Everyone acknowledges that physician integration is the key to success for healthcare systems. Trouble is, few integrated networks are willing to give up even a small measure of control to doctors.
As today's kids would say: Duh!
One of the biggest obstacles to increased organizational integration is physician distrust of systems, as a recent survey by Northbrook, Ill.-based consulting firm Arista Associates confirms. Distrust ranked only behind inertia as a major hurdle, according to responses from 60 system chief executive officers.
Maybe that's because so many of them in the past have expected their doctors to behave like little lambs following a mythical Mary wherever she wanted to go. As a result, systems face a herculean task of proving their organizational plans are in doctors' best interests.
One promising technique is for hospitals to establish equity management service organizations, which can partner with physicians to co-own all but the medical assets of the practices they contract with. It's a way to align incentives for both groups without making physicians employees of the hospital. Unlike arrangements with PPMs, doctors can share in the profits -- whether or not they are co-owners of the MSO.
Provider-sponsored organizations offer another partnership opportunity for hospitals and physicians. In suburban Philadelphia, Crozer-Keystone Health System's Medicare Choices demonstration program compels the system to negotiate with its physicians about how much of the premium goes to primary, specialty and hospital care, and how much to prescription drugs.
Unfortunately, strategies that have alienated physicians far outnumber success stories. Some of the most ill-conceived efforts have contributed to increased interest in physician unions.
What better mission is there for medical executives than committing themselves to creating fruitful partnerships that restore trust among physicians and the top leadership of their local healthcare system?