2 ways systems can come of age, gain efficiencies around medical staff issues

Healthcare has been rapidly consolidating, with hospitals and smaller health systems forming large systems, and already large systems combining into mega-systems, to gain operating efficiencies and leverage over payers. But obtaining value as a large system is easier said than done, according to Rick Sheff, MD, principal and CMO of The Greeley Company.

"You put together a system to get value out of being a system," he said during the Becker's Hospital Review 7th Annual Meeting in Chicago on April 28. "The problem is the value isn't automatically there. You have to do a lot of hard work to capture that value."

While many health systems are striving to achieve "systemness" — standardization throughout a system — this may not always be the right approach to drive overall value. Dr. Sheff noted that systemness should be present when it adds value, but local autonomy should also be present when it adds value.

According to Dr. Sheff, there are two areas ripe with opportunities to balance both systemness and local autonomy and ultimately drive system value.

Credentialing & provider enrollment

Adding physicians to a medical staff, especially when it comes to a system with multiple hospital locations where the physicians will need to be credentialed, can be a tedious, time-consuming and costly experience — for both the health system and the physician. Having to jump through hoops to get credentialed at several locations separately wastes time and energy.

The solution, according to Dr. Sheff, would be to centralize the credentialing process within the system, which nets a return on investment and lowers turnaround time, according to Greely Co. case studies.

"These are all opportunities that as [health systems] move into becoming an operating company, not just a holding company, that you can actually capture," he said.

Medical staff integration

While a centralized credentialing process achieves value from systemness, integrating medical staff is an opportunity to allow some local autonomy.

Medical staff integration is "one of the things people really stumble on" when creating a system, Dr. Sheff said. "Have you ever tried to do this? This is a full contact sport."

Generally, physicians do not want to give up autonomy at the local level, he said. However, there are opportunities in bylaws, credentials and peer review to address the issue of legacy culture.

"Getting docs together to collaborate and think about what's going to be consistent across the system and what's not is harder than it looks," he said.

One example is a 13-hospital system that standardized bylaws and peer review across the system, but still allowed local variation and control when it came to rules and regulations. "Their attorneys are happy, the system CMO is happy, the system leadership is happy and the docs in the individual hospitals are at least reasonably happy," he said.

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