Bridging Business & Healthcare : Healthcare Management Consultants for Dispute Resolution, Valuation & Clinical Compliance

For many years, hospitals have sought assistance from physicians in helping manage clinical departments. This assistance has come primarily in the form of medical directorships. In the traditional medical directorship, the physician attends departmental meetings and provides clinical input when asked. Generally, the physician tracks the hours spent and is compensated at an administrative rate of pay.

Hospitals are seeing more of a movement toward quality-based reimbursement and bonuses or penalties based upon performance against quality metrics. For this reason, hospitals have recognized the need for greater assistance and more clinical input from the physicians on their medical staffs.

In response to the increased need for physician input, hospitals are rethinking medical directorships and are transitioning them to clinical leadership positions. In some cases, the clinical leadership positions resemble the old medical directorship positions. However, clinical leaders are more involved in day-to-day management of the service line, typically requiring more hours from the physician. These arrangements usually have some portion of the compensation at risk or a bonus available, based on achievement of quality-based metrics.

Because these arrangements are fairly new, it remains to be seen if they will result in the quality improvement goals sought by the hospital. However, hospitals that wish to be on the leading edge should consider implementing the clinical leaders model in place of their current medical directors. This will best position them for likely changes coming down the road from governmental and commercial payors.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

On a recent trip to speak to a group of physician leaders, I had the privilege of sitting next to a retired commercial pilot. I travel frequently and my usual routine on the plane is not very conversational, as I use that time as catch up time for work. However, it always gives me a lot of comfort to sit next to a pilot because if they are willing to fly, I have no worries.

Wanting to get to know him a bit better, I struck up a conversation. In short order he found out that I was a physician executive and shared with me that his daughter was a physician as well. As we continued to talk, he shared with me the struggles his daughter was having making it as a primary care physician. And, she had recently been sued over a very frivolous issue. Although she was not found guilty of any wrongdoing, the cost and disruption to her practice were significant.

He then looked at me and said, “You know, pilots have the same risks. We have people’s lives in our hands every day, but we do handle it a lot differently than doctors.” Intrigued, I asked him to explain. He told me that even if a pilot has an untoward outcome, every airline has a hold harmless clause in the pilot’s contract that assumes all of liability for damages. He then looked at me and said something that really stuck, “How else could we get anyone to do this job? You’d think doctors could get together to do something like this.”

I don’t write this to lament the necessity of tort reform, but to highlight the need for partnership and alignment for physicians if we intend to survive. Pilots have figured it out. They have partnered with their industry on many of the issues they can’t solve on their own, allowing them to focus on the safety and well being of those they are entrusted to care for.

We as physicians have long insisted on our need for autonomy and individualism, considering them not only privileges but rights. We have long resisted the pull of aligning with one particular health system partner, fearing that we would somehow lose control. The sea of change is now upon us, however, and the powers that be in healthcare reform are designing models that will force us, not lead us, to partnering around reimbursement. If we as physicians wish to keep our place at the table in healthcare today, we must find new and innovative ways to partner with our industry. Although we risk losing some of our autonomy, the reward of being able to focus on the safety and well being of those we are entrusted to care for far outweighs the risk of keeping the status quo.

• Email This
• Print
• Comments
• Trackbacks
• Share Link