Successful hospital-physician integration is considered a core element of any successful response to mounting demands for higher-quality, lower-cost patient care. Click on the following infographic to find a challenging—and rewarding—route to this still elusive destination. Also, scroll down for details and examples of the integration strategies that are highlighted in the infographic.
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The infographic highlights all of the following strategies and risks. See the correlating footnotes on the infographic.
A Fall 2012 Leadership article highlights a different type of compensation: Boston Children's is exploring the possibility of giving faculty or attending physicians continuing medical education credits or credits toward board certifications for participating in improvement projects.
St. Luke’s modeled its program after the safeguards laid out in the other OIG advisory opinions rather than applying for its own opinion. As a result of the program, St. Luke’s was able to save a total of $11.2 million over the program’s duration, from 2007 through 2012.
For example, Texas Health Physicians Group (THPG) felt that a separate MSO was critical to its future success, according to Sam Civello, vice president of operations, in a 2010 HFMA roundtable. “The MSO is physician-centered and structured by those knowledgeable with practice management, which greatly facilitates our talks with physicians. We were able to assure them that we have their intentions as practitioners at the forefront in building this organization. The MSO’s success can be attributed to having a common goal, common directives, and a shared technology base. Having a single operating and reporting platform allowed us to be consistent and efficient in deploying technology and processes.”
Some PHOs require physicians to meet certain quality targets before they are allowed to join the PHO.
"This will facilitate communication between providers, between the providers and the hospitals, and ultimately, between providers and patients," said Scott Eathorne, MD, medical director for the PHO. The goal is to have about 1,000 physicians connected electronically by 2013. All physicians who contract with insurers through the PHO will be expected to adopt technology that allows them to share patient data, although a range of options will be permitted. Those physicians who have their own EHR systems, for example, may use the HIE; others may only use the disease registry function. Within the limitations allowed by law, St. John Providence is subsidizing the cost of the ambulatory EHR system.
The agreement provides a base management fee and opportunities for surgeons who are shareholders to earn a clinical incentive fee tied to the hospital’s performance on various measures. The limited liability corporation distributes its profits to surgeons who are shareholders.
The academy offers a 12-month curriculum that combines self-paced, online courses with group, onsite education sessions that bring the physicians together once a quarter.
Dozens of disparate medical groups sent representatives to a special meeting to determine how to achieve this. “We brought in everyone in through a senate model so that the biggest group of 300 physicians did not overwhelm the little groups of 10 physicians or 50 physicians,” says Alan Kaplan, MD, president and CEO, UnityPoint Clinic. “We sat as equals. Instead of deciding which group we were going to merge into, we used a blank piece of paper to create the medical group that we would all aspire to be part of.”
The pilot has shown how improved care coordination of patients with chronic conditions, supported by IT, can help position a health system for success as payment increasingly rewards value rather than volume, as reported in a June 2011 hfm article.
In another example, Geisinger Health System uses a pay-for-performance formula, according to a Summer 2013 Leadership article. More than 800 Geisinger physicians receive a base salary that is about 80 percent of their expected total compensation. The other 20 percent—paid in two installments each year—reflects physicians’ individual performance on specialty-specific cost and quality goals that reflect Geisinger’s priorities.
Physicians receive incentives for adhering to evidence-based protocols, safety measures, and interventions that the program has identified for each key result area (116 measures in all; about two dozen measures apply to each specialty). All measures are approved by the Advocate Physician Partners board, which is comprised of physician and system members.
Education regarding new measures is provided through a web-based application, so that physicians can take part in the learning modules at their convenience. Adherence to the measures is tracked electronically through an online disease registry and reporting system, and physicians and their office managers receive a report each quarter from Advocate Physician Partners that provides information on their performance.
For the program to work, Blue Cross agreed to share data with Advocate so that Advocate could better manage the health of this patient population. Advocate invested in technologies and staff to support predictive modeling, so the health system could better determine which patients would most benefit from preventive care and interventions that could reduce admissions, readmissions, and emergency department (ED) visits. Advocate Physician Partners also hired care management coordinators to work with high-risk patients in physician offices, improved post-acute care transitions, enhanced patient access to care through expanded physician hours and new outpatient programs, and implemented evidence-based protocols for referrals and prescribing.
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