One of the significant concerns about Barack Obama's health plan is that he might require large and medium companies to contribute as much as 6% of their payrolls to cover healthcare benefits for their workers. Obama would also prohibit insurers from rejecting applicants because of medical conditions, require health insurance for children, and create a new federal health plan to provide comprehensive coverage to the uninsured. Those beneath certain income levels would be granted tax credits to make premiums affordable, and small businesses would be offered tax credits to provide benefits.
HealthSouth Corp. continued its winning streak against the regime of former Chief Executive Richard Scrushy, recovering $133 million from an investment bank accused of aiding a massive corporate fraud at the company. UBS, a New York investment bank that sold shares and bonds of the physical therapy company to investors, agreed to pay $100 million cash and forgive $33 million it was owed by HealthSouth. The suit said UBS investment bankers knew HealthSouth faked its books to the tune of $2.6 billion from 1996 through 2002 to boost profits and trigger performance bonuses for top executives. It also says UBS analysts recommended investors buy HealthSouth shares while knowing the stock was being propped up by phony numbers.
An effective relationship with physicians is critical to the success of any hospital, and an effective relationship with hospitals is important to most physicians. But the vexing reality is that the physician-hospital relationship is as complex as it gets. Few professional relationships have such unique and particular dynamics with so much at stake. The relationship between a Major League Baseball player and the front office may come close, but even that simile falls short of capturing the gravity of this blend of personality, responsibility, talent, and pressure. The importance of this relationship coupled with its relational complexities present a constant challenge to the best of hospitals and physicians. Here are 10 ways to strengthen the physician-hospital relationship.
1.The Hospital is the Pace-Setter.
Hospitals need physicians more than physicians need hospitals. Organizational hubris may, for some, make that difficult to swallow—but it's the truth. Simultaneously, hospital leaders must be willing to assume responsibility for the overall liaison with staff physicians. Every medical staff will be characterized to some degree by challenging physicians, specialty turf wars, and entrepreneurial physicians seeking income opportunities that compete with the hospital. Hospital leaders should set a positive pace and tone for the relationship with their physicians by accepting overall responsibility, and they should be prepared to defuse the inevitable conflicts.
2. The Physician as Honored Guest. Successful hospital leaders accept the imbalance in the "professional importance spectrum" and work diligently to overcome the connectional challenges that exist. Most importantly, they communicate in attitude, word, and deed that physicians are honored guests in their organization. Viewing physicians as honored guests will permeate a hospital, from the dietary department to the laboratory to the C Suite, with a positive and appropriate message.
3. Master Relational Dynamics. When hospital leadership views its physicians as honored guests, the groundwork is laid for effective management of the relational dynamics with physicians. Executives and physicians aren't required to be the best of friends, but mutual trust and professional courtesy is indispensable. Hallmarks of relational excellence are listening to and hearing the needs of physicians, showing appreciation for their work and expertise, following through on commitments made, creating a more efficient workplace for physicians, and being transparent with hospital plans, challenges, and financial status.
There is finesse to any communication, but especially so for healthcare executives attempting to communicate effectively with a group as dynamic and intelligent as physicians. Communication needs to be intentional, thorough, and continuous. Hospital leaders should perfect the art of articulating negative facts and difficult events. All leaders are fairly adept at communicating things which are inherently positive; it is the willingness to address negative or delicate matters expeditiously and effectively which separates good leaders from great ones.
4. Ramp up Responsiveness. Hospitals face daily operational challenges, and as a result there is always a "fire to extinguish." Further, the typical board of trustees and medical staff structure dictates numerous meetings, which can become ends unto themselves. This creates a rigorous and hectic work schedule for most hospital leaders. An unintended consequence, however, is that leadership may be convinced they are being responsive, when in fact the majority of physicians perceives the exact opposite. Hospital leaders should perform a review of recent important decisions, and then develop a new performance metric and process for decision making. Physicians will notice and appreciate the difference.
