivery. Working together offers everyone involved the greatest opportunities to succeed.

However, this time, both hospitals and physicians have learned what works for them, and equally important, what does not work. In some instances hospitals are employing doctors, in other cases they are using joint ventures or other management agreements to employ them, but in all instances, the goal is ultimately the same: to bring the physician and the administration to an agreement that unites and aligns everyone toward achieving the same strategic, financial and leadership goals—the biggest goal of all being patient satisfaction.

Over the years several structural and economic physician-hospital alignment models have evolved, including:

  1. Organizational structures (e.g., physician-advisory councils)
  2. Economic models (e.g., joint ventures and employment of physicians by hospitals)
  3. Emerging models (e.g., the anticipated growth of "super groups," the changing roles of physician-hospital organizations, and the potential for gainsharing).

 

Rather than concentrate on the variety of models out there, this week I'd like to share with you the story of how one system is successfully approaching hospital-physician alignment by putting the patient's needs first.

Seattle's Virginia Mason Medical Center, is an integrated health system that employs 440 of the 900 physicians that work there. Suzanne Anderson, Virginia Mason's senior vice president, CIO and CFO, says the physicians and the hospital work together to create their strategic goals for the year-an inclusionary process, which unfortunately, some hospitals forego during their strategic planning process and that can result in a misalignment between the administration and the physicians.

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