John McCain's health plan would bring about a dramatic shift in how millions of people get health insurance coverage. He would let people shop around for plans offered by insurers in other states.
The idea sounds simple, but has huge implications.
An ailing Massachusetts Sen. Edward Kennedy is trying to lay the groundwork for a breakthrough on healthcare reform next year, though many believe the enormous undertaking has been made even more difficult by the troubled economy. Kennedy, aides say, has held several video conferences with lawmakers and staff in recent months as he fights from home to overcome brain cancer. His staff has held more than a dozen meetings in recent weeks with various advocacy and interest groups that will help influence the debate.
Federal health officials said they will soon address growing concerns about the lucrative commissions that some Medicare insurers plan to pay their agents and brokers this year. Documents obtained from some companies participating in Medicare Advantage show that their agents stand to make $500 to $550 this year for enrolling a beneficiary into one of their plans. In subsequent years, the agents could make another $500 for every year the beneficiary stays with the plan. After five years, an agent could have made more than $2,500, a big jump from previous years.
Americans spend more than $265 billion a year out of pocket on healthcare and pile up medical debt, but now Haddam, CT-based Criterion Ventures is creating a new approach to dealing with world of deductibles, co-pays and care for the uninsured. Criterion's idea is to weave together private and public sources of payment, negotiate discounts on hospital and doctor care, community by community, and load it all onto a hybrid debit-credit card. The card is aimed at insured as well as uninsured consumers.
Richard Berger, MD, of Chicago has a Zimmer Conference Center down the hall from his busy orthopedic office at Rush University Medical Center. He stars in a training video on the Warsaw, IN-based medical device-maker's Web site that shows him installing one of the implantmaker's artificial knees. Berger's experience as a leading expert in Zimmer's development of minimally invasive surgery illustrates the high stakes when doctors and medical-supply firms join in business ventures. Some fellow surgeons say Berger and Zimmer pushed new ideas too far, too fast, before the evidence supported them. But Berger rejects that notion and defends his relationship with Zimmer.
Healthcare stocks have dropped alongside another swoon in the broader market, pouring water on the notion that the industry is a safe place to hide when the economy heads south. Many areas within healthcare are traditionally viewed as economically insulated, and indexes tracking big pharmaceutical and medical-technology companies have declined less precipitously this year than other indexes. But concerns about the harmful impact from higher out-of-pocket patient expenses, or the push toward generic drugs, are taking a toll.
The Food and Drug Administration allows thousands of medical devices onto the market each year after only cursory review and with no clear evidence that they help patients. Doctors are free to use those products as they see fit, without telling patients that the devices are not proved. And because the doctors are frequently paid more by Medicare as a way to compensate them for the extra time and expense of adopting new procedures, these unproven products can become widely adopted. FDA officials defend the quick-review process as a way to promote innovation.
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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