Abstract
Background
Recently, quality, financial, and regulatory demands have driven physicians to seek alignment opportunities with hospitals. The motivation for alignment on the part of physicians and hospitals is now accelerating because the new paradigm under healthcare reform requires an increased focus on improving quality, cost, and efficiency.
Questions/purposes
We (1) identify the key drivers for physician-hospital alignment models; (2) summarize comanagement as a physician-hospital alignment model; and (3) explore a detailed case study of comanagement as an option to better align physicians with hospital goals on quality, safety, and outcomes.
Methods
A Medline abstract review was performed that identified 45 references that discuss options for physician-hospital alignment. None of the articles identified provide a detailed example of successful alignment structures. A detailed case study of a successful comanagement alignment program is reviewed.
Results
The key drivers for alignment are inpatient growth rates, declining reimbursements, and the opportunity to improve quality, decrease costs, and increase efficiency. Two general strategies of alignment involve noneconomic and/or economic integration. In our example, comanagement with economic integration was chosen as the preferred structure for physician-hospital alignment.
Conclusions
The choice of structure will vary depending on the existing relationships and governance of the hospital and the physicians in the targeted area of focus. The measure of success in building physician-hospital alignment is measured in improvements in care for the patient, reduced cost of care delivery, and improved relations between physicians and hospital leadership.
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References
Burns LR, Muller RW. Hospital-physician collaboration: landscape of economic integration and impact on clinical integration. Milbank Q. 2008;86:375–434.
Cuellar AE, Gertler PJ. Strategic Integration of Hospitals and Physicians. Working Paper. New York, NY, USA: Columbia University; 2002.
Gillies RR, Shortell SM, Anderson DA, Mitchell JB, Morgan KL. Conceptualizing and measuring integration—findings from the health systems integration study. Hosp Health Serv Adm. 1993;38:467–489.
Goldsmith J. Perspective—hospitals and physicians: not a pretty picture. Health Aff (Millwood). 2007;26:W72–W75.
Harris DM. Contemporary Issues in Healthcare Law and Ethics. 2nd ed. Chicago, IL, USA: Health Administration Press; 2003
Henningsen JA. Why the numbers are dropping in general surgery: the answer no one wants to hear—lifestyle! Arch Surg. 2002;137:255–256.
Kocher R, Sahni NR. Hospitals’ race to employ physicians—the logic behind a money-losing proposition. N Engl J Med. 2011;364:1790–1793.
Kohn LT. Organizing and managing care in a changing health system. Health Serv Res. 2000;35:37–52.
Mark TL, Evans WN, Schur CL, Guterman S. Hospital-physician arrangements and hospital financial performance. Med Care. 1998;36:67–78.
Pauly M, Redisch M. Not for profit hospitals as a physician cooperative. American Economic Review. 1973;63:87–99.
Trybou J, Gemmel P, Annemans L. The ties that bind: an integrative framework of physician-hospital alignment. BMC Health Serv Res. 2011;11:36.
Acknowledgments
We sincerely thank Mark Gustafson, JD, and Steven A. Olson, MD, for their valuable recommendations and insightful comments on earlier drafts of the article.
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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
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Sowers, K.W., Newman, P.R. & Langdon, J.C. Evolution of Physician-Hospital Alignment Models: A Case Study of Comanagement. Clin Orthop Relat Res 471, 1818–1823 (2013). https://doi.org/10.1007/s11999-013-2911-0
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DOI: https://doi.org/10.1007/s11999-013-2911-0