Factors Driving Physician-Hospital Alignment in Orthopaedic Surgery
ABSTRACT BACKGROUND: The relationships between physicians and hospitals are viewed as central to the proposition of delivering high-quality health care at a sustainable cost. Over the last two decades, major changes in the scope, breadth, and complexities of these relationships have emerged. Despite understanding the need for physician-hospital alignment, identification and understanding the incentives and drivers of alignment prove challenging. QUESTIONS/PURPOSES: Our review identifies the primary drivers of physician alignment with hospitals from both the physician and hospital perspectives. Further, we assess the drivers more specific to motivating orthopaedic surgeons to align with hospitals. METHODS: We performed a comprehensive literature review from 1992 to March 2012 to evaluate published studies and opinions on the issues surrounding physician-hospital alignment. Literature searches were performed in both MEDLINE(®) and Health Business™ Elite. RESULTS: Available literature identifies economic and regulatory shifts in health care and cultural factors as primary drivers of physician-hospital alignment. Specific to orthopaedics, factors driving alignment include the profitability of orthopaedic service lines, the expense of implants, and issues surrounding ambulatory surgery centers and other ancillary services. CONCLUSIONS: Evolving healthcare delivery and payment reforms promote increased collaboration between physicians and hospitals. While economic incentives and increasing regulatory demands provide the strongest drivers, cultural changes including physician leadership and changing expectations of work-life balance must be considered when pursuing successful alignment models. Physicians and hospitals view each other as critical to achieving lower-cost, higher-quality health care.
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ABSTRACT: Analysis of federal laws, regulations, and commentary relevant to gainsharing and other physician-hospital collaborations. Review of health, legal, and medical literature to identify relevant case studies, primarily from 2000 to the present. To illustrate a number of physician-hospital collaboration and joint venture models to explore opportunities for physicians and hospital partners to enhance revenues and contain costs in the provision of health care. There are numerous physician-hospital joint ventures throughout the United States and 8 approved gainsharing programs. Few comparisons of gainsharing as compared to other joint venture structures are available to hospitals and physicians. A narrative review of health, legal, and business literature, regulations, and commentary to identify physician-hospital collaborations and ventures as well as applicable regulatory authorities. There are numerous joint venture and collaboration models used throughout the country for physician-hospital collaborations with varying degrees of success. Eight approved gainsharing programs have been implemented. Physician-hospital collaborations, gainsharing, and joint ventures are expanding throughout the country in response to reimbursement pressures and movement of care into the ambulatory setting. These partnerships can be successful where there is sufficient alignment of interests to offset the operational and regulatory complexities that such partnerships present.Spine 06/2007; 32(11 Suppl):S27-32. DOI:10.1097/BRS.0b013e318053d478 · 2.45 Impact Factor
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ABSTRACT: Lingering fallout--loss of jobs and employer coverage--from the great recession slowed demand for health care services but did little to slow aggressive competition by dominant hospital systems for well-insured patients, according to key findings from the Center for Studying Health System Change's (HSC) 2010 site visits to 12 nationally representative metropolitan communities. Hospitals with significant market clout continued to command high payment rate increases from private insurers, and tighter hospital-physician alignment heightened concerns about growing provider market power. High and rising premiums led to increasing employer adoption of consumer-driven health plans and continued increases in patient cost sharing, but the broader movement to educate and engage consumers in care decisions did not keep pace. State and local budget deficits led to some funding cuts for safