Whether your view is from the hospital or the practice, the unifying factor is diminishing reimbursement. Outpatient reimbursement is being slashed, while inpatient reimbursement is being reconfigured, likely heading toward bundled payments based on the continuum of care. In this changing healthcare environment, it is vitally important for physicians and hospitals to work together to achieve common goals.
CMS will invariably set thresholds for optimum outcomes that will be tied to reimbursement. In this model, the initial reimbursement may be reduced, but hospitals will be rewarded on the back-end through Medicare incentives. Conversely, hospitals that do not meet these outcomes will not receive these payments. How do hospitals partner with physicians to align their goals and improve patient care that meets quality indicators?
Hospitals need to gain physician trust by building relationships based on transparency. Involve key physicians early in the decision-making process, revealing the hospital’s executive challenges in operations, costs and quality. Tell physicians your goals, strategic plan and quality indicators. Educate them about the expectations of CMS and how those expectations fit into the hospital’s overall strategy. Listen to their concerns and suggestions. Such upfront transparency will forge trusting bonds, resulting in less friction down the road.
In a bundled payment model, physicians in certain departments can be penalized by the hospital for underperforming. Decisions will have to be made on how much money each physician will receive along the continuum of care. If there are outliers in terms of quality metrics or time thresholds, payment can be reduced or rewarded, according to the hospital protocols. All physicians and every staff member should have a thorough understanding of performance expectations.
Public reporting could have an effect on physician performance. Hospitals should be upfront about what outcomes they intend to publicly report and where they will report them. Several public reporting programs have resulted in wholesale performance turnarounds, and some CMS pilot programs for quality metrics have proven beneficial in effecting change in physician performance. With either of these two models, it is integral for hospitals and physicians to work as a team. Hospitals will not value physicians if they do not already have a proven track record for quality, and physicians will not value relationships with hospitals that consistently underperform. In the era of healthcare reform, hospitals need physicians and physicians need hospitals. The goals of each group must align for optimal partnering.
Inventory considerations also can cause consternation between hospitals and physicians. As hospitals attempt to find a balance between product quality and price, they must involve physicians regarding new product choices. It is sometimes difficult, however, to make decisions based on price alone, especially when physicians have become accustomed to certain products and vendors. Hospitals need to consider the clinical importance of the product over price. They should be open with physicians about the process. Let physicians know what goals you are trying to achieve, the potential choices of products and seek their input. If a product is critical for best patient care, stay with that product. Hospitals will gain physician trust and in the future, physicians will be more willing to make compromises on other preferred commodity products.
The next few years will be a period of adjustment on both sides: hospitals and payors. We will see some specialties of cardiology growing, while others will decline. However, hospitals and physicians must find common ground with which to forge relationships that allow them both to benefit in the upcoming years of financial and practice transition.
Mr. Araneta is the senior director of cardiac and gastroenterology services at NorthShore University HealthSystem, based in Evanston, Ill.