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Hospital Physician Integration. ACHE West Virginia Conference May 30, 2014. Physician-Hospital Integration Arrangements. Employment Contracting to provide services Provider Service Arrangements Co-management arrangements Gain Sharing arrangements Physician Hospital Arrangements (PHOs)
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Hospital Physician Integration ACHE West Virginia Conference May 30, 2014
Physician-Hospital Integration Arrangements • Employment • Contracting to provide services • Provider Service Arrangements • Co-management arrangements • Gain Sharing arrangements • Physician Hospital Arrangements (PHOs) • Risk Arrangements • Medical Home Arrangements (ACO)
CAMC ARRANGEMENTS • 1. Affiliation/partnership with WVU physicians of Charleston to provide the teaching physicians for our residency programs and to teach WVU students and other students • 2. traditional private practice model • 3. employment • 4. contract model to provide services: radiology, anesthesiology and emergency room services • 5. employment model • 6. provider services arrangement
Baldrige Framework • Deployment of 32 systems to run the business and manage the quality • Leadership, Governance, Communications, and strategic planning are key system that guide the physician integration efforts • Workforce development, learning, data management, and process improvement are key systems that help deliver results
Key Processes • Governance process with all physician board for the employed physicians • CAMC is part of the practice plan board of directors of the WVU PC Charleston Division • Physicians in the Physician Advisory Group, Physicians from the employed group are part of the strategic planning process • Leadership of these groups help set aims, communicate the aims, execute the plans, reassess progress, and revise plans
Key Processes • Key requirements are determined as part of the strategic planning process for the physicians and their patients • Improvement and learning issues are determined as part of the strategic planning process • Physicians are engaged in many improvement efforts for patient care
Key Requirements • Quality • Safety • Timely • Efficiency
Metrics • Patient Engagement and Satisfaction • Employee Engagement and Satisfaction • Quality and Performance Improvement Programs • involvement • outcomes • Safety Initiatives • Financial Performance • Office Level • Physician Level • Affiliate and Company Level
Value of Hospital Physician Arrangements • Porter, “What is the Value in Health Care?” NEJM, 2010 • High Value: health outcomes achieved per dollar spent with the goal being what matters to the patient and unites the interest of all actors in the system. • Value should define the framework for improvement in health care and would include all services and activities that meet the set of patient needs.
Value for Physicians • Great outcomes for my patient • Efficient practice environment • Home/work balance environment • Don’t waste my time • Process and procedures that are effective and efficient • Arrangements that are fair and equitable and reward equally and appropriately • Page appropriately • Culture of respect and trust
Value for Hospitals • Physician engagement/partners • Physician providing high quality care • Physicians engagement in quality improvement • Physician engagement in utilization of resources • Physician engagement in processes of care improvement • Access for patients to receive care • Culture of respect and trust • Physicians understanding the deal and communicate often
Incentives • Physicians: better work/lifestyle balance; better compensation security; more efficient, high quality care for patients; better security; better feeling that patients are safely cared for by the system. • Hospitals: High quality care for patients; patient safety; access to care; better design of systems and processes; predictable flow and revenue
Risks • Physicians: time waste; life work imbalance; unpredictable income; hassles; frustrations • Hospitals: inefficient processes of care; poor quality; increase patient risk; patient safety concerns; imbalance of revenue and expense • Government policy changes for reimbursement, payment methods (bundled payment), quality indicators and reporting • Value Based Payments for physicians
Lessons Learned • Culture is a key issue that creates the trust • Transparency in goals and numbers • Agreed communication channels • Have clear articulated and understood goals and expectations • Have mutual commitment and clarity on actions required to meet the goals • In compensation arrangements have clear defined exit strategies • Have clear measurable targets • Respond to Physicians promptly
Common Ground • The Patient is the center of the efforts and all need to focus on patient requirements and expectations for service and clinical quality/safety • System/processes of care understood and measured and communicated • Safety/quality/respect are common values • Goal setting from all parties (plan together not plot separately) • Common understanding of the numbers and the data • Consistent communication regarding the deal and data
Patient benefit • Access to care • Consistent application of Evidence Based Care • Use of systems helps with more timely information for the physicians • Well trained specialists and primary care • Consistent Quality and Safety
Obstacles and barriers to integration • Physicians are from Mars and Administrators are from Uranus • Common understanding of issues, language, and data for example • Knowledge of how to work together • Federal laws, rules and regulations are sometimes barriers such as Stark, Antitrust, Anti-kick Back Laws • Agreed to measurement systems and trust in them and processes to validate the data and information • Physicians and management having common understanding of expectations and processes of care
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