Lessons in co-management agreements: 3 takeaways

Hospital-physician co-management agreements have become a somewhat trendy way for hospitals to more closely align with physicians and work more closely with them. As more organizations form this arrangement, they can learn lessons from some who are more experienced in the model.

Claude Barrett Minor Jr., MD, a vascular surgeon, and Chris Masone, a manager with DHG Healthcare, discussed some lessons learned from a co-management agreement in Louisiana from year one to year two.

They shared the following takeaways:

1. Watch how metrics are defined. For example, a co-management group may want to reduce readmissions for a certain group of patients, but readmissions as a metric is difficult to define and therefore it is difficult for the physicians to achieve success on that metric.

2. Choose focused metrics. This group started with a total of 16 overall metrics in year one, but narrowed the focus of those down to 12 in year two. "It's not always ideal to tackle 16 to 20 different things all at the same time," Mr. Masone said. In fact, the most progress was made on metrics that the physicians spent the most time on in meetings. So in year two, "it came down to paring it down to what was the most important," he said. "What we tried to do was identify the important."

3. Become collaborative with physicians outside the agreement. To really move the needle on performance metrics, sometimes physicians who are not part of the co-management agreement need to get involved. For example, Dr. Minor and the physicians in his co-management agreement wanted to get patients out of the ICU and discharged sooner, but they couldn't do it alone. He described the situation in which surgeons like himself would have patients set up for discharge early in the morning, but hospitalists were not making rounds until later in the evening.

"We had to go to the hospitalists and say, 'OK guys, y'all have to get out of bed and start making rounds at 8 o'clock in the morning because we want these folks discharged by 10,'" he said. And once the groups collaborated on the problem, it stared to work — length of stay, as well as readmissions, decreased.

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