I read an article recently that implied the practice of hospitals acquiring physician groups encouraged “clinical integration and multidisciplinary team-based health care.”
I guess that would depend on your definition of clinical integration.
The American Hospital Association has a particularly cogent one, which is: “[A practice] needed to facilitate the coordination of patient care across conditions, providers, settings, and time in order to achieve care that is safe, timely, effective, efficient, equitable, and patient-focused. To achieve clinical integration we need to promote changes in provider culture, redesign payment methods and incentives, and modernize federal laws.”
But does a hospital purchasing a group of physicians really accomplish this?
If being employed by a hospital causes this to happen, why aren’t all hospitals thriving epicenters of clinical integration?
Having been a hospital-employed physician, I understand the advantage of sharing an electronic medical record (EMR) with other members of the patient care team. But, sharing an EMR is a far cry from clinical integration. Multidisciplinary patient care is easy to talk about, but difficult to execute.
First of all, you have to have the right team. Even one weak or missing team member can seriously affect the quality of patient care. Take breast cancer, for example. In order to be an effective multidisciplinary team, you need a surgeon, an oncologist, a radiologist, a pathologist, a radiation oncologist, a psychologist and/or social worker, not to mention all of the support staff required to help the team function well. Then, you need those team members to be accessible to one another.
Ideally they see their patients in a temporally and physically co-located environment (patient-centered care). The group should then convene at a regular interval to discuss their evidence-based treatment plans (perhaps at a weekly tumor board) and engage in open conversations where everyone on the team feels they’re able to express their clinical opinions, which should be backed by evidence.
Once a plan is rendered, the team should be able to collect data on the type of treatment, cost and patient outcome for each case, in order to guide future decision making and begin the steps needed to shape future payment reform.
Does being employed by a hospital afford physicians everything they need to be able to do this? I would say no. In fact, this type of integrated patient care is incredibly time consuming. If hospitals simply look at RVUs and amounts billed, they will never realize the enormous gains this type of patient care can provide toward cutting costs and, most importantly, to their patients’ lives.
Alexandra S. Brown is associate director, Healthcare Delivery Institute, HORNE LLP.
