Physician Alignment: Constructing Viable Roadmaps for the Future

151 Pages·2012·5.67 MB·English

by  George Mayzell MD MBA FACP

Healthcare Management / Health Administration & Policy
M Physician
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As one who participates in medical school and health system administration,
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I recommend this volume for its emphasis on understanding and creating the e
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health system of the future.
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—David Stern, MD, Executive Dean, Vice Chancellor of Clinical Affairs,
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UT College of Medicine r Alignment
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e
n
Through healthcare reform, payment modifications, transparency, and a
renewed focus on value, the healthcare industry is changing its organizational
structure from one of a multitude of individual entities to one of a system-
of-care model. This restructuring and subsequent alignment of information
presents new risks and opportunities for physicians, hospitals, and other
P
healthcare providers. Constructing Viable Roadmaps
H
Emphasizing effective interactions between physicians and the health system, Y for the Future
Physician Alignment: Constructing Viable Roadmaps for the Future
S
examines the different ways physicians and hospitals can create systems to
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not only survive, but thrive through the changes facing healthcare. It draws on C
experienced authors in the area of physician purchasing to explain the various
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integrative models for physicians and hospitals. A
• Provides an accessible introduction to the different types of healthcare N
delivery models

A
• Covers the various types of integration—starting with the simplest
and evolving into full employment models with full integration L
• Includes helpful information for doctors considering a transition I
G
to physician employment
• Highlights emerging trends in healthcare N
M
Explaining how these systems should be constructed and aligned, the book
provides healthcare organizations with a roadmap for planning for the E
future. The book concludes with a chapter on accountable care organizations
N George Mayzell, MD, MBA, FACP
and patient-centered medical homes that moves from the conceptual to
administrative embodiments of the principles of an integrated health system T William R. Breen, Jr., MBA
as we now know it.
Foreword by David Stern, MD, Executive Dean,
Vice Chancellor of Clinical Affairs,
K14540
UT College of Medicine
ISBN: 978-1-4665-0476-9
90000
www.crcpress.com
9 781466 504769
www.productivitypress.com
K14540 cvr mech.indd 1 10/25/12 11:51 AM

Physician
Alignment
Constructing Viable Roadmaps
for the Future

Physician
Alignment
Constructing Viable Roadmaps
for the Future
George Mayzell, MD, MBA, FACP
William R. Breen, Jr., MBA
Foreword by David Stern, MD, Executive Dean,
Vice Chancellor of Clinical Affairs,
UT College of Medicine
CRC Press
Taylor & Francis Group
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Boca Raton, FL 33487-2742
© 2013 by Taylor & Francis Group, LLC
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Version Date: 20120615
International Standard Book Number-13: 978-1-4665-0477-6 (eBook - PDF)
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Contents
Foreword ........................................................................................................ix
Preface ............................................................................................................xi
Acknowledgments .......................................................................................xiii
About the Authors .........................................................................................xv
1 Introduction: How We Got Here ............................................................1
Historical Perspective ...................................................................................2
Economic Imperatives ..................................................................................7
Bibliography ..............................................................................................11
2 Overview of the Future .........................................................................13
Introduction ..............................................................................................13
Physician and Hospital Trust .....................................................................17
Bibliography ..............................................................................................19
3 Traditional Integration Models ............................................................21
Medical Staff .............................................................................................21
Medical Directorships ................................................................................23
Call Coverage ............................................................................................25
Bibliography ..............................................................................................27
4 Revenue of the Acronyms: Co-management, IPA, and
PHO Integration Structure ..................................................................29
Introduction ..............................................................................................29
Clinical Co-management: Share the Gain .................................................29
Co-management Example ................................................................33
The Independent Practitioners Association: How Exclusive Is the Club? .....34
The Physician Hospital Organization: Venus and Mars Form a Company .....35
Bibliography ..............................................................................................38
v
vi  ◾  Contents
5 Physician Employment .........................................................................41
What Is Old Is New: Employment ............................................................41
Employment Considerations .....................................................................46
Changing World: Making the Decision .....................................................48
Physician Employment Agreements ...........................................................48
From the Physician Side ....................................................................48
From the Hospital Side .....................................................................50
Physician View ..................................................................................51
It Is All About Integration ................................................................56
Foundation Model .....................................................................................56
Physician Service Agreements ....................................................................56
Clinical Institutes ......................................................................................57
Governance ................................................................................................57
Physician Payment Models .........................................................................59
Appendix: Cultural Assessment Tool .........................................................62
Bibliography .............................................................................................64
6 Clinical Integration ..............................................................................67
What Is Clinical Integration? .....................................................................69
Bundled Payments .....................................................................................71
Legal Limitations to Integration ................................................................73
Information Technology ............................................................................75
Bibliography .............................................................................................77
7 Accountable Care Organizations and the Patient-Centered
Medical Home ......................................................................................79
Introduction ..............................................................................................79
Accountable Care Organizations ...............................................................80
Patient-Centered Medical Home ................................................................86
How Doctors Want to Be Paid for Providing a Medical Home.........92
Bibliography ..............................................................................................93
8 Assessing Your Current Alignment Strategy ........................................97
9 Examples of Systems Strategic Alignment Initiatives .........................105
Methodist Le Bonheur Healthcare ..........................................................105
WILLIAM BREEN, JR.
Geisinger Health System ..........................................................................106
WILLIAM BREEN, JR.
Piedmont Healthcare’s Integration Strategy .............................................109
JAMES SAMS, MD
Norton Healthcare System .......................................................................110
GINGER FIGG
Contents  ◾  vii
Summa Health System.............................................................................112
NANCY A. MYERS, PHD
Hospital Physician Integration: Baylor Health Care System .....................115
DAVID J. BALLARD, MD and PAUL B. CONVERY, MD
Bibliography ............................................................................................117
10 Putting It All Together: Full Integration ...........................................119
Introduction ............................................................................................119
Blurring of Boundaries ............................................................................120
Health versus Healthcare .........................................................................120
Performance-Based System ......................................................................121
Demographic and Environmental Factors ................................................122
Legal Environment ..................................................................................123
Metrics and Transparency ........................................................................123
Population Health....................................................................................124
Physician Leadership ................................................................................125
Patient Engagement .................................................................................126
Transformation ........................................................................................127
Bibliography ............................................................................................129