Not all physi­cians in­ter­ested in the em­ploy­ment model

Modern Healthcare - - COMMENT -

Your re­cent cover story (“Mak­ing physi­cians pay off,” Feb. 24, p. 12) high­lighted a sig­nif­i­cant is­sue in our cur­rent mar­ket­place. Hos­pi­tals are ag­gres­sively grow­ing their em­ployed physi­cian net­works. There are two ques­tions, how­ever, that many CEOs over­look in their quest for more FTEs: Why do we need to em­ploy these physi­cians? And are the re­sult­ing op­er­at­ing losses a given? Com­pet­i­tive is­sues are driv­ing the need to grow, while a fo­cus on the strate­gic is­sues—al­though more dif­fi­cult—might help sys­tems avoid the prob­lems that the ar­ti­cle high­lighted.

It is clear that as the re­im­burse­ment mod­els change from a “do more, make more” model to a “do bet­ter, make more” ap­proach, hos­pi­tals and physi­cians will need to get along and fos­ter a mu­tu­ally ben­e­fi­cial en­vi­ron­ment. A pay­check does not guar­an­tee this re­sult. Some of the most for­ward­think­ing physi­cians may have no in­ter­est in an em­ployed re­la­tion­ship. Hospi­tal lead­er­ship needs to de­vote more ef­fort to ad­dress­ing the needs and wants of this group. Hospi­tal man­age­ment has a bet­ter un­der­stand­ing of the evolv­ing health­care land­scape as a re­sult of their pro­fes­sional con­tacts and ed­u­ca­tional op­por­tu­ni­ties.

Physi­cians sim­ply don’t have the time to de­vote to this and, as a re­sult, have a much more limited un­der­stand­ing of what might be needed to thrive in the fu­ture. Hos­pi­tals should de­vote time and re­sources to ed­u­cat­ing their med­i­cal staff. Col­lab­o­ra­tive mod­els need to have a non-em­ployed com­po­nent as well as folks on the pay­roll.

Los­ing $176,463 on each em­ployed physi­cian is the re­sult of poor plan­ning, un­re­al­is­tic prom­ises and the fail­ure to fos­ter mean­ing­ful physi­cian in­volve­ment in the struc­ture and oper­a­tion of the physi­cian pro­gram. Pri­vate physi­cians can run their prac­tices and make a com­fort­able liv­ing. Un­less physi­cians are hired for strictly strate­gic rea­sons, such as bring­ing a crit­i­cal spe­cialty to the com­mu­nity, the hospi­tal net­work should be able to do so as well. Yes, an­cil­lary ser­vices typ­i­cally get stripped out of hospi­tal-owned prac­tices, but this does not have to make six­fig­ure losses in­evitable. Re­vised physi­cian com­pen­sa­tion mod­els, con­sol­i­dat­ing lo­ca­tions into more ef­fi­cient prac­tices, and bet­ter match­ing staff to ef­forts will have a dra­matic im­pact on op­er­at­ing mar­gins.

As hospi­tal mar­gins shrink, lead­ers need to re­think their af­fil­i­a­tion mod­els and op­er­at­ing struc­tures for their physi­cian pro­gram. It’s never too late to get things right. Gre­gory Mertz

Man­ag­ing di­rec­tor Physi­cian Strate­gies Group Vir­ginia Beach, Va.

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