Physician alignment: 4 snapshots

Four healthcare leaders tell their unique stories about physician alignment and offer ideas to improve performance.

At the Becker's Hospital Review 6th Annual Meeting in Chicago May 7, Paula Lovell, founder and CEO of Lovell Communications prompted four healthcare leaders to discuss how their organizations deal with physician alignment, particularly in regards to operational and financial performance.

Here are their stories.

Note: Responses have been edited for length and style.

William Scott Hurst, director of network development – professional service, Children's Health in Dallas. Children's Health is located at the heart of a vibrant market. "Something like 300 people a day are moving to North Texas," Mr. Hurst said. As one of the country's largest pediatric facilities, the leadership determined Children's Health needed to find a better way to align physicians in a rapidly expanding market, according to Mr. Hurst. The hospital does not yet officially have a clinically integrated network, but it is well on its way. The first physician member enrolled in April 2013 and now they have approximately 305 pediatricians and pediatrics specialists involved. Only 50 of the members are employed, he said, making the spirit of the organization truly independent. Most are primary care physicians and 37 are pediatric specialists.

The speed with which Children's is building this CIN has been driven primarily by the premise of physician leadership and physician buy-in. Now, he says, the real challenge will be taking the network from a conceptual idea to an operational state. For example, they didn't require the same EHR, so now they are working with 15 different EHR systems across 40 practices.

"Dallas is in a bubble," Mr. Hurst says. "It still exists in a fee-for-service world with really good rates, but that is changing." He says his organization stresses to physicians that it isn't interested in micromanaging them, but that narrow networks are coming. "We have to get big to stay small," he said. "It's still independent medicine, but we are working together."

Bernard Wheatley, DBA, CEO of Schneider Regional Medical Center in St. Thomas, U.S. Virgin Islands. Dr. Wheatley started his role as CEO of Schneider in April 2013. When he started there were eight unions, and two physician unions. "The challenge for me, the executive team and the board was not only physician concerns — I have difficulty recruiting ER physicians and intensivists — but I also find myself negotiating with the unions." Mr. Wheatley said he's been called a union buster, but, "Not everybody wants to come to the Virgin Islands and be part of a union; they want to be part of a hospital."

Schneider Regional's board attends a leadership retreat in the fall that focuses on five basic strategies: To become the Virgin Island care center of choice, provide high quality care, strive for financial excellence, develop staff and establish an IT infrastructure with an EMR.

"It sounds simple," Dr. Wheatley said, "but each of these strategies have goals and deliverables for each executive team member and we track the progress on those." Dr. Wheatley's focus is to settle down the unions and work on developing physician leadership, he said.

Lucy Hammerberg, MD, chief quality officer of Northwest Community Hospital in Arlington Heights, Ill. Dr. Hammerberg, who serves as chief quality officer for a 400-bed hospital, said no physicians that she has spoken with have jumped at the chance to be aligned. In fact, when she asked her colleagues what physician alignment means to them in preparation for the panel, she got the following responses: "That sounds like someone is going to make us do things we really don't want to do," "Will there be a follow up panel on administration alignment?" and, "Physician alignment? Is this some kind of new government plot?"

What we're really talking about, she said, is healthcare alignment — getting on the same page and moving toward patient-centered goals. "[Physicians] are going to look at you sideways if you ask them to align, but if you ask them to be the leaders and determine what the future will look like, they will rise to the challenge," she said.  

For example, in her hospital, physicians were presented with data showing that the C-section rate at the hospital was too high. At first, she said, the physicians balked at the data. But when they realized it was truly a hospital-wide problem, they verified the data and tackled it. In a year, they were able to bring the C-section rate from 38 percent to 20 percent. "We never would have been able to do that without physician leaders," she said.

Ricardo Martinez, MD, CMO of North Highland in Atlanta. Dr. Martinez, who serves as the CMO of a global consulting firm, said he still sees patients and stays clinically active. This is the first thing physicians ask him, he said. They say, "When is the last time you saw a patient?" This simple question made it very clear to Dr. Martinez the importance of physician leadership, especially on the clinical side.

"I'm not sure what alignment means," he said, "but people often focus on the business side of it: Contracting, recruiting, onboarding, etc." Physicians like it when leadership also shares their clinical values.

When it comes to engaging physicians, Dr. Martinez said, it is important to think about how physicians think, how they learn and what they value. Physicians will buy into new strategies if they see them as enhancing workflow and allowing them to spend more — not less — time with their patients, he said.

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