Sound bite and slogan, strapline and headline, at every turn, we meet hyperbole. The soaring inflation of the English language is more urgently in need of control than the economic variety.” (Trevor Nunn, b. 1940, in Evening Standard, 3 June 1999.
The senior partner of a clinical group I was associated with over a decade ago was lamenting the ever-approaching topic of physician-hospital collaboration. His final words in that discussion were, “We will pay to get us into collaboration until it hurts and then pay to get us out of collaboration until we learn our lesson.”
His perspective was the result of a cyclical approach to the alignment or engagement of physicians and medical staff within the hospital setting. Reading between the lines, the message really was about the fear of loosing independence, not understanding the unknown and partnering with individuals – he believed, didn’t share the same goals and objectives. A decade or more later, we are in the midst of a fast-paced industry shift in which physician are approaching health system about employment, health systems are looking toward physicians to create a unified system of care, and physicians are hanging the lab coat and replacing it with a seat at senior leadership and governance. These seats are no longer as chief medical office alone. “M.D., MBA, CEO” is not uncommon.
A dialogue of physician integration and affiliation is not new. Industry discourse is wide, fervent, and meaningful. As a result of regulatory and legislative changes, the role and responsibility of the physician today is different than one generation ago. My heart goes out to those physicians who are in the 60’s today. Their rationale for entering the profession and building a practice is no longer part of the value proposition. Physicians who entered the world of “M.D., MBA” in the 1980’s and 1990’s began a journey to create large single- or multi-specialty practices. The intent of these business enterprises was to create a substantial business enterprise that would, potentially and hopefully, outlast the individual physician.
The driving forces of today’s physician, hospital, health system integration reflect a unique time in our nation’s culture. At the forefront of these industry drivers,
An industry long in economic turmoil is now exacerbated by a national economy unable to support a medical infrastructure. Payment for clinical services has historically shifted from one segment to another – individuals, employers, government. There are no rich aunts or uncles left to pick up the bill.
- The lack of a clear champion or leader to address corrective measures to the healthcare industry.
- Our nation’s insatiable desire for health and wellbeing, consistent search for an easy fix to personal health, and a generational belief the value of healthcare expenditures is equivalent to the co-pays and deductibles experienced.
The industry response focuses on transparency and integration. Since the 1970’s children are taught that it is better to work in a team. Hours are spent in formal and informal education touting, promoting, and focusing on our ability to play well with others. The power of the team versus the individual has been ingrained in two generations of DNA. Therefore, when faced with the need to improve the healthcare industry, a team is needed. Add complete transparency courtesy of devotees of Deming, and you have the foundation for integration, affiliation, and alignment strategies.
The key strategies today include the organization of the physician medical staff and their physician extenders, focused on performance improvement. Integration is used as a noun, adjective, and verb. One size doesn’t fit all. The level of integration is tempered by organization culture and history.
The menu of integration options is a greater than a connoisseur’s wish list:
- Medical Directorship
- Call coverage agreement
- Professional Service Agreements
- Co-management
- Service line management agreements
- Gain sharing agreements
- Information technology shared strategy, hardware, planning
- Joint venture
- Employment
Language and intent are essential building blocks in developing a trusting relationship and successfully surpassing all expectations of success. The legal structure, employment model, or financial pro forma are secondary to the identification and specificity of goal, objective, and strategy. Sharing an understanding of the future and your role in crafting that future is the hurdle to overcome.
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