The Changing Delivery System —
Can the Status Quo Survive?
- Will future reimbursement be sufficient to replace technology?
- Will critical manpower be available at a reasonable cost?
- Will competition be based on reputation and marketing, not value?
- Will employers, government and employees continue to pay for uncompensated care?
- Will competition from physicians and other providers remain static or decrease?
Is your answer to all of these “no”? As the delivery system changes, the role of governance will
increase and become more detailed. What should hospital Boards be doing now to prepare?
Effect of Scientific Advances
- How will patient-specific therapeutics affect your mix of inpatient and outpatient services?
- How will robotics change the organization of your surgical services?
How can hospitals change from being just providers of care to organizers, directors and managers of care?
Who is Your Competitor? Everyone!
- What drives patients to hospitals halfway around the globe?
- What drives patients to seek care in drugstores or Wal-marts?
- What drives patients to your hospital? Is it your physicians? The same ones who compete with you?
What are the key aspects of a financial conflict of interest policy for physicians who compete with the hospital?
Clinical Integration
- What can you learn from integration “failures” such as “aligning incentives,” Medical Director contracts, paying for call, paying for meeting attendance, “stipends” for Medical Staff Officers, “gainsharing” and joint ventures?
- The good news: everything doctors want — and more — is available through a clinically integrated structure!
But wait! Been there? Done that? Lost your shirt? How to create a new model of integration that is based on patient needs, not short-term fixes to physician unhappiness.
Can the Medical Staff Control Costs?
- Why even “good” physicians act counter to the utilization interests of the hospital
- The problem with weekends — optimizing weekday activities to reduce length of stay
- What is the impact of length of stay reduction on effective bed capacity?
- From quality costs money to quality saves money to quality gets you extra money
How long can a model be sustained in which the primary
controllers of cost and outcomes (physicians) have different priorities than those of the entity (hospitals) whose success depends on them? Purposes must be aligned! But how?
Designing Patient-Centered Care
- What demonstrates substantial clinical integration?
- Steps toward integration
Traditional Medical Staff Structure — good leaders get worked to death, put out fires instead of move the organization forward and struggle to recruit new leaders
Traditional with a Twist — integrating one clinical area at a time
Hospitalists and Beyond — many hybrid medical staffs
Academic Model in Community Hospital/System — CMOs, CQOs, full-time clinical chiefs
Joint Ventures — in most cases, a bad deal
“Closed Staffs” and Financial Conflict of Interest Policies
Fully Integrated — employed physicians, multispecialty group, clinic, merger of clinic and hospital
What will move us forward? How long will it take?
Board Responsibility for Safety and Quality
- What information should Boards be looking at in safety and quality?
- Who is really being profiled on public websites — the hospital or the physicians?
- What are the problems behind the statistics? For example, hand hygiene and C.diff cases
- What are HCAHPS and how will they affect your bottom line and your reputation?
- Board Quality Committee — Who should serve? What are its tasks?
- How does the Board oversee the quality and credentialing processes that it delegates to the Medical Staff?
Will the current Medical Staff structure — based on the model proposed by the American College of Surgeons in 1919 — continue to serve the hospital well in achieving the goals of excellent care and service to the community?
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