In reference to your article on crafting physician-hospital partnerships (Dec. 13, 1993, p. 39), our company knows the success of any integration strategy lies in the ability to align economic incentives for all participants.
Many physicians we talk to complain about hospitals and their practice of the "Golden Rule"-that is, whoever has the gold "rules." They complain that hospitals have access to capital and therefore have the advantage to assume the lead role in most integration programs. The physicians who leap to join these groups now are motivated by fear.
Isn't the age-old argument that "physicians drive the demand for healthcare and therefore the cost of care"? If so, physicians should drive the development of these integrated programs and take responsibility for maintaining a high standard of quality and cost-effectiveness in patient care. We have learned the ulterior motives so often found in hospital-sponsored integration strategies cost too much money.
The programs more likely to be favored in the short term allow for a more gradual integration over time, as economic pressures clearly require more drastic changes in practice styles. Over the long term, programs that allow for the participants who drive the cost of healthcare to share in the success of the program will survive the test of time.
Sharing in the success of the program requires an adequate return on labor and an adequate return on capital. Physicians are smart, and they learn quick. Implying "I own everything and forget you" is bad customer relations and, over the long term, physicians won't stand for it.
The successful integration program will clearly define economic incentives for all participants and share success with the participants who make it successful.
Senior vice president
Medical Asset Management