Physician – Hospital Relationships “Come Together”

1. Physician – Hospital Relationships“Come Together” Kathryn D. Beattie, MD, MBA

2. Increasing Medicare Medicaid and Self-pay Shortage of Key Specialties Declining Reimbursement Rising Expenses: Staffing, Operations & Depreciation Outpatient Competition Increasing Regulations Capital Investment Demands Recruitment Challenges Healthcare Environment Fuels the Fighting “What Goes On” National Trends Local Factors

3. HOSPITALS Big Community/External Focus Long-Range Perspective Management Control Bureaucratic Delegated Decision Making Organizational Funds Conflict and Risk Addressed PHYSICIANS/GROUPS Small Internal Focus/Survival Short-Term Perspective Owner Control/Entrepreneurial Anarchistic Concensus-Based Personal Funds Conflict and Risk Avoided Physicians and Hospitals Compared“Tell Me What You See”

4. Very Different Perspectives

5. HOSPITALS Often Not-for-profit Mission Driven Proactive – Strategic Planning Focused on Program Growth Capital intensive (high fixed expenses) Medicine from a business perspective (MBA) Owns the “house” Physician as “tenant” Bundled payment per case Incentive to shorten LOS and efficiency PHYSICIANS For-profit entrepreneurs Self Driven Reactive – Minimal Planning Focused on Individual Patient Thinly capitalized (minimized fixed expenses) Medicine as science/profession (MD/DO) Owns the “patient” Hospital as “landlord” Fee-for-service payment Risk averse which may extend care Physicians and Hospitals Think Differently“I Want to Tell You”

6. Despite our differences, “We can work it out!”

7. Customer or Competitor? Both, just get used to it! “Come Together” • Physicians control the elective patients: • significant proportion of admits (only a small percentage of inpatients are admitted through the ED) • Higher margin patients • Professional reimbursement cuts push physicians into technical billing opportunities that previously were hospital domain • Independent Outpatient Surgi-Centers • Independent MRI and CT Scanners and Labs

8. Physician Customers - Building Physician Loyalty“Don’t Let Me Down” • Quality • Primary Care Access and Subspecialty Consultants • Nursing and Technical Staff • Up-to-Date Facilities and Equipment • Efficiency of hospital services and scheduling • Imaging • Lab • OR/Anesthesia services • Direct Admissions • Convenience and Responsiveness • Communication • Adaptability

9. Loyal Physicians Create Competitive Advantage“Getting Better” PREDICTORS OF PHYSICIAN LOYALTY • Satisfaction • Quality • Practice Efficiency and Convenience • Administrative Adaptability Address issues such as: • ED Call • New technology requests • Staffing specialization

10. BUT…Medical Staff Are Not All The Same“Helter Skelter”

11. Primary Care – Keep them engaged!“All Together Now”

12. What they want: Financial Stability (Practice Support) Responsive high-quality specialty consultants Communication on admission/discharge Convenient Ancillary Services Strategy: Employment opportunity Recruitment Assure full complement of specialists Inpatient support (Hospitalists) EMR (office-based and physician portal) Efficient/Available Ancillary Services Referral Base - Primary Care PhysiciansMinimal Need to Practice in the Hospital

13. Ambulatory Specialists - Appreciate them!“Got To Get You Into My Life”

14. What they want: Strong relationship with primary care referral network Ease of communication with referring physicians Access to technical revenue Efficient ancillary services Ease of scheduling Quick report turnaround and availability Strategy: Engaged primary care network Excellent customer service Efficient Day Surgery Center Quality Equipment & Staff Service Line Management for improved quality and patient experience Partnership opportunities ED “On-Call” strategies EMR (office-based and hospital-based) Ambulatory Medical Physicians and SurgeonsClinical Services at Risk for Outpatient Migration

15. Surgeons Control Revenue - Take them seriously!“Drive My Car”

16. What they want: Inpatient capacity Efficient and modern clinical services Throughput – coordination of care Clinical caregivers dedicated to quality and patient satisfaction Strategy: Facilities and Technology Expansion Physician input on capital spending for both physical plant and equipment Dedicated Clinical Service Lines and Inpatient Units Physician input and accountability for some aspects of operations ED “On-Call” Strategies Treatment Protocols Partnership Opportunities Physicians Driving Hospital RevenueSurgical and Interventional Proceduralists

17. Hospital-based Physicians Determine Efficiency“You Really Got a Hold on Me”

18. What they want: Inpatient Capacity Employment or Exclusive Arrangement Throughput – Coordination of care and information management Clinical caregivers dedicated to quality and patient satisfaction Strategy: Facilities and Equipment Physician input on capital spending for both physical plant and equipment High quality and efficient service Develop relationships between physicians and nursing/clinical staff Drive patient satisfaction Partner to develop service and quality standards champions of a positive physician culture Physicians with a Dependent RelationshipHospital-based Specialties Hold the Power to Create Efficiency

19. Physician Strategies“Things We Said Today” • Business • Relationships • Medical Directorships • Joint Ventures • Professional service agreements • Co-Management agreements • Specialty • Development • Recruitment • Expanded Specialty Clinics • Service Line Development • Physician • Support • Services • Primary Care Network • Orientation • Physician Liaison • IT (EMR) Link: EMR • Marketing and Outreach • Efficient • Hospital • Environment • Hospital/physician communication • Efficient privileging/credentialing • Intensivist/ICU availability • OR scheduling and availability • Hospitalist program success

20. COMMUNICATION

21. Multi-channel Interactive Communication Provide forums for idea and information exchange Off-site retreats - meetings for leaders Credentialing/Privileging Medical Staff Issues Leadership Training & Business Education Physician – Management Networking Board member engagement Structured, but informal, physician-hospital social activities How to Connect with Physicians“Ob-la-di, Ob-la-da”

22. Negotiation Strategic thinking Polarity management – impact and intent Establish a written conflict resolution mechanism Address conflict in person and in a timely manner Celebrate successes, big and small Successful Communication Requires Skill

23. Development of physician leadership competencies Commitment (time) Business Competency (not taught in Medical School) Cultural conflict (mediate conflict in values, communications and behavioral norms between clinical medicine and administrative leadership) Develop mutual expectations (align mission statements of hospital and medical staff) Invest in Social Capital (Develop Relationships, Networks, and Trust) Seriously Address and Develop Physician-Hospital Communication

24. “The End”