5. Run a Great Hospital. Although this sounds old-fashioned, it's still true. A well-run hospital will not be ignored by local physicians and is the underpinning for a successful relationship. Physicians respect excellence. They have to trust that their patients are being referred to a safe, high-quality hospital. Physicians will be more accepting of medical staff and board committee appointments in a hospital characterized by excellence, and contribute further to the clinical and operational strength of the organization.
Physicians are also attracted to hospitals that succeed financially—confirming for them effective leadership, wise strategic planning, and an organization that is able to keep up with technological advances. At the end of the day, beyond the noise of the daily friction of the physician-hospital dynamic, a well-run hospital will do more to generate physician alliances and loyalty than any other strategy.
6. Develop Physician Leaders. The vast majority of medical staffs has at least a handful of physicians interested in the hospital's welfare. These physicians may not always agree with the hospital leadership, but their interest and commitment is an incredible asset. Wise hospital leaders will encourage these physicians to become more involved in hospital affairs, develop their personal leadership skills, and be exposed to major developments within the industry. These physician leaders will function as positive hospital advocates with their patients and community leaders. Most importantly, the resulting physician leaders will complement the existing executive leadership team by serving as a hospital advocate to physician colleagues.
7. Don't Ignore the Reticent Physician The typical medical staff consists of three physician camps: Interactive Supporters, Interactive Antagonists, and Reticent Physicians®. Hospital leaders know these interactive types—the people who actively support the hospital and the people who actively defy the hospital and its initiatives. But Reticent Physicians® are that large—they often include the majority of physicians on most medical staffs—yet relatively silent group. This behind-the-scenes group may not be heard from often, and it is tempting for a hospital leader to interpret their silence as support. Hospital leaders should actively seek input and participation from physicians in this silent majority, as the investment will reap future dividends.
8. Adopt and Execute an Integration Strategy. The creation of aligned incentives can powerfully impact physician behavior and hospital outcomes. A well thought out integration plan involving trustees and medical staff leadership will lay the foundation for effective execution at the appropriate time. Hospitals are understandably reluctant to share the pie. But proprietary entities are actively—and successfully—luring physicians away from hospitals and taking all of the pie, creating an even greater fractious environment. In the absence of a physician integration strategy, health systems and hospitals will find themselves simply reacting to future threats. Most physicians will respond favorably to the hospital's sincere desire to achieve a greater alignment of economic interests.
9. Do Common Things Uncommonly Well. Football Coach Tony Dungy writes in his book, "Quiet Strength," that his players are encouraged to do "common things uncommonly well." We believe this philosophy has applications to most human endeavors, certainly in the physician-hospital relationship. Resisting the urge to chase the latest fads in management theories, hospitals should commit to doing everyday things uncommonly well. Paying attention to the finer details of events like planning medical staff retreats or Doctor's Day celebrations or common occurrences such as meeting preparations and handling delinquent medical records, will reap dividends and garner physicians' attention and respect.
10. Connect During Moments of Truth. Hospital leaders will inevitably face tough situations where they are caught between two immovable forces: the needs of the hospital and the perspective of the physicians. These moments of truth challenge the best of leaders. No leader can guarantee, or be guaranteed, success as they make difficult decisions during these "Catch 22" situations. However, there is a guarantee of failure if hospital leaders don't connect with their medical staff during these critical junctures.
Peter Drucker, who is widely considered to be the father of modern management, stated that hospital administrators (and pastors) have the most difficult jobs he has encountered. In support of Mr. Drucker's observations, we believe the physician-hospital dynamic is the most challenging aspect of a hospital leader's responsibilities. But as in economics, where there is great risk, there is also great reward. A hospital that enjoys a positive and upbeat relationship with its physicians should find itself in a favorable position with patients, payers, and the community it serves.
Jesse O. Weatherly, III, FACHE, former CEO of Cullman (AL) Regional Medical Center, and Stephen C. Nyquist are co-founders of Salient Health Ventures based in Cullman. They may be contacted atsteve@salienthealthventures.com.
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Successful organizations are often tempted to hunker down and keep the secret formula to their success under wraps. But many healthcare executives at top health systems, medical groups, and health plans have a different view. These leaders feel it is their responsibility to share their knowledge with other industry leaders in an effort to improve the quality of patient care and the healthcare industry overall.
One of the things that I enjoy about our annual Top Leadership Teams in Healthcare Conference, held last week in Chicago, is that it provides a forum for senior healthcare executives to exchange ideas and hear how some of the industry's top performers are not only surviving the current challenges in healthcare—such as reimbursement, the regulatory environment, physician relations, and staff shortages—but thriving. My head is brimming full of story ideas gleaned from the conference, and attendees came away with a "few jewels" of wisdom, as well.
Chris Van Gorder, president and CEO of Scripps Health in San Diego (this year's TLT winner in the large hospitals and health systems category), says the strength of the program is the speakers involved. "These are practitioners who are out in the field experiencing the same crises that we may be in, and [they] have found innovative ways of taking their organization through that mine field. It is very practical and very pragmatic," he says. "I have already jotted a few notes down electronically and there are some people that I would like to talk to after this to get a little bit more detailed information."
Here are just a few examples of the ideas that were shared.
Executives from Gundersen Lutheran Health System in La Crosse, WI, discussed how they saved more than 20% on construction costs. Some the best practices they followed were:
Building in base pricing to their contracts so if they wanted to change a plan on the fly, it would cost them. Taking more risk on themselves forced them to be more disciplined. Many of the impromptu changes dried up as a result, says Jerry Arndt, senior vice president of business services.
Forcing local construction companies and vendors to compete more on price by expanding their search grid. The local companies still got preference if the costs were equal.
Training internal staff to oversee construction projects, which has yielded huge dividends, says CEO Jeffrey Thompson, MD.
Jerry Miller, MD, from the Holston Medical Group in Kingsport, TN, discussed how they were commercializing their services. For example, they are rolling out electronic medical record systems to other medical groups and servicing them. "IT one of best things that we did," says Miller. They also have 37 clinical trials that bring in revenue, and educational programs that they are rolling out to schools, payers, and businesses.
Involving physicians in quality and transparency initiatives from the start is considered good practice. But many organizations involve doctors only in the clinical components of their transparency efforts. Panelists Bruce Crowther, CEO of Northwest Community Hospital in Arlington Heights, IL, and Thomas C. Royer, MD, president and CEO of CHRISTUS Health in Irving, TX, said that if they had it to do all over again they would involve physicians not only in the clinical elements of their transparency initiatives, but in other areas like the patient satisfaction components, as well.
We'll be sharing more in-depth coverage of each of the panels along with profiles of the 2008 winning teams in the December issue of HealthLeaders magazine.
The 2008 Top Leadership Team in Healthcare award winners are:
Scripps Health, San Diego: Large Hospitals and Health Systems (500 or more beds)
Griffin Hospital, Derby, CT: Community and Mid-size Hospitals (100-499 beds)
Lakewood Health System, Staples, MN: Small Hospitals (Less than 100 beds)
Bangkok Hospital Medical Center, Bangkok, Thailand: Global Hospitals
HealthTexas Provider Network, Dallas: Medical Group Practices
CareSource Management Group, Dayton, OH: Health Plans
Carrie Vaughan is leadership editor with HealthLeaders magazine. She can be reached at cvaughan@healthleadersmedia.com.
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OhioHealth hospitals and doctors are back in the central Ohio Medicaid network after CareSource, a Medicaid managed care plan, signed a new contract with the area's largest health system. CareSource had severed ties with OhioHealth on July 1 after the two sides could not come to an agreement about reimbursements. The new contract is effective through Dec. 31, 2010.
Balance billing is officially illegal in the state of California. The practice, which is when physicians bill patients for services not paid by a health insurer, had been common practice in some California facilities. Opponents of balance billing say the policy puts consumers in the middle of insurer/physician battles. The California Medical Association has bought suit against the state's Department of Managed Care in hopes of reversing the state's decision.