Structured, but informal, physician-hospital socia

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Physician Hospital RelationshipsCome Together
Kathryn D. Beattie, MD, MBA
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Healthcare Environment Fuels the Fighting What
Goes On
National Trends
Local Factors
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Physicians and Hospitals ComparedTell Me What
You See

• HOSPITALS
• Big
• Community/External Focus
• Long-Range Perspective
• Management Control
• Bureaucratic
• Delegated Decision Making
• Organizational Funds
• Conflict and Risk Addressed

• PHYSICIANS/GROUPS
• Small
• Internal Focus/Survival
• Short-Term Perspective
• Owner Control/Entrepreneurial
• Anarchistic
• Concensus-Based
• Personal Funds
• Conflict and Risk Avoided

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Very Different Perspectives
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Physicians and Hospitals Think DifferentlyI
Want to Tell You

• HOSPITALS
• Often Not-for-profit
• Mission Driven
• Proactive Strategic Planning
• Focused on Program Growth
• Capital intensive (high
  fixed expenses)
• Medicine from a business perspective (MBA)
• Owns the house
• Physician as tenant
• Bundled payment per case
• Incentive to shorten LOS and efficiency

• PHYSICIANS
• For-profit entrepreneurs
• Self Driven
• Reactive Minimal Planning
• Focused on Individual Patient
• Thinly capitalized (minimized fixed expenses)
• Medicine as science/profession (MD/DO)
• Owns the patient
• Hospital as landlord
• Fee-for-service payment
• Risk averse which may extend care

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Despite our differences, We can work it out!
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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

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Physician Customers - Building Physician
LoyaltyDont 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

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Loyal Physicians Create Competitive
AdvantageGetting Better

• PREDICTORS OF PHYSICIAN LOYALTY
• Satisfaction
• Quality
• Practice Efficiency and Convenience
• Administrative Adaptability
• Address issues such as
• ED Call
• New technology requests
• Staffing specialization

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BUTMedical Staff Are Not All The SameHelter
Skelter
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Primary Care Keep them engaged!All Together
Now
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Referral Base - Primary Care Physicians Minimal
Need to Practice in the Hospital

• What they want
• Financial Stability (Practice Support)
• Responsive high-quality 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

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Ambulatory Specialists - Appreciate them!Got To
Get You Into My Life
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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
• Ease of scheduling
• Quick report turnaround and availability

• Strategy
• Engaged primary care network
• Excellent customer service
• Efficient Day Surgery Center
• Quality Equipment Staff
• Service Line Management for improved quality and
  patient experience
• Partnership opportunities
• ED On-Call strategies
• EMR (office-based and hospital-based)

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Surgeons Control Revenue - Take them
seriously!Drive My Car
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Physicians Driving Hospital RevenueSurgical 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

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Hospital-based Physicians Determine
EfficiencyYou Really Got a Hold on Me
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Physicians with a Dependent RelationshipHospital-
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

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Physician StrategiesThings We Said Today
Business Relationships Medical Directorships Joint
Ventures Professional service agreements Co-Manag
ement 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
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COMMUNICATION
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How to Connect with PhysiciansOb-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

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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

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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)

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The End