Physician alignment is a key goal of hospital leaders for decades — and that's "not a new development," as the authors of a new white paper from Staff Care explain. Indeed, even before recent healthcare reform efforts and the current widespread initiative to replace fee-for-service delivery with value-driven models, optimizing hospital/physician relations have been top of mind for many healthcare leaders and executives.
However, while the goal of physician alignment may not have changed, the parameters of meeting that goal successfully have. "In traditional, volume-driven systems, 'physician alignment' meant that physicians supported hospital admissions and generated referrals and procedures to their aligned hospital rather than to a competitor," the authors note.
Today, though, physician alignment more commonly suggests a common mindset among hospital leaders and physicians that "care should be provided globally to large patient groups, that quality should be rewarded, and that financial risk should be shared within a capitated reimbursement structure."
Chart: Healthcare Spending in the US, by Percentage
Needless to say, the path to accomplishing those goals isn't always seen the same way by physicians and hospital leaders. With that in mind, Staff Care's physician recruitment experts offer 11 methods for hospital leaders and executives to "maintain and enhance physician relations and foster physician alignment."
The goal of the white paper is to improve hospital/physician relations in a way that maximizes operational efficiencies within a healthcare marketplace where doing so is increasingly necessary to stay competitive. To meet this goal, the authors offer 11 specific methods by which hospital leaders can achieve more productive, long-lasting physician alignment.
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White Paper: 11 Methods to Maximize Physician Alignment & Improve Hospital/Physician Relations
1. Understanding the Value Physicians Bring. Even allowing for the rise of utilization of practitioners like physician assistants and nurse practitioners, "physicians remain at the center of the healthcare system ... from a quality of care perspective, they are indispensable." They also continue to drive healthcare economics, directing 87% of personal spending on healthcare in nationwide.
"The inability or unwillingness of some hospital executives to acknowledge or value physicians accordingly has negatively affected their careers, while the opposite is true for hospital leaders who understand the impact physicians have on their hospital’s success."
2. Considering the Physician’s Perspective. When considering physician/hospital relations, it's important to remember that "hospital leaders and physicians come at each other from different perspectives," the authors note. "Hospital leaders embrace hierarchical, top-down management structures while physicians are by nature soloists who resist management." In addition, leaders are budget- and community-minded, while physicians tend to focus on care over costs and the individual patient over the community.
These disparities are understandable and a common point of physician/hospital relations. Less understood, however is the lack of "physician participation in or support for the various mechanism of healthcare reform." More than 66% of physicians, for example, "do not agree that hospital employment of physicians is a positive trend likely to enhance quality of care and decrease costs." Half of physicians don't agree that hospital employment of physicians enhances quality or reduces costs. Physicians also often feel stymied by electronic medical records and administrative burdens. All this presents a challenge for hospital leaders "to create practice conditions that allow physicians to reengage with medicine. Understanding the physician’s perspective is the first step to achieving that goal."
3. Utilizing Locum Workers to Avoid Physician Burn-out. About half of physicians in a recent survey conducted by Merritt Hawkins on behalf of The Physicians Foundation report "frequently or often" experiencing feelings of burnout, while a whopping 80% said "they now are either overextended or are at full capacity in their practices, with no time to take on new patients or more duties."
One way to alleviate this burnout is with the strategic use of locum tenens "to supplement medical staffs that are feeling the strain of overwork, either during peak usage periods or due to understaffing," as the white paper authors explain. "Physicians working locum tenens represent an increasingly large and important resource that can be used to enhance the retention of full-time doctors by reducing overwork and burn-out."
4. Define Your Vision. To ensure positive physician/hospital relations, executives should "express their vision to physicians about the future direction of their facilities," the authors note. How? One key is to define and articulate just where the facility lands "along the continuum between traditional fee-for-service and the integrated, value-driven model," as the authors put it.
"Clearly articulating a vision removes uncertainty and promotes the retention of physicians likely to buy-into the direction the facility is heading, while allowing those physician who may impede the facility from realizing its vision to move on. When developing an organizational vision, it is important to solicit physician opinions and allow physicians to have a direct influence on the direction the organization will take."
5. Seek Input. "Hospitals should develop a formal survey for seeking input from physicians regarding their practice patterns, how they rate hospital services and management, their practice needs and their concerns," the authors write. "The content of the medical staff survey may vary depending on a variety of factors, including the hospital’s size and its relationship with its physicians." To this end, the white paper offers a comprehensive, multi-page sample survey designed to give hospital leaders a foundation for gaining such essential input, including 26 key questions.
6. Recruit to Retain. Physician alignment begins with physician recruitment, which can be "the foundation on which positive physician relations rests," as the authors put it, "or it can undermine the relationship physicians have with hospitals." They define problems "created or compounded" by physician recruiting practices as:
- Insufficiently detailed practice opportunity presentation
- The potential to alienate those already practicing in the service area
"A thorough, candid recruitment process can build the trust and cooperation needed to ensure physicians and hospital leaders are able to work through the challenges that almost inevitably will arise at some point in this key relationship."
7. Add Physician Leaders. Physicians traditionally rise to leadership roles within the physician/hospital relationship via committee assignments, medical directorships and board memberships. These roles are important, and can grant physicians the influence over issues pertaining to patient care that of are most importance to them. They can also instill within hospital leadership a perspective that's important for:
- convincing specialists of the workability of new delivery models
- defining fair evaluation and compensation metrics for the hospital staff
- convincing medical staff members to embrace healthcare reform ("quality payments, population health, standardized care, EHR")
For this to work, though, physician leaders must be "perceived to have real authority" and not seen as mere figureheads, the authors note. "It therefore is in the hospital’s best interest to incorporate multiple avenues by which physicians can evolve as leaders, including mentoring and future leadership programs, and to encourage their participation in governance and administrative issues."
8. Employ Physicians. More than ever, physicians are embracing hospital employment "as a safe harbor from the financial uncertainty, regulatory burdens, and reimbursement challenges of private practice." In the 2012 Merritt Hawkins/The Physicians Foundation survey, "49% of doctors identified themselves as private practice owners or partners," the authors note. "In the 2016 survey, that number decreased to 33%."
"Employment of physicians by hospitals and health systems is seen as necessary to achieve the care coordination, EHR standardization, and global revenue sharing typical of ACOs and other value-based delivery models," they add. Yet, from a hospital's perspective, "employing physicians does not equal alignment," and "merely employing physicians does not guarantee that they will embrace the behaviors and practice patterns required to make the transition from volume to value." All the same, "the employed model can promote physician alignment and positive physician relations when it is used in concert with other steps outlined in this white paper."
9. Create a Positive Workplace. No two medical practices or workplaces are exactly the same. And while hospitals cannot control some aspects of their desirability as a workplace — their location or patient base, for instance — they can control others, to some extent: "the quality of the medical practice environment they are offering."
Indeed, the “primacy of the workplace ... may be the most important factor to consider when seeking to enhance physician/hospital relations," the white paper authors note. "First and foremost, physicians want a safe, efficient place to treat their patients, one in which they can focus on what they were trained to do." Easier said than done, perhaps, but to help leaders meet this goal, the white paper authors provide more than a dozen guidelines to help create a more favorable workplace for physicians, such as improving physician access to patient data, enhancing test turnaround times, and providing flexible scheduling.
10. Offer Clear, Competitive and Fair Compensation. Most physicians are well aware of salary data sources "and usually have a fairly accurate view of what is competitive in their specialty," the authors write. Leaders can do much to improve hospital/physician relations by offering physicians "income in the range of what is competitive."
As leaders also know, however, that prospect can be complicated. The white paper outlines in detail the components of physician compensation — such as production bonuses, value-based components (MIPS), outcome evaluations, and similar metrics that comprise a modern physician contract. And, although a magic formula for physician compensation is admittedly elusive, the “Goldilocks zone” whereby "physicians are rewarded sufficiently for volume to stay productive, yet also are rewarded enough on value to embrace new delivery models, is still aspirational for many healthcare facilities."
11. Continuous Communications. "Several years ago, Merritt Hawkins recruited a neurologist to a growing group practice," write the authors. "When contacted some months later to see how he was fitting in with the group, we were informed that he was leaving because the group had not yet put his name on the door or on other signage, and he therefore assumed he was not wanted. A simple lapse in communication almost caused this group to lose a good doctor."
This anecdote highlights the importance of continuous communication between a hospital and its staff, "and the hazards of assuming physicians have received a message when it has not been explicitly stated." Such communication should be both formal ("regular medical staff surveys") and informal ("regular contact in the physicians’ lounge, at lunch, in the operating room, or at informal gatherings"), recommend the authors.
“When you need the goodwill of physicians, it is too late to create it," as the white paper quotes one health system CEO. "My advice is get ahead of the competition by having a really good relationship with your doctors.”
Indeed, that final quote can serve to illustrate the importance of each of the 11 steps above, which, taken as a whole, can be a powerful tool for hospital leaders to build positive physician alignment and ensure that hospital/physician relations are fruitful today and well into the future. In a healthcare marketplace that's full of constant changes and uncertainty, and with physicians feeling more uncertain than ever about their futures and their careers — that's a more important goal than ever before.
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