Health Law

HOSPITAL AND PHYSICIAN CLINICAL INTEGRATION - FIRST HAVE A PLAN.

By Greg Piche'

    One of the lessons of recent health care reform legislation is that effective clinical integration of hospital/physician systems will be a core feature of health care delivery in the future, whether through accountable care organizations or other structural permutations. Hospitals and physicians have traditionally enjoyed separate and often competitive revenue streams in a near zero sum context in which the advancement of one meant the recession of the other.

    While ?fee for service? medicine survives, governmental systems will continue to advocate and agitate for alternative structures of payment related to quality and efficiency. The key to substantive improvements in quality and efficiency is the collaboration of hospitals and physicians in the delivery of effective, efficient health care services along a rational continuum of care. That model cannot be achieved without the alignment of both hospitals and physicians in a system and on a plan.

    In order to effect alignment and develop a plan, hospitals must surrender the traditional paradigm of maximizing income by filling acute care beds and physicians must eschew the maximization of procedure based income. Leadership is required to develop an alternative, collective vision based upon a data driven model for effective and efficient care. Efficacy and efficiency require accountability. Accountability requires that there be a rational plan, that there must be ongoing measurement of data regarding the success in implementation of the plan, that there must be appropriate periodic adjustments to the plan correct mistakes and that there be oversight and counseling for providers who fail to implement the precepts of the plan.

    An appropriate plan requires a fair assessment of the current structure of the extant health care delivery system and a comparison with normative data from effective systems elsewhere. Comparison of local achievement against realizations of other systems gives rise to an informed assessment of where quality and efficiency can be improved. Consideration of evidence based protocols and effective health care delivery system data against local performance is essential. The identification and correction of physicians practicing in a manner outside of articulated  norms of efficiency and quality requires a commitment to the surrender of a level of autonomy in practice parameters so as to achieve systemic success.

    The allocation of compensation between system hospitals and physicians must be fair to all and tied to a thought out incentive structure defined in the plan. The development of the plan requires the committed, dedicated moral, business and professional leadership of responsible physician and hospital stakeholders to reach an operating consensus. A consensus cannot be reached without mutual trust - the hardest quality to obtain and the easiest to loose. Those that have it will succeed. Those that don?t will not.

Full post as published by Healthcare Law Blog on June 18, 2010 (boomark / email).