Hospitals are bringing in physicians, but who’s benefiting?
Hospitals have been hiring physicians at an unprecedented rate this year, leaving administrators to figure out how to align clinical strategies, quality initiatives and compensation to best keep costs down and still provide quality care.
“Physicians are moving to hospital-owned practices for a number of reasons,” said Brenda Lewis, president of B.E.L. & Associates and a Medical Group Management Association survey advisory committee member. “There is uncertainty of reimbursement for the future. Physicians are looking to sustain income to pay office overhead and have a paycheck to take home, and those with large Medicare populations are more likely to want to move to hospital-employed positions.”
Sixty-five percent of established physicians were placed in hospital-owned practices, according to the MGMA’s "Physician Placement Starting Salary Survey: 2010 Report Based on 2009 Data," while 49 percent of physicians hired out of residency or fellowship were placed in hospital-owned practices.
“There needs to be quality and it leads to cost (increases),” Gregory said. “To be successful in providing quality healthcare, hospitals and physicians need to work together.”
One health network leveraged its participation in three different quality initiatives to improve physician alignment.
St. Luke’s Hospital & Health Network in Bethlehem, Pa., includes 1,158 licensed physicians, so getting them to participate in the quality initiatives was important. Joe Merola, MD, chairman of obstetrics and gynecology, said the health system designated physicians with “preferred” provider status to get them to buy into the quality initiatives.
St. Luke’s found that assigning leadership positions in departments, divisions and sections helped staff feel involved. Designating physician champions for quality and safety change agendas was another effective method, he said.
“We have leadership in quality and this is translated all the way down,” he said. “As a result, we have a collective spirit and good will and can retain people who work in this area.”
According to David A. Gregory, executive vice president for Prescott Associates in Avon, Conn., barriers to hospital-physician collaboration on quality include:
70 percent to 80 percent of hospital admissions and patient visits are influenced by a physician’s recommendation, yet only 59 percent of physicians are loyal to the hospitals where they practice;
Hospitals don’t have extensive control over physicians who practice in their facilities, other than those who are hospital-based or employed physicians;
Relationships are often tenuous between physicians and hospital administrators;
Hospital and physician incentives and reimbursement are not aligned.
“If you don’t know what your physicians want, survey them,” said Gregory. “They are pulling their hair out with all the (reform) changes. If you’re able to help them with that aspect of their life, then you’ll get their attention.”
A national survey shows that primary care physicians make up 11 percent to 50 percent of those physicians employed by hospitals, but despite that, “Employment is just one approach to hospital-physician alignment,” said Craig E. Holm, senior vice president at Health Strategies and Solutions in Philadelphia. He noted that other approaches include independent physicians and independent partnerships.
