The panel began by discussing the traits they consider the most telling of whether a physician group is successful or not, and if those characteristics have changed in the past 10 years. “I don’t actually think there is a lot of change in terms of what [a practice] needs to be successful,” said Mr. Peck. “My opinion about this hasn’t changed in 35 years. Everybody gets focused on ‘the deal,'” Mr. Peck said, referring to hospital-physician joint ventures, acquisitions, and other employment models. “It’s not about ‘the deal.’ It’s about the relationship.”
Mr. Peck also noted that he has never seen a “practice alive” that did not have strong physician leadership and autonomy. He said leaders have to assume that not every physician can be a leader, and it takes time to understand a physician’s psychological and character attributes that can either make or break their leadership potential.
Mr. Halley emphasized the importance of physician involvement in governance structures. “We went from this, ‘We’re going to boss the doctors around,’ to ‘We’re going to be physician-led,'” said Mr. Halley. He said this extreme shift can end up in a game of “Mother May I,” in which physicians make decisions but then have to return to hospital management and the board to ask for money. “Make decisions with them,” he said. “Physicians like having the CEO and CFO with them in the room for a couple hours every month to make strategic decisions that drive a model.”
The topic of physician compensation models was also discussed. Mr. Peck said a “significant enough portion” of pay needs to be performance-based. He also said what most physicians are incentivized to do has changed –– from treating the sick to keeping people from getting sick in the first place.
“When you think about the whole concept of bundled payment, if you think about moving from where we are today where physicians are compensated on individual billing, to bundled payments –– I mean, my God, does anybody in this audience have a system in place that’s ready to do that? No. When we talk about details and philosophy of compensation, but everything we talk about is going in the garbage. If we talk about this a year from now, everything will be different,” said Mr. Peck.
Mr. Mason was quick to say he nor his organization have all the answers, and the design of compensation models is still something they are working to perfect. “Compensation is very difficult. The key issue is: What do you want to incentivize? It’s often easy to settle on a compensation formula that isn’t in line with what you want to incentivize. That’s where you’re setting yourself up for problems,” said Mr. Mason. “The rules are changing quickly now with ACOs and bundled payments and so forth, and we’re in this window period where we need to figure out the best incentives and get physicians comfortable with trying out a new mechanism.”
Going forward with new payment models, such as bundled payments and ACOs, Mr. Halley said he believes productivity, volume and quality will remain key motivators for physician compensation models. He also said physicians must be somewhat able to control measures to which their pay is tied. “Physicians in private practice and hospital-owned settings who are alert and engaged are frustrated because they can’t deliver the kind of care they’d like to deliver because their office doesn’t support what they’d like to do as effectively,” he said. “Physicians know what they need to do. Sometimes we have to get out of the way or engage them as partners in solving the problem.”
More Articles on Physician Practices and Hospitals:
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