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Physicians Prep for Bundled, Performance-based Payments

Karen Minich-Pourshadi, for HealthLeaders Media, August 13, 2010
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With four  hospitals, approximately 1,400 beds, and more than 6,500 staff members, Saint Thomas Health Services in Tennessee knows the value in employing physicians: It employs more than 200 of them.

“Our goal was to keep the patient-provider relationship at the core of everything, so we created our model with that in mind,” explains Jordan Asher, MD, MS, physician network executive for Saint Thomas Physician Services.

Saint Thomas Health Services is a regional health system that includes a network of affiliated joint ventures in diagnostics, cardiac services, and ambulatory surgery as well as medical practices, clinics, and outpatient rehabilitation facilities.

“The key to what we’re doing is based on what the physician needs. So we do align with the physicians, and we want them to align with us,” he says.

To figure out how to accomplish this, Asher says facilities should answer one question before they set up their model: “The primary question to ask before working with physicians is: What is our strategic direction? Do we want to be just a hospital company or do we want to be a healthcare delivery company? Unless you answer that first, then setting up models is going to be problematic. Know who you are and where you want to go.”

It’s not necessary to choose only one path; just to know your goals when you select a model. Saint Thomas opted to create integrated and straight employment models as well as contractual affiliations based on physician and hospital needs.

For the 200 employed providers, it created a productivity-based compensation model with RVUs and capitation and using quality measures to guide them. For the nonemployed physicians, it has a unique approach for alignment with practices that affiliate with its facilities.

“We say to the providers we want you to help us work on our quality initiative and patient safety. Through IT and other strategies, we are able to work with our private physicians to help them provide enhanced patient care, but also help the system with its quality and safety initiatives,” he explains.

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