The physician/hospital executive relationship hasn't always been an easy one. However, as healthcare becomes more collaborative — and ultimately patient-focused — leaders with all backgrounds are working together to provide the best care for the patient possible.
At the Becker's Hospital Review 6th Annual Meeting May 7 to 11, James D. Swift, MD, Chief Development Officer of MEDNAX, gave a presentation titled "Fear and Loathing in the Physician Hospital Relationship: How to Build Relationships That Deliver Higher Quality Patient Care." The presentation addressed the strengths and weaknesses for both physicians and non-clinician leaders, and how to bring both sides together around providing better quality, sustainable healthcare.
There are many assumptions made on both sides about the other; physicians don't always understand the pressures hospital executives are under, and hospital executives can't always conceptualize how healthcare reform is impacting physicians and their practices.
According to Dr. Swift, the administration's fears include:
1. Physicians will build their own freestanding ASC, ED or urgent care to compete against the hospital.
2. Hospital reimbursements are going down.
3. Referral patterns are changing and that could negatively impact patient volume.
4. Physicians will sign a contract with another health system and move their volume elsewhere.
5. The hospital won't have the subspecialty support it needs.
6. The physicians don't have my interest in mind.
At the same time, the hospital executives are dealing with several issues on the ground that make it difficult to keep the hospital running harmoniously:
1. The ED metrics are killed because physicians won't admit the patient.
2. There is dissatisfaction with the staffing level.
3. Lack of trust in physician leaders.
4. The physicians aren't loyal to the hospital system.
5. The physicians don't engage leadership; they just complain.
6. The physicians don't show up on time to start their cases, but they're always on time for lunch.
"The physicians try to be all things to all people and that doesn't breed collegiality with the hospital leadership," said Dr. Swift. Collegiality goes both ways, however, and there are several similar fears physicians have about their own careers:
1. Physicians are making less and being asked to do more.
2. They are reducing their office staff.
3. Physicians are learning electronic health record system that changes their workflow.
4. The hospital and insurance company are negotiating pay for performance without them.
5. The hospital could terminate the physician's contract.
6. Patients aren't always getting the care they need.
7. Physicians are doing extra paper work on the back end so they aren't getting through all their rounds.
And then factor in the things physicians hate:
1. Hospital leadership and participation in hospital decisions is limited just to the C-suite.
2. Hospital administrators are more concerned about putting patients in beds than care.
3. Hospital leadership doesn't know about quality of care.
4. There is too much paperwork and too many steps to taking care of patients.
5. Physicians don't have a say in staffing decisions.
6. Case management takes up a significant part of the day.
7. Hospital leadership is facilitating clinical decisions about care location, accepting patients and discharge.
"The reality is, physicians feel underappreciated sometimes in this venue," said Dr. Swift.
So what can hospital executives do to reach their physician leadership and form a loyal bond?
"At their core, physicians are scientists," says Dr. Swift. "They respond to data and algorithms; they are very analytical. But physicians don't come out with a great business background or management background. They come out with the ability to care for patients. It would serve us well to give them management and business training so they can understand. They don't realize the hospital is under siege and the hospital margins are dropping."
Many times physicians want to understand hospital operations so they can help build a successful healthcare facility. The physicians don't always consider regulatory or reimbursement issues; they aren't dealing with unions or collective bargaining, either. On the other hand, administrators are coming from a business background and don't understand the clinical setting. They are divorced from actually delivering care to the patients and don't realize the pressure points in the operating room. But there are common concerns both groups can understand.
"All of us want safe, highly effective care," said Dr. Swift. "It's all about the data. If you sit down with physicians and talk about the data, the question comes up about who is collecting it, who owns it and how to share it. At the end of the day, everyone needs to share the data and work together."
This is especially true as hospitals and physicians move toward accountable care organizations. Independent physicians are moving into hospital employment, or alignment, and payment mechanisms are shifting for providers to take on more risk. Physician shortages are also around the corner and already in many hospitals there are specialist deficiencies.
"We need to work together to figure out how to solve these issues," said Dr. Swift. "Bundled payments, episodes of care and gain sharing are going to occur. They are immaterial without having the data you can share together. We want to talk about the data and we need to align both groups to show the insurance companies that the hospital and physicians are willing to take risk on patient populations."
When you go at risk with the insurance company, leverage data to show you are reducing the length-of-stay and cost of care while improving outcomes and patient satisfaction. Drive physician buy-in for new initiatives and make them stakeholders in the business, as well as clinical, sides of the project.
"You have to change the culture at the physician-level so they feel strongly about the new initiative," said Dr. Swift. "Try partnering with them to look at telemedicine and other projects to invest in together, collect data and bring value to the community."