A cursory scan of news reports about the healthcare industry could make one wonder why hospitals and physicians today seem fiercely at odds with each other.
Docs are not only entering business ventures to open up new revenue streams, they're also competing in many cases directly against hospitals in profitable service lines.
Hospital administrators are complaining more and more that there are fewer physicians to maintain key services, and many of the physicians they have now refuse to take ED call or expect to get reimbursed for it.
Don't get me wrong, hospitals and physicians need each other now more than ever. Reimbursements remain tight and the cost of running a medical group has never been higher. Many physicians are looking to their hospital partners for relief in the form of administrative and technical support.
But true hospital-physician alignment is a tough task in no small part because hospitals and medical groups operate in such fundamentally different ways.
Hospital-physician alignment strategies was the topic of conversation at a recent HealthLeaders Media Roundtable that I hosted in downtown Nashville. As a reporter, I follow these issues closely, but there is no substitute for getting out of my cluttered office and having direct, in-person conversations with physicians and administrators.
Our panel of experts pointed out that medical groups and hospitals still struggle to speak the same language and understand each other's distinct business needs. This inability to communicate effectively can be a major barrier for dissimilar organizations that are trying to align objectives.
Jeffry James, CFO and COO for Christie Clinic, an 85-physician multispecialty medical group based in Champaign, IL, said that reimbursements, regulations, and expectations for medical groups and hospitals are so different that it's hard for a clinic to grasp all the things that hospitals need, and the lack of understanding can breed distrust.
"Take data transparency, for example," James said. "It's very difficult for us on the physician side to really understand how the numbers at the hospital work because they don't relate directly to what we do. When a hospital talks about losses per physician that they employ, we don't know whether that includes credit that the hospital may be receiving or not receiving for ancillary services. When a hospital talks about finances, it's hard for us to put it in terms that we can understand, because the way we account is different than the ways hospitals account."
So a hospital might share data with its volunteer medical staff in an effort to be transparent with its business partners, but if the physicians and medical group administrators don't fully understand the data, what good is it? Certainly, the data won't factor into the physicians' negotiation strategy to increase pay for call coverage.
The incentives today for hospital-physician alignment are great, said John Phillips, president of PivotHealth, a practice management firm based in Brentwood, TN. But the organizations need to begin a difficult dialog about how to align incentives.
And James said that in many cases it comes down to whether a hospital is proactive or reactive in reaching out to its medical staff. "The reactive hospital can do more harm than just encouraging a physician down the path of adding services for themselves; that stance actually pushes physicians away," he said. "In our market right now, we have one hospital that is very proactive, and one hospital that is being very reactive. This is pushing our physicians toward a hospital that they typically did not practice at. By proactive, I mean that the administration is talking to us about marketing strategies, EMR, and generally about how we get on the same page. At the same time, the reactive hospital's administration is talking about curtailing our privileges, recruiting against us, and changing the way unassigned call is provided. I think the way these two hospitals are interacting with volunteer medical staff is going to change the landscape in our market."
The Joint Commission has announced proposed 2009 National Patient Safety Goals (NPSG) requirements and implementation expectations (IE) for field review. These proposed NPSGs affect hospitals and critical access hospitals, ambulatory care and office-based surgery, behavioral healthcare, disease-specific care, home care, laboratories, and long term care.
The Joint Commission seeks comments on these potential new NPSGs and will be accepting feedback via an online survey through February 27, 2008.
The field review focuses on the following areas:
Goal 1, patient identification
Goal 3, safe use of medications
Goal 7, hospital acquired infections focusing on methicillin-resistant staphylococcus aureus (MRSA) and clostridium difficile-associated disease (CDAD); catheter-associated bloodstream infections (CABSI); and surgical site infections (SSI) in acute care hospitals
Goal 8, medication reconciliation
Goal 13, patient involvement in their care
Universal Protocol
Last year, after the NPSGs were finalized, healthcare organizations faced one new National NPSG in preparation for 2008 requiring clinicians to respond rapidly to changes in a patient's condition, and another new requirement about anticoagulant therapy, and was intended to be a light year for NPSG changes. Unlike in previous years, the 2008 goals will be phased in throughout the year, with full implementation required by January 2009.
Goal 1 Under the proposed revisions, Requirement 1A would be expanded to include an IE requiring that the patient is actively involved in the identification process, when possible, before any venipuncture, arterial puncture, or capillary blood collection procedure. Proposed Requirement 1C aims to eliminate transfusion errors related to patient misidentification.
Goal 7 Perhaps most newsworthy is the inclusion of a new proposed requirement aimed to stop drug resistant organism infections in hospitals. Specifically, proposed Requirement 7C targets MRSA and CDAD. Among its 16 IEs, 7C requires education for healthcare workers, patients, and their families, as well as the measurement and monitoring of infection rates. It also requires lab-based alert systems when MRSA patients are detected, and a surveillance system for CDAD.
Requirement 7D proposes 13 IEs, including IEs for before and after insertion of the catheter. Requirement 7E has both general and specific IEs, seven in total, for the prevention of SSIs.
Goal 8 Proposed revisions to Goal 8 are composed of new and revised requirements and IEs intended for clarification, not alteration, of previous requirements. Revisions have been made to Requirements 8A, 8B, and 8C, for the reconciliation of patient medication across the continuum of care. A Requirement 8D has been added requiring modified medication reconciliation processes in settings where medications are not used, used minimally, or prescribed for short durations, such as outpatient radiology, ambulatory care, and behavioral healthcare.
Goal 13 Two IEs have been proposed to Goal 13, which targets increasing patient involvement in their own care. The first new IE would require facilities to provide patients with information regarding infection control (for example, hand hygiene or respiratory hygiene practices), while the latter requires facilities to provide surgical patients with information on preventing adverse events during surgery (such as patient identification or surgical site-marking processes).
Universal Protocol Proposed changes to the Universal Protocol, like those made to Goal 8, are not meant to change the overall concept of the Goal, but rather to clarify existing requirements. According to the draft 2009 NPSGs, the Universal Protocol contains the same concepts as it has in previous iterations.
Extensive clarifications have been proposed for Requirements 1A, 1B, and 1C, including four rewritten IEs under 1B (surgical site marking), and six rewritten IEs under 1C ("time out" verifications).
At press time, The Joint Commission did not respond to a request for comment.
According to a survey, two out of three Georgians say they would pay $25 or more a year to support a statewide system of trauma care. That positive response has impressed several state officials, who are considering allocating millions of dollars for trauma care. Advocates of the system say it would increase funding for hospitals with trauma units and improve communications among these centers.
Despite healthcare industry challenges such as a rising number of uninsured people and fewer employers offering health benefits, entrepreneurs such as Gary C. Bell are note discouraged from getting into the business. "People will always need help, and it's hospitals' responsibility to take care of them," said Bell, who was in attendance at a panel discussion sponsored by the Nashville Health Care Council.
A flurry of Chicago-area hospitals discussing plans to merge or seek buyouts. The trend reflects a push by smaller hospitals to combine with larger providers to gain market share and clout with insurance companies who pay for the hospital's services, help fund expansions or deal with the rising number of uninsured patients. It's also easier to merge instead of going through regulatory and financial hurdles when building, analysts say.
Members of the newly formed Massachusetts Prescription Reform Coalition will unveil a new effort to rein in the pharmaceutical industry's marketing efforts. Members of the coalition that rapid growth in the cost of prescription drugs threatens the state's new healthcare law and other efforts to extend insurance coverage to all residents.