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Although all parties may initially envision a range of positive outcomes to be achieved through integration, there must be relative consensus around the answer to the question: “What primary goal, or vision, can we accomplish together that we could not achieve independently?” As hospitals/health systems answer this question, they will realize that true alignment with a cardiology group not only will change the culture of the organization, but also will shift the strategy for the system. If hospitals can relinquish control of the integrated cardiovascular organization, they will realize the potential of shared management and decision-making. The change for physicians is no less dramatic, but it is more personal. Instead of an organization existing to achieve physicians’ professional and personal goals, the new model requires physicians to adopt a system-oriented strategy and serve a broader organizational vision. Physician compensation. Our experience is that a well-structured relationship between a health system and cardiology group has ample capacity to yield competitive incomes for physicians. In order to sustain quality cardiovascular care, the private practice business model must change. The compensation model should include selected metrics for volume and productivity, but it also must recognize the importance of achieving system goals and objectives related to the delivery of cardiovascular services. Volume-based compensation models risk creating a “transaction-based” culture between the hospital and the physicians (not to mention that they will be challenging as market incentives shift toward more qualitative, outcomes-oriented metrics under reform). Clarity around roles and responsibilities. Once the transaction is complete, cardiologists and administrators can find the exhilaration related to “finishing the deal” quickly dissipates in the face of the daily challenges of operations and working together. Essential to the long-term success of the new entity is clarity around the nuts and bolts of daily decision-making related to operational matters like staffing, billing and collections functionality, EMR implementation, and compliance.
Before the ink is dry, both sides must have a clear sense of how “day one” post-transaction operations will function, including:
• Who has input and/or voice on which decisions?
• Who has “final call?”
• How will physicians participate in decisions on matters that affect their clinical practice?
Operational and management issues likely will provide the first early test of the strength of the new integrated relationship. Cardiologists and hospital leaders who are able to establish a very clear understanding about all of these variables are in an excellent position to reap the financial and clinical rewards inherent in genuine physician-hospital integration. Hunter is president of Ethos Partners Health Care Management Group, an Atlanta-based health care management and consulting firm. Molden is president and CEO of Piedmont Heart Institute in Atlanta.