3 physician alignment perspectives: Urban, suburban and rural

The leaders of three diverse healthcare organizations discuss physician alignment in a changing healthcare landscape.

At the Becker's Hospital Review 6th Annual Meeting in Chicago May 7, three hospital executive leaders weighed in on topics regarding physician alignment amidst industry transformation in a panel discussion led by Molly Gamble, editor-in-chief of Becker's Hospital Review.

Panelists included:

  • Jeff Hill, CEO of Steele Memorial Medical Center in Salmon, Idaho.
  • Cherie L. Sibley, CEO of Clark Regional Medical Center in Winchester, Ky.
  • Joseph Golbus, MD, president of NorthShore Medical Group in Evanston, Ill.

Note: Responses have been edited for length and style.

On how hospital-physician relationships have changed in the last five years

Ms. Sibley, who leads a small community hospital outside of Lexington, Ky.,said patients are now coming to the emergency departments in droves as they receive coverage under Medicaid expansion. Her hospital has really had to start collaborating with physician partners to get patients out of the EDs and into physician practices. Physician leadership is also gaining traction as employment declines, according to Ms. Sibley. Today, physicians increasingly appreciate having a seat at the table, she said. "Many say they never wanted to be employed. We've actually taken that word out of our vocabulary," she said.

Dr. Golbus, who leads a medical group in Chicago's highly competitive market, said the proverbial dream is the continued integration of physicians into NorthShore Medical Group. "We live in an environment now where many hospital systems and organizations are seeing a big difference between employed physicians and integrated physicians." Systems and processes have to be hardwired for this shift, he says. A big part of this is giving physicians a seat at the governance table.

Mr. Hill, who leads one of the most remote hospitals in the lower 48, said that the biggest change he's seen in the past five years is the move to value-based models of care. Physicians are becoming focused on providing value to the patient, versus the actual amount of tests that they are doing, he said. It's a move from a financial focus to a quality focus. "We are also getting ready to start a rural accountable care organization," he said. "It's a big thing for us and it's spooky for a lot of doctors, who are wondering what this really means for them."

On pay-for-performance vs. fee-for-service

Dr. Golbus said NorthShore is somewhere between dipping a toe into the pay-for-performance waters and knee-deep in the pool. "Given the uncertainty we've seen, we've been a little hesitant to dive into pay-for-performance models, though the path has become increasingly clear," he said.

Historically, the Chicago market hasn't taken a lot of risk, but the major payers like Blue Cross Blue Shield of Illinois have been pushing more risk-based products, so most of the market is going that way, he said. "Most of the models are 'risk lite,'" Dr. Golbus said. "We have partial capitation, but global capitation is not very prevalent in Chicago yet. The market is evolving, but predominant mechanism of payment in Chicago is still fee-for-service."

Ms. Sibley said there is very little pay-for-performance in Kentucky. "We are still getting our hands around ACOs and how we fly together," she said. Based on the initiatives her organization has started with their physicians now, 10 percent of services will be based on quality metrics in three years, she said.

Mr. Hill said his medical center had a productivity model for physician compensation prior to implementing the Epic EHR and it was suggested to move away from that during the installation because physician productivity may initially decrease. "It is still lower than it was," Mr. Hill said. "Our physicians are on salary right now and the agreement was to change the compensation model for a finite time and then move to a more diverse model. We are in that process right now."

He said Steele Memorial has partnered with the National Rural ACO Consortium and we will be moving to a rural ACO model. "The risk is mitigated so my board is comfortable moving forward with that. However, it is unknown territory for us."

On developing physician leaders

Dr. Golbus said physician leadership starts with strategy. "Physicians are an important part of the enterprise and we will be at the table together both literally and figuratively," he said.

Ten years ago NorthShore started an ad hoc program to teach leadership in a didactic setting, according to Mr. Hill. Now it's a formal program in conjunction with The Advisory Board Company. It has a core curriculum strategic planning class where the CEO of NorthShore goes and gives an overview of the system and the current healthcare landscape. As part of the course, physicians get together over the next few months to develop a plan. The curriculum also helps physicians develop soft skills in leadership.

"Historically people have said physicians were bad business people and didn't understand hospital administration, but who better takes disparate information, synthesizes it, analyzes it and makes a decision?"

Ms. Sibley said on the hospital level, her organization takes inventory on its current set of leadership skills and then they build their organizational structure based on where physicians' interests lie. This manifests itself in book clubs held in the physicians' lounge, new physician orientations, financial training and other additional educational training.

Mr. Hill said his organization invests in the professional development for all staff and only more recently has been focusing on physician development. "We look for physicians who are respected by peers, aligned with the organization and good communicators. That is so important," he said. Steele Memorial holds quarterly leadership institutes in partnership with the Studer Group, according to Mr. Hill.

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