Coordinating Care Through Physician Outsourcing

A strategic imperative

Statistically, about two-thirds of civilian hospitals outsource some of their physician staffing needs to some other entity, says Lynn Massingale, MD, executive chairman of TeamHealth in Knoxville, TN, which works in 45 states and more than 500 hospitals to provide emergency medicine, hospital medicine, and anesthesiology physician services.

Some 55% of hospitals that outsource do so with a local group—most commonly a local emergency medicine practice—while 20% outsource to regional groups, and 25% outsource to big national groups like TeamHealth or its competitors.

As hospitals move increasingly toward value-based purchasing, which uses a variety of tools to drive efficiency in the provision of healthcare services, that shift puts a lot of pressure on the physical plant of the hospital, says Massingale. Many hospitals’ daily census runs near 100%, which can cause big problems getting patients from the ED to admission to the main hospital, for example.

“Most everyone has trouble getting patients out of the ED because the inpatient beds are also full,” he says. “Hospitals have to be more productive and work better together, but that interface between the ED and the hospital is sometimes good and sometimes terrible.”

When it’s terrible, hospitals can have trouble getting physicians in different departments, say the emergency docs and the hospitalists, to work together to relieve capacity issues on both sides. Critical to effective patient flow, as well as quality and satisfaction accountability, is that physicians have incentives to:

• Work together for smooth transitions
• Reduce admission wait times  (for a bed)
• Work together with the rest of the clinical staff
• Effectively communicate, which improves the patient handoff from the ED to admission

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