Evolution of Physician-Hospital Alignment Models: A Case Study of Comanagement
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Clin Orthop Relat Res (2013) 471:1818–1823 DOI 10.1007/s11999-013-2911-0
A Publication of The Association of Bone and Joint Surgeons®
SYMPOSIUM: ALIGNING PHYSICIAN AND HOSPITAL INCENTIVES
Evolution of Physician-Hospital Alignment Models: A Case Study of Comanagement Kevin W. Sowers MSN, RN, Paul R. Newman MHA, Jeffrey C. Langdon MHA
Published online: 14 March 2013 Ó The Association of Bone and Joint Surgeons1 2013
Abstract Background Recently, quality, financial, and regulatory demands have driven physicians to seek alignment opportunities with hospitals. The motivation for alignment on the part of physicians and hospitals is now accelerating because the new paradigm under healthcare reform requires an increased focus on improving quality, cost, and efficiency. Questions/purposes We (1) identify the key drivers for physician-hospital alignment models; (2) summarize comanagement as a physician-hospital alignment model; and (3) explore a detailed case study of comanagement as an option to better align physicians with hospital goals on quality, safety, and outcomes. Methods A Medline abstract review was performed that identified 45 references that discuss options for physician-
Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. K. W. Sowers, J. C. Langdon Duke University Hospital, Durham, NC, USA P. R. Newman Duke Private Diagnostic Clinic, Duke University Medical Center, Durham, NC, USA J. C. Langdon (&) DUMC 3545, Duke University Hospital, Durham, NC 27710, USA e-mail: [email protected]
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hospital alignment. None of the articles identified provide a detailed example of successful alignment structures. A detailed case study of a successful comanagement alignment program is reviewed. Results The key drivers for alignment are inpatient growth rates, declining reimbursements, and the opportunity to improve quality, decrease costs, and increase efficiency. Two general strategies of alignment involve noneconomic and/or economic integration. In our example, comanagement with economic integration was chosen as the preferred structure for physician-hospital alignment. Conclusions The choice of structure will vary depending on the existing relationships and governance of the hospital and the physicians in the targeted area of focus. The measure of success in building physician-hospital alignment is measured in improvements in care for the patient, reduced cost of care delivery, and improved relations between physicians and hospital leadership.
Introduction The national dialogue about healthcare and payer reform has expedited the transformation of organizational structures and governance m
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