Two hot topics in healthcare today are physician alignment and consolidation.
Both are intertwined and affect each other dramatically, and that thought came through loud and clear at the CEO roundtable discussion at the IDN Summit and Reverse Expo held at the Arizona Biltmore in Phoenix recently.
Included on the panel were Charlie Martin, president and CEO with Vanguard Health Systems based out of Nashville, Michael Means, president and CEO of Health First in Melbourne, Fla., Dr. James Ramsey, president of the University of Louisville and Don Wegmiller, chairman and co-founder of C-Suite Resources. I had the pleasure of moderating the panel and the first question I posed pertained to consolidation.
Charlie Martin didn't waste any time stating that consolidation was all about physicians. In other words, bringing physicians together so that a system or hospital could lower costs, improve patient care and prepare for payment models that reward collaboration. All of those things make sense when talking about physician alignment, but I believe health systems realize that without a large number of employed physicians bringing revenue into their coffers, surviving lower and lower reimbursement from payers will become increasingly difficult, if not impossible.
No doubt about it, the future is going to get tougher and tougher for healthcare and for hospitals to survive, and that's why hospitals are spending so much time recruiting and buying physician practices. Physicians are the revenue producers and without a large number of them involved with a system, that system is destined to struggle.
Recently, Kenneth Cohen, MD, MBA, FACS, a practicing surgeon and author of "Getting It Done," discussed physician alignment with the Becker Hospital Review. He suggested a variety of problems that will plague physician alignment and hospitals.
The first one has to do with the fact that physicians are trained as individualists and Dr. Cohen states that while collaboration is essential for the new wave of payment models in healthcare, hospitals could very well struggle to align with "individualistic" physicians. He comments, "I think the most glaring reason it's difficult to align is the way we are trained. Physicians have very different backgrounds and training and experience, and we tend to personalize our differences." Physicians in his generation had virtually no formal lessons in communication and collaboration, and the lack of training in those two areas could present serious challenges for hospital execs.
Another challenge for hospital execs? Just because physicians are employed by hospitals does not necessarily mean they will become more engaged in strategic initiatives and cost-cutting measures. Cohn raises this flag: "Physicians are like tenured professors. I've heard a number of deans say that just because you pay somebody, doesn't mean that they put you at the top of their list." Physicians often see meetings as a waste of time, a burden that cuts into their clinical time.
Cohn also warns that physicians and administrators treat problem-solving differently. Physicians are trained to take a large amount of data and distill it into a single diagnosis. He believes that hospital administrators, on the other hand, are taught to take data and use it to create different options. Consequently, to a busy physician, it would appear the healthcare executive can't make a decision. Meetings and problem solving can become a struggle.
Cohen believes that Hospitals have to make expectations clear up front when hiring physicians. Mayo Clinic in Rochester, Minn., for example, has a salary, incentive and physician-to-physician mentoring system that makes expectations clear from day one.He also points to Virginia Mason in Seattle and Gundersen Lutheran in La Cross, Wis., as systems that use compacts to spell out certain expectations for physicians and the hospital.
Finally, Cohn feels that physician mentors are under-utilized. A survey on physician turnover by the AMGA and Cejka Search says that 74 percent of physicians groups believed a mentorship program reduces turnover, yet only 56 percent of groups assigned a mentor. Physicians with mentors are more likely to engage in hospital initiatives, communicate well with administrators and stay with the hospital for a longer period of time. Cohn's comments areabout people dealing with people. In order to make it an even playing field, we have to understand the other person's background and training. Doing so makes collaboration a much more positive experience and out of collaboration usually comes progress.
The future is going to be filled with negotiation and collaborative moments between physicians and hospital execs. Hospital execs need to understand the thinking process of physicians. If they do, negotiations and collaboration with physicians can go very well and that, in the end, should be the goal. It will be interesting to watch.