The path of least resistance: This and 2 other strategies for hospital-physician alignment

Physician alignment and engagement are intangible processes that depend on a physician's pride, loyalty and commitment to an organization's soul, mission and values, according to Scott Nygaard, MD, CMO of Lee Memorial Health System in Fort Meyers, Fla.

Dr. Nygaard was joined by Alan J. Papa, president and COO of Akron (Ohio) General Health System, to discuss hospital-physician alignment at their respective institutions in a panel moderated by Meggan Michelle Bushee, an associate at McGuireWoods, at the Becker's Hospital Review 6th Annual Meeting in Chicago May 7.

While both Dr. Nygaard and Mr. Papa serve in unique markets, they see similar trends in physician engagement and alignment within their hospitals. Dr. Nygaard, who has served at Lee for 4.5 years, says it is situated in a snowbird community, and about 30 to 40 percent of the population is transient. The independent physician group in his community does a lot of finger pointing, Dr. Nygaard said, and trust has been an issue. Mr. Papa, on the other hand, said his hospital has a medical staff of 1,000 and serves in an urban area. Akron General is working to explore new approaches to physician integration, including joint ventures and co-management agreements.

Here are three hospital-physician alignment trends Dr. Nygaard and Mr. Papa touched on while discussing the state of hospital-physician relationships in their markets.

1. Developing physician leaders helps engage physicians. Dr. Nygaard said there was a frustration among physicians because they didn't understand how to partner with the health system — they were having trouble organizing and presenting ideas in a constructive way. So the system started a leadership foundation to help build trust and give physicians a seat at the table. The foundation is in its second year, and has seen success so far in encouraging physician participation as well as personal and professional development. "Now physicians sell [the leadership institute] to their colleagues. We don't have to sell it anymore," Dr. Nygaard said. "They go talk about the things they learn and the difference it made, and it sells itself."

2. There are options to align short of employment, and hospitals are using them. Mr. Papa said Akron General has 200 employed physicians, and this number has grown exponentially in the last three years. However, he also said part of the system's strategic plan with physician groups is not to force employment. They go for the path of least resistance, he said, and offer other partnership options such as a pseudo-employed arrangement called a professional service agreement. Under this model, the health system leases the practices, but the physicians still have control. Some of these arrangements are simply on-ramps to employment for physicians who have recently completed residencies or fellowships.

3. Hospital-physician alignment is key for broader strategic initiatives. "We do not have one way that we approach physician integration," Mr. Papa said. In addition to employment, Akron General also works with physicians through joint ventures and co-management agreements. As the system prepares to affiliate with Cleveland Clinic, Mr. Papa said he expects its employed physicians and tightly affiliated physicians will become part of the Cleveland Clinic Quality Alliance.

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