Success key No. 1: Overcoming alignment challenges
Two years ago, the leadership team at the 422-licensed-bed Borgess Medical Center in Kalamazoo, MI, moved toward a full-employment model for physicians in cardiology programs, but hospital officials figured out quickly they had to confront some significant obstacles to attain their goal.
As they negotiated with physician groups, they realized there was a lack of alignment in the doctors' goals, and different expectations for compensation. Hospital officials knew physicians sought a degree of control of their day-to-day operations and did not want to lose autonomy, says J. Patrick Dyson, executive vice president for strategy and corporate services at Borgess Health, which includes the Borgess Heart Institute, where most cardiology and cardiac surgery services are centered.
One of the most important system changes was to create a cardiovascular leadership council to oversee overall performance of the Borgess Heart Institute. The council consists of physicians—both employed and in private practice—from various groups that comprise the institute. The groups represent various cardiac subspecialties, such as surgeons and hospitalists.
Dyson says the hospital system ensured that the employed cardiology medical groups retained oversight of day-to-day clinical operations and had a role in governance of the service line. Although the hospital system did not have a comanagement model in which physicians and administrators have joint ownership, the leadership council system was important to maintain and develop a stronger, more representative leadership structure for physicians employed by the system, says Dyson.
Another key component centered on citizenship.
"These citizenship expectations are what is expected from physicians—behaviors on a day-to-day basis," Dyson says. Among the rules that are unique to one particular group: Nobody is late to start a clinic; if someone has a concern about an issue, how do you voice that concern? Do you get your billing done on time? How is your documentation? Is it done in time?
M. Sue Anderson of ECG Management Consultants, Inc., in Arlington, VA, who has worked with Borgess, says that the framework of operating councils has "really transformed the relationship between the hospital and physicians, and has empowered the cardiologists, allowing them to move forward to not only focus on operational issues, but also to target strategic initiatives.
"With many cardiology groups, the opportunity to play an active role in management and governance is just as important as compensation," says Anderson. When Borgess incorporated a newly employed cardiology group, it was incorporated into an existing physician structure, but was able to operate as a "separate and distinct practice," she says.
Dyson says the hospital system is using the physician alignment structure to improve the hospital clinical outcomes. Borgess has focused on various aspects of cardiac care, he says, with good results. The hospital system's 30-day readmission rate for patients admitted with heart failure is 21.4% for 1,800 Medicare patients, compared to the national 30-day readmission rate for heart failure at 25%, according to Centers for Medicare & Medicare Services data from 2007 to 2010.