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Physician Affiliations Don't Affect Quality—Yet

Analysis  |  By Debra Shute  
   September 29, 2016

Hospital employment appears to have a neutral effect on clinical quality, but that could change if healthcare leaders partner more effectively with physicians.

Think employing physicians at your hospital will inherently boost clinical quality? Think again, suggests a study published this month in the Annals of Internal Medicine. But don't jump to the conclusion that tight physician integration harms care, either.

In fact, researchers found that switching to an employment model had no effect on hospitals' readmission rates, lengths of stay, or patient satisfaction metrics.


1 in 2 Physicians Demoralized, Dissatisfied


For the study, researchers compared quality data for 2,085 hospitals that don't employ physicians to the same metrics for 803 hospitals that converted to an integration model during the study period.

Up to two years after hospitals began employing physicians, the 30-day mortality rates for patients with acute myocardial infarction, congestive heart failure, and pneumonia stayed virtually the same—10.8% at "switching" hospitals and 10.9% at hospitals that had no employment relationships.

Leveraging Employment

Given that physician employment rates continue to rise steadily—up from 29% of hospitals employing physicians in 2003 to 42% doing so in 2012—these results present hospitals with an opportunity to optimize the new normal, according to study co-author Kirstin Woody Scott, MPhil, PhD.

"The key question for all of us is, 'What do we do with this, and what can we do to leverage the tightly integrated relationships that hospitals and physicians are finding themselves in to improve quality of care?'" she told me.

Woody Scott acknowledges limitations of the study, particularly that it looked at data for hospitals that integrated only two years out. "Maybe it takes longer to see the benefit," she says. "But the notion that that's all it takes—a formal on-paper relationship—that's clearly not enough."


3 Ways to Foster Physician Alignment


Indeed, a recurring comment I've heard from healthcare executives is that physician employment does not guarantee physician engagement or alignment.

"A focus on true clinical integration, as well as a renewed focus on improving the quality of patient care and clinical outcomes, will be essential," the study authors wrote.

That statement "speaks to the importance of ensuring that there is an authentic focus on creating a sense of shared partnership between physicians and hospitals," Woody Scott says, "with the shared interest not primarily driven by financial survival or provider preference but rather on how these provides can work more synergistically to improve patient care."

Moving the Needle

As a member of Harvard Medical School's class of 2019, Woody Scott says she's optimistic about the future of clinical integration. "This study has been personally motivating to recognize that we—both physicians and hospitals—must and can do better for our patients," she says.

"Though this study did not show the needle moving (yet) in the direction proponents for hospital-physician integration had hoped for, our findings do not suggest that this needle is incapable of moving in this desired direction," she says.

"Rather, it is more of an accountability check to providers that there must be ways to better leverage these working relationships such that quality can improve.

"I hope it will promote better engagement between providers, creativity, and genuine efforts to sit around the table together to work collectively toward this shared goal of improving patient care, and I am excited to personally encourage and engage with such discussions as I advance in my training."

Debra Shute is the Senior Physicians Editor for HealthLeaders Media.

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