Promoting Health with a Common Denominator
Accountable Care Organizations (ACO), Shared Savings Programs (SSP), Patient Centered Medical Homes (PCMH), Medical Neighborhoods, Bundled Payments for Care, Gainsharing. What do all of these federal programs have in common? What is the common denominator? The answer is physicians. But it may not appear entirely clear how physicians, especially surgeons and specialists, fit into these. The bottom line may be that in light of declining admissions and revenues, hospitals must develop an organized, comprehensive strategy to succeed in the new health care environment.
The role of hospitals continues to change. Diversification was implemented some time ago but the goal was to bring other entities into the hospital fold so that physicians brought their patients to the hospital. The measurements of success were admissions, surgeries, ED visits and births. Today, care is shifting to lower cost options, such as outpatient facilities and primary care offices. And who controls the flow of patients to these sites? Physicians. While physician salaries constitute 20% of total healthcare spending, their decisions affect the majority of all health care spending. It is vital to incorporate them into the comprehensive plan developed by hospitals and health systems.
Physicians may be engaged in specific programs as independent practitioners, through joint ventures or by direct employment. Primary care practitioners (e.g. family physicians, pediatricians and gynecologists) are typically the driving forces in several of the programs, especially those that focus on improving the overall health of their patients through care management and preventive measures. These would include ACOs, SSPs, PCMHs and Medical Neighborhoods, programs that are designed to meet the needs of the patients in their service area.
So how can surgeons and specialists be included in the strategy? These physicians tend to focus on one episode of care rather than long term disease management. They may join ACOs, but unless inpatient care is included, they may not benefit much from the participation. Bundled payments initiatives may be more attractive to them. These are typically related to specific inpatient hospitalizations. Gainsharing, a stand-alone program, is a tool used to further engage the physician in delivering cost efficient care, providing the incentive needed to engage all physicians. The physician benefits through the incentive program while the hospital wins through a reduction in care costs and improved efficiency. An effective way to include the surgeon, the specialist and the hospitalist.
By employing a mix of all of the available programs, health care organizations can collaborate with their physicians in providing care that promotes health, manages chronic diseases and lowers cost without sacrificing quality. But to be successful, incentives are key and gainsharing is a proven and effective tool.
