As we begin the journey to value-based health care, the relationships between a hospital and its medical staff are changing. For decades, these relationships were straightforward: doctors admitted patients to the hospital, performed procedures and delivered therapies, and at some point, sent the patients home. This simple formula was the business model for hospitals, and it worked well.
Same with the doctors. The hospital would pretty much let us do what we wanted as long as we took call, rounded on our patients, and weren’t too disruptive. Docs worked under a tacit understanding that we didn’t question each other’s care. This “craft of medicine” worked for us but not so well for our patients.
For better or worse, hospitals are taking the lead in risk-based reimbursement models, dragging the medical staff with them. Risk-averse doctors are not sure what to do and may sit on their hands until the payment schemes catch up with them, and that is a bad strategy.
Doctors should work with the hospitals to help them improve, and here are several reasons why:
1. You need the hospital. Sooner than later, you will need to be part of a system of care. No more Lone Rangers. You may join a physician-led ACO, but you still need access to specialists and hospitals.
2. The quality of the hospital will reflect on you. As quality measures mature, patients will become much savvier in their health care decisions. If your hospital scores poorly, patients will think, “Why does my doctor work in such a bad hospital?”
3. If you are a hospital-based doctor such as a surgeon, you will most likely be at financial risk with bundled payments and eventually capitation. Your livelihood will depend on the activities of the hospital, and the hospital needs you to deliver good care at a low cost. These “aligned incentives” are intentional byproducts of health policy, and they aren’t going away.
4. Primary care docs will be responsible for populations of patients. The payment schemes will reward engaged teams. You are no longer a solo provider. Instead, you are now part of a medical neighborhood. The pharmacist and home health agency are your best friends. Your job is to keep patients out of the hospital. You need data analytics to know who is late with their eye exams this week, or who has not had an A1c in 6 months. These responsibilities require resources that you don’t have, but the hospital does. Again, aligned incentives.
5. There are no greener pastures. If you think the hospital is so messed up it’s time to leave, forget about it. Do you really think things will be better at another situation in another state? Look, when you go to another job, you will learn that your clinic looks just like the one you left. And don’t be shocked if your new hospital is actually worse than what you just left. Believe me, I have done it.
6. Finally, helping your hospital improve is just the right thing to do. You chose to become a leader the day you became a medical student. Maybe things aren’t turning out like you expected, but that is no excuse to sit on the sidelines. The hospital management and staff have an investment in you and need your help. And most importantly, your patients need you.
Tommy Prewitt is director, Health Care Delivery Institute, HORNE LLP.
