Transcript Physician - Hospital Relationships "Come Together"

Physician – Hospital Relationships
“Come Together”
Kathryn D. Beattie, MD, MBA
Healthcare Environment Fuels the Fighting
“What Goes On”
National Trends
Local Factors
Shortage of
Key Specialties
Increasing Medicare
Medicaid and Self-pay
Declining
Reimbursement
Rising Expenses:
Staffing, Operations
& Depreciation
Outpatient
Competition
Increasing
Regulations
Recruitment
Challenges
Capital Investment
Demands
Physicians and Hospitals Compared
“Tell Me What You See”
HOSPITALS
PHYSICIANS/GROUPS
• Big
• Small
• Community/External Focus
• Internal Focus/Survival
• Long-Range Perspective
• Short-Term Perspective
• Management Control
• Owner Control/Entrepreneurial
• Bureaucratic
• Anarchistic
• Delegated Decision Making
• Concensus-Based
• Organizational Funds
• Personal Funds
• Conflict and Risk Addressed
• Conflict and Risk Avoided
Very Different Perspectives
Physicians and Hospitals Think Differently
“I Want to Tell You”
• HOSPITALS
• PHYSICIANS
– Often Not-for-profit
– For-profit entrepreneurs
– Mission Driven
– Self Driven
– Proactive – Strategic Planning
– Reactive – Minimal Planning
– Focused on Program Growth
– Focused on Individual Patient
– Capital intensive
(high fixed expenses)
– Thinly capitalized
(minimized fixed expenses)
– Medicine from a business
perspective (MBA)
– Medicine as
science/profession (MD/DO)
– Owns the “house”
– Owns the “patient”
– Physician as “tenant”
– Hospital as “landlord”
– Bundled payment per case
– Fee-for-service payment
– Incentive to shorten LOS and
efficiency
– Risk averse which may extend
care
Despite our differences,
“We can work it out!”
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”
• 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”
PREDICTORS OF PHYSICIAN LOYALTY
• Satisfaction
• Quality
• Practice Efficiency and Convenience
• Administrative Adaptability
Address issues such as:
– ED Call
– New technology requests
– Staffing specialization
BUT…Medical Staff Are Not All The Same
“Helter Skelter”
Importance of the Hospital to Physicians
HIGH
LOW
Dependent
Emergency Physicians,Anesthesiologists, Pathologists,
Hospitalists, Neonatologists
Hospital Based Proceduralists
Orthopedists, Neurosurgeons, Trauma/General Surgeons, OB,
Interventional Cardiologists, Interventional Radiologists
Ambulatory Proceduralists
Medical Specialists (GI, Cardiology, Rheumatology, Oncology, Pulmonary/Sleep),
Gynecology, Ambulatroy Surgeons (Ophthalmology, ENT, Plastics)
Referral Base - Primary Care
Internal Medicine, Family Medicine, Pediatrics
Primary Care – Keep them engaged!
“All Together Now”
Referral Base - Primary Care Physicians
Minimal Need to Practice in the Hospital
What they want:
– Financial Stability
(Practice Support)
– Responsive highquality 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
Ambulatory Specialists - Appreciate them!
“Got To Get You Into My Life”
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
Strategy:
– Engaged primary care
network
– Excellent customer service
• Efficient Day Surgery Center
• Quality Equipment & Staff
• Ease of scheduling
– Service Line Management
for improved quality and
patient experience
• Quick report turnaround and
availability
– Partnership opportunities
– ED “On-Call” strategies
– EMR (office-based and
hospital-based)
Surgeons Control Revenue - Take them seriously!
“Drive My Car”
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
Hospital-based Physicians Determine Efficiency
“You Really Got a Hold on Me”
Physicians with a Dependent Relationship
Hospital-based Specialties Hold the Power to Create Efficiency
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
Physician Strategies
“Things We Said Today”
Business
Relationships
Medical Directorships
Joint Ventures
Professional service agreements
Co-Management agreements
Physician
Support
Services
Primary Care Network
Orientation
Physician Liaison
IT (EMR) Link: EMR
Marketing and Outreach
Specialty
Development
Recruitment
Expanded Specialty Clinics
Service Line Development
Efficient
Hospital
Environment
Hospital/physician communication
Efficient privileging/credentialing
Intensivist/ICU availability
OR scheduling and availability
Hospitalist program success
COMMUNICATION
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
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
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)
“The End”