In their telling of two tales of trying to integrate their hospital systems with physicians, two prominent healthcare executives highlighted how difficult that process will be for other systems that head down the same path. The executives, Dan Wolterman, president and CEO of the Memorial Hermann Healthcare System in Houston, and Alyson Pitman Giles, president and CEO of Catholic Medical Center in Manchester, N.H., were co-presenters at a session on physician integration and alignment at the American College of Healthcare Executives annual Congress on Healthcare Leadership in Chicago.

Wolterman described a 20-year process that began in 1983 that ultimately led to the creation of a separately incorporated legal entity called the Memorial Hermann Physician Network, known as MHMD, under the Memorial Hermann Healthcare System corporate structure. Some 2,000 of the network's 3,500 physicians are clinically integrated independent physicians. That means they can collectively enter into contracts with payers without running afoul of federal antitrust laws.

In order to participate as a clinically integrated physician, Wolterman explained, a doctor must agree to four criteria: participate in evidenced-based medicine, protocol development and implementation; participate in a preferred electronic health-record platform; submit quality data for both inpatients and outpatients; and agree to transparent use of data to elevate quality and reduce costs.

“If you're not committed to evidence-based medicine, it won't work,” Wolterman said.

He added that MHMD will be part of Memorial Hermann's application to become a Medicare-certified accountable care organization under the Patient Protection and Affordable Care Act.

Meanwhile, Catholic Medical Center's efforts to integrate its operations with physicians are still on hold, as Giles explained in her personal account of how CMC's affiliation plans with the Dartmouth-Hitchcock Clinic were all but derailed by everyone from local activists to the media.

“I'm trying not to sound quite so bitter, but it's been bitter,” Giles vented as she read newspaper accounts attacking her and the affiliation plans, first proposed in February 2009, to the several hundred executives who attended the session. “Maybe we'll be allowed to affiliate right before we close,” she said, referring to the recent sale of Caritas Christi Health Care in Boston to Cerberus Capital Management as an example of what may happen.

Giles said Catholic activists wrongly accused CMC of allowing prohibited reproductive services through the affiliation, while women's rights groups wrongly accused CMC of denying those same services through the affiliation. She said the agreement properly addressed both concerns.

“I'm not Catholic, and that's part of the problem. They think I'm doing abortions in my office,” said Giles, jokingly saying later that she, a Protestant, considered converting to Catholicism but decided against it.

In addition to local opposition from both sides, the state attorney general criticized the affiliation, Giles said, and the Federal Trade Commission is investigating the proposed deal.