Physician alignment : constructing viable roadmaps for the future PDF
Preview Physician alignment : constructing viable roadmaps for the future
Healthcare Management / Health Administration & Policy M Physician a y As one who participates in medical school and health system administration, z I recommend this volume for its emphasis on understanding and creating the e l l health system of the future. • —David Stern, MD, Executive Dean, Vice Chancellor of Clinical Affairs, B UT College of Medicine r Alignment e 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 I 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 I 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 N • Highlights emerging trends in healthcare 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 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2013 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20120615 International Standard Book Number-13: 978-1-4665-0477-6 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. 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Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com 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
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