Your recent cover story (“Making physicians pay off”
) highlighted a significant issue in our current marketplace. Hospitals are aggressively growing their employed physician networks. There are two questions, however, that many CEOs overlook in their quest for more FTEs: Why do we need to employ these physicians? And are the resulting operating losses a given? Competitive issues are driving the need to grow, while a focus on the strategic issues—although more difficult—might help systems avoid the problems that the article highlighted.
It is clear that as the reimbursement models change from a “do more, make more” model to a “do better, make more” approach, hospitals and physicians will need to get along and foster a mutually beneficial environment. A paycheck does not guarantee this result. Some of the most forward-thinking physicians may have no interest in an employed relationship. Hospital leadership needs to devote more effort to addressing the needs and wants of this group. Hospital management has a better understanding of the evolving healthcare landscape as a result of their professional contacts and educational opportunities.
Physicians simply don't have the time to devote to this and, as a result, have a much more limited understanding of what might be needed to thrive in the future. Hospitals should devote time and resources to educating their medical staff. Collaborative models need to have a non-employed component as well as folks on the payroll.
Losing $176,463 on each employed physician is the result of poor planning, unrealistic promises and the failure to foster meaningful physician involvement in the structure and operation of the physician program. Private physicians can run their practices and make a comfortable living. Unless physicians are hired for strictly strategic reasons, such as bringing a critical specialty to the community, the hospital network should be able to do so as well. Yes, ancillary services typically get stripped out of hospital-owned practices, but this does not have to make six-figure losses inevitable. Revised physician compensation models, consolidating locations into more efficient practices, and better matching staff to efforts will have a dramatic impact on operating margins.
As hospital margins shrink, leaders need to rethink their affiliation models and operating structures for their physician program. It's never too late to get things right.
Physician Strategies Group
Virginia Beach, Va.
Regarding the article “U.S. lags behind in healthcare innovation”
, those interested in fostering healthcare innovation should read Daniel Pink's book, Drive, view his TED talk, or look up the Robert Wood Johnson Foundation's work on motivating professionals. Motivation for innovation is dependent on autonomy, mastery and purpose. Does anyone really think that HHS Secretary Kathleen Sebelius' actions and mindset reflect a cogent understanding of this? Healthcare is a complex adaptive system. It follows emergent, not imposed, order. Attempts to impose order shift a complex adaptive system into chaos. In other words, it looks a lot like healthcare now.
Dr. Russell Gonnering
Elm Grove, Wis.
Regarding the March 3 editorial (“Keep the public health information exchanges open"
), public HIEs are a wonderful concept, as were CHINs (community health information networks) and RHIOs (regional health information organizations) before them. While technology and the Internet have taken some of the challenges from these information-sharing efforts out of the equation, two substantial issues remain.
HIEs fundamentally lack a robust revenue model. Patients in other industries are known as clients. Getting businesses to pay to publish their clients' information for competitors is a hard sell. Also, consumers have an inherent aversion to allowing their most personal information to be stored or accessible via a quasi-governmental entity.
The HIE concept needs to be re-envisioned as a consumer-centric model where control and access are based around the individual or authorized caregiver (mom, adult child of a frail elderly parent, etc.). Even this model lacks a robust source of revenue, but at least issue No. 2 is addressed. And consumers who learn to own and control their medical record will find conveniences that force providers to participate—like not having to fill out the long form on that darn clipboard.
The ONC seems to be working in this direction.
Dr. Edward Fotsch
Regarding the story “Truven rescinds Calif. hospital's 100 Top Hospitals recognition”
, this is an indication that attention is beginning to focus on quality and holding organizations accountable. We'll be seeing much more of this and must know that quality is everybody's business. Think about transparency and other recent actions, such as Baylor's decision not to accept the Baldrige National Quality Award for one of its hospitals, for example.
Principal and co-founder
ZIA Healthcare Consultants