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Physician – Hospital Relationships “Come Together”. Kathryn D. Beattie, MD, MBA. Increasing Medicare Medicaid and Self-pay. Shortage of Key Specialties. Declining Reimbursement. Rising Expenses: Staffing, Operations & Depreciation. Outpatient Competition. Increasing Regulations.

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healthcare environment fuels the fighting what goes on

Increasing Medicare

Medicaid and Self-pay

Shortage of

Key Specialties

Declining

Reimbursement

Rising Expenses:

Staffing, Operations

& Depreciation

Outpatient

Competition

Increasing

Regulations

Capital Investment

Demands

Recruitment

Challenges

Healthcare Environment Fuels the Fighting “What Goes On”

National Trends

Local Factors

physicians and hospitals compared tell me what you see
HOSPITALS

Big

Community/External Focus

Long-Range Perspective

Management Control

Bureaucratic

Delegated Decision Making

Organizational Funds

Conflict and Risk Addressed

PHYSICIANS/GROUPS

Small

Internal Focus/Survival

Short-Term Perspective

Owner Control/Entrepreneurial

Anarchistic

Concensus-Based

Personal Funds

Conflict and Risk Avoided

Physicians and Hospitals Compared“Tell Me What You See”
physicians and hospitals think differently i want to tell you
HOSPITALS

Often Not-for-profit

Mission Driven

Proactive – Strategic Planning

Focused on Program Growth

Capital intensive (high fixed expenses)

Medicine from a business perspective (MBA)

Owns the “house”

Physician as “tenant”

Bundled payment per case

Incentive to shorten LOS and efficiency

PHYSICIANS

For-profit entrepreneurs

Self Driven

Reactive – Minimal Planning

Focused on Individual Patient

Thinly capitalized (minimized fixed expenses)

Medicine as science/profession (MD/DO)

Owns the “patient”

Hospital as “landlord”

Fee-for-service payment

Risk averse which may extend care

Physicians and Hospitals Think Differently“I Want to Tell You”
customer or competitor both just get used to it come together
Customer or Competitor? Both, just get used to it! “Come Together”
  • Physicians control the elective patients:
    • significant proportion of admits (only a small percentage of inpatients are admitted through the ED)
    • Higher margin patients
  • Professional reimbursement cuts push physicians into technical billing opportunities that previously were hospital domain
    • Independent Outpatient Surgi-Centers
    • Independent MRI and CT Scanners and Labs
physician customers building physician loyalty don t let me down
Physician Customers - Building Physician Loyalty“Don’t Let Me Down”
  • Quality
    • Primary Care Access and Subspecialty Consultants
    • Nursing and Technical Staff
    • Up-to-Date Facilities and Equipment
  • Efficiency of hospital services and scheduling
    • Imaging
    • Lab
    • OR/Anesthesia services
    • Direct Admissions
  • Convenience and Responsiveness
    • Communication
    • Adaptability
loyal physicians create competitive advantage getting better
Loyal Physicians Create Competitive Advantage“Getting Better”

PREDICTORS OF PHYSICIAN LOYALTY

  • Satisfaction
  • Quality
  • Practice Efficiency and Convenience
  • Administrative Adaptability

Address issues such as:

    • ED Call
    • New technology requests
    • Staffing specialization
referral base primary care physicians minimal need to practice in the hospital
What they want:

Financial Stability (Practice Support)

Responsive high-quality specialty consultants

Communication on admission/discharge

Convenient Ancillary Services

Strategy:

Employment opportunity

Recruitment

Assure full complement of specialists

Inpatient support (Hospitalists)

EMR (office-based and physician portal)

Efficient/Available Ancillary Services

Referral Base - Primary Care PhysiciansMinimal Need to Practice in the Hospital
ambulatory medical physicians and surgeons clinical services at risk for outpatient migration
What they want:

Strong relationship with primary care referral network

Ease of communication with referring physicians

Access to technical revenue

Efficient ancillary services

Ease of scheduling

Quick report turnaround and availability

Strategy:

Engaged primary care network

Excellent customer service

Efficient Day Surgery Center

Quality Equipment & Staff

Service Line Management for improved quality and patient experience

Partnership opportunities

ED “On-Call” strategies

EMR (office-based and hospital-based)

Ambulatory Medical Physicians and SurgeonsClinical Services at Risk for Outpatient Migration
physicians driving hospital revenue surgical and interventional proceduralists
What they want:

Inpatient capacity

Efficient and modern clinical services

Throughput – coordination of care

Clinical caregivers dedicated to quality and patient satisfaction

Strategy:

Facilities and Technology Expansion

Physician input on capital spending for both physical plant and equipment

Dedicated Clinical Service Lines and Inpatient Units

Physician input and accountability for some aspects of operations

ED “On-Call” Strategies

Treatment Protocols

Partnership Opportunities

Physicians Driving Hospital RevenueSurgical and Interventional Proceduralists
slide18
What they want:

Inpatient Capacity

Employment or Exclusive Arrangement

Throughput – Coordination of care and information management

Clinical caregivers dedicated to quality and patient satisfaction

Strategy:

Facilities and Equipment

Physician input on capital spending for both physical plant and equipment

High quality and efficient service

Develop relationships between physicians and nursing/clinical staff

Drive patient satisfaction

Partner to develop service and quality standards

champions of a positive physician culture

Physicians with a Dependent RelationshipHospital-based Specialties Hold the Power to Create Efficiency
physician strategies things we said today
Physician Strategies“Things We Said Today”
  • Business
  • Relationships
    • Medical Directorships
    • Joint Ventures
    • Professional service agreements
    • Co-Management agreements
  • Specialty
  • Development
  • Recruitment
    • Expanded Specialty Clinics
    • Service Line Development
  • Physician
  • Support
  • Services
    • Primary Care Network
    • Orientation
    • Physician Liaison
    • IT (EMR) Link: EMR
    • Marketing and Outreach
  • Efficient
  • Hospital
  • Environment
    • Hospital/physician communication
    • Efficient privileging/credentialing
    • Intensivist/ICU availability
    • OR scheduling and availability
    • Hospitalist program success
how to connect with physicians ob la di ob la da
Multi-channel Interactive Communication

Provide forums for idea and information exchange

Off-site retreats - meetings for leaders

Credentialing/Privileging

Medical Staff Issues

Leadership Training & Business Education

Physician – Management Networking

Board member engagement

Structured, but informal, physician-hospital social activities

How to Connect with Physicians“Ob-la-di, Ob-la-da”
successful communication requires skill
Negotiation

Strategic thinking

Polarity management – impact and intent

Establish a written conflict resolution mechanism

Address conflict in person and in a timely manner

Celebrate successes, big and small

Successful Communication Requires Skill
seriously address and develop physician hospital communication
Development of physician leadership competencies

Commitment (time)

Business Competency

(not taught in Medical School)

Cultural conflict (mediate conflict in values, communications and behavioral norms between clinical medicine and administrative leadership)

Develop mutual expectations (align mission statements of hospital and medical staff)

Invest in Social Capital (Develop Relationships, Networks, and Trust)

Seriously Address and Develop Physician-Hospital Communication