Key Strategies to Align Independent and Employed Physicians

In a session at the Becker's Hospital Review Annual Meeting in Chicago on May 17, Paul Summerside, MD, CMO at BayCare Clinic in Green Bay, Wis.; Chris Karam, president & CEO of CHRISTUS St. Michael Health System in Texarkana, Texas; and Allan Fine, senior vice president and chief strategy and operations officer at The New York Eye & Ear Infirmary in New York City, shared key thoughts on strategies to align independent and employed physicians in a panel moderated by Scott Becker, JD, partner at McGuireWoods and publisher of Becker's Hospital Review.

Dr. Summerside kicked off the session by sharing how his organization's model is unique in that its physicians are part owners of a hospital along with a non-profit health system. The arrangement inherently provides physicians an incentive to provide high quality, low cost care. He believes, though, other health systems can mimic this "ownership" by providing incentives that make physicians feel more like owners than "renters". "You're either an owner or a renter," he said. "[Determining] how you incent people so they feel like they own it is a good management strategy for engagement."

Dr. Fine's organization similarly compensates physicians for efficient care. Fifty-five percent of every dollar The New York Eye & Ear Infirmary earns goes to the physicians, and 45 percent goes to the institution. Thus, performance drives compensation. Performance also determines OR block time and many other opportunities, noted Dr. Fine.

However, not every organization has physician ownership as a built-in incentive. Mr. Karam explained that CHRISTUS uses a number of different alignment models from employment to co-management, and models vary by region based on market characteristics. CHRISTUS brings these physicians together with the health system in various quality and other initiatives, which he believes further engages the physicians. He found that when CHRISTUS created an opportunity for physicians to improve patient care, the physicians responded with excitement. "When we can do that, we get a lot of buy in," he said.

Mr. Summerside then noted that one key element of any incentive is transparency and understanding. "Lack of clarity breeds disengagement," he said.

Mr. Karam turned the conversation toward the importance of aligning with primary care physicians. While employment is an option, CHRISTUS St. Michael has grown its relationships with primary care providers by providing excellent hospitalist services, which helps PCPs better manage patients without spending a great amount of time at the hospital. He shared a recent "win" for the system: A local primary care group now refers all patients to his system largely because of its hospitalist program.

Mr. Becker brought the session to a close by asking the panelists if there was a single model they would recommend for alignment. The consensus was that there is no single model to focus on. Instead, model selection is dependent on each market. Additionally, the panelists agreed that engagement and governance opportunities for physicians are more important than the individual model.

The key is providing physicians an opportunity to "influence the day-to-day operations and performance" of a hospital, says Dr. Fine. "Try to be egalitarian but still demonstrate you're looking at performance."

More Articles on Physician Alignment:

6 Ways to Enhance Physician Communication, Alignment
Primary Care Strategy: The Most Important Decisions Hospitals Can Make
Recruiting Physicians: Easier Said Than Done?

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