• Fostering Hospital-Physician Collegiality

    May 25, 2012

    An interview with Joyce Zimowski

    Joyce Zimowski is known as a CPA who sees beyond the numbers. For years, she has advocated financial-clinical collaboration around performance improvement and budgeting. Now she's teaming up with a physician to expand Unity Medical Group.


    Amid all the uncertainty about the future of healthcare delivery, one thing is clear: Successful health systems will be those that have effective working relationships with physicians. That is why Unity Health, a one-hospital system in Rochester, N.Y., recently underwent a major reorganization and why Joyce Zimowski jumped at the opportunity to be part of the greatly expanded Unity Medical Group.

    Zimowski, FHFMA, CPA, a financial leader and former HFMA chair, has served as Unity Hospital's senior vice president since 2006. She successfully worked with clinical department leaders to set goals, create work plans to achieve these goals, and measure performance.

    In her new position as senior vice president and COO of the medical group, she will help bring together an increasing number of employed physicians who have been working in various departments within the system. "What we're doing with the physician group is probably the most important thing that we are doing in this reorganization," she says. "We are really elevating the importance of physicians within the organization."

    Positioning for the Future

    Unity Health has many elements needed to deliver well-coordinated patient care: a 300-bed hospital, a for-profit laboratory, a wide range of outpatient services, rehabilitation and inpatient psychiatric services, adult daycare, senior housing, and three nursing homes.

    At the moment, system leaders have no plans to pursue the accountable care model, but they want to be positioned to thrive regardless of what economic model takes hold in the Rochester market. That means giving physicians more responsibility and authority to improve the way care is delivered.

    Unity Medical Group, which was previously limited to 75 employed primary care physicians, is expanding to include 100 additional employed physicians. This includes hospital-based intensivists, hospitalists, and emergency physicians as well as specialists in various fields.

    One goal of the reorganization is to foster closer relationships among Unity physicians. "We want Dr. Jones, an internist in one of our primary care offices, to think about sending his patients to his colleague, Dr. Smith, who is an emergency department physician, as opposed to Dr. Jones thinking, 'I'm sending this patient over to the emergency department at Unity Hospital,'" says Zimowski.

    The expanded medical group also helps Unity develop a succession plan for several top administrators who will retire in the foreseeable future. "The reorganization is opening up opportunities for physician leaders, as well as some other staff who we believe have potential to be leaders," she says.

    Standard Treatment Plans

    Zimowski is serving as the top administrator for Unity Medical Group in partnership with a physician who also has the senior vice president title. "He's got the vision and the credibility with the physicians; I need to be the doer who coalesces the right group of people to get things done," she says.

    Some tasks will be administrative, such as creating a standard compensation and benefit structure for physicians and a leadership training program. But the most important job will be creating a culture in which physicians have more power to influence change.

    Currently, a patient's treatment plan in the hospital is not coordinated with his or her care in the nursing home or the outpatient clinic. "We should have physicians around the table deciding how we're going to treat that patient in the office, in the hospital, and in the nursing home," says Zimowski. "What do we want to happen if the patient goes back to home care and then back into the physician's office?"

    While the fee-for-service payment model does not currently reward care coordination among providers, Unity Health intends to be ready when the incentives emerge. "We are going to be well-positioned so that financially we will be able to benefit from that," she says. "More important, patients are going to see a huge difference between the way we treat them and the way others in town treat them. That's what we're looking for-the competitive advantage."

    Joyce Zimowski is senior vice president and COO of Unity Medical Group, Unity Health System, Rochester, N.Y. (JZimowski@unityhealth.org).