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should use to prepare for upcoming reimbursement changes: 1. Develop medical staff-hospital collaborations that include both private and employed physicians 2. Develop integrated and comprehensive continuums of specialty care 3. Deliberately invest in and implement clinical and functional outcomes collection and reporting 4. Proactively define quality with payors and pilot alternative reimbursement models Physician-hospital collaboration As a result of market changes fostering unprecedented collaboration, physicians will have more opportunities for leadership and accountability in specialty program development, delivery and management than ever before. One common barrier is that of historical distrust between administration and medical staff. According to Michael J. Dacey, MD, FACP, SVP MA and CMO for Kent Hospital in Warwick, R.I., “Most doctors believe that very few administrators understand physicians and the problems they face. And most administrators at both hospitals and insurance companies would say the same thing about doctors. And both groups are correct.” He further comments that in the current and near-future environment, hospitals and physicians are co-dependent for clinical and financial success. (HealthLeaders, 2/23/12) The most successful collaborations will engage physicians, regardless of private or employed status, in mutually beneficial initiatives where benefits accrue to those willing to invest in program development that benefits patients, practices and specialty programming. Hospital must lead with resources — almost without exception, every hospital and medical staff has a long-standing organizational skepticism. That is, when faced with or given the opportunity to engage in a new initiative, many will react with skepticism. It is not uncommon that new projects, initially bright and compelling, are discarded when faced with a lack of progress due to poor planning and implementation. Hospital staff and physicians are reluctant to invest their time and reputations in endeavors that do not arise out of a common vision, are not well planned and therefore have little chance of achieving key milestones and producing lasting change. In the most successful health systems, administration actively seeks physician participation in service line development and management of clinical, financial and business development matters with decisions made based on shared vision and values. Carrie Willets, director of orthopedics at Sports Medicine & Rehabilitation at Rockingham Memorial Hospital in Harrisonburg, Va., can attest to the impact of alignment. RMH has experienced a dramatic growth in their total joint replacement program, in large part due to the institution of key elements of effective service line development. Vital among them is administrative support and the deep involvement of employed and private orthopedists in all aspects of the program. In addition to the fundamentals of a comprehensive strategic plan, RMH challenged their medical staff to take leadership and accountability for both their patients and program quality as well. This included not only the orthopedic surgeon’s involvement in leadership council but also leadership from anesthesia and radiology. All stakeholders review program operational, clinical and financial metrics regularly and manage the program from these metrics. Develop integrated and comprehensive continuums of specialty care While hospital-physician alignment and collaboration, exploration of alternative reimbursement models and mutually defining quality with payors are both important to prepare for the future, ultimately, each is fundamentally dependant on the organization and delivery of specialty care. Welldefined, standardized and reliable systems of care are inextricably linked with medical staff-hospital collaboration and quality, which set the stage for novel reimbursement pilots and models. The commitment to effective systems, structures and resources for specialty care is a prerequisite for the future of orthopedics, spine and pain management. When preparing for any of these initiatives, it is not uncommon that systems must be redesigned and protocol developed to allow the organization/service to reliably perform at a remarkably high level, elevating the staff, patient and service above routine crisis, ultimately achieving consistently impressive patient outcomes, experience and metrics. sign up Today Stay updated on the latest news, trends and business concepts for spine surgeons and practices Sign up today for our Spine Business Review E-Weekly at www.beckersorthopedicandspine.com Spine Business E-Weekly 10th Annual Orthopedic, Spine and Pain Management-Drive ASC Conference – Full Conference Brochure Inside, p. 31 9 Clinical and functional outcomes to substantiate effectiveness “One of these days we will be paid for our outcomes…” I recall that statement over 20 years ago from a hospital administrator as he chain-smoked in his office. Even then it made sense. Yet, aside from the development and use of standard assessment tools, surprisingly little has been done to bring measures of effectiveness to orthopedics and spine on a larger and national scale. That is about to change. Pay for performance and bundled reimbursement will dramatically alter care organization and delivery.
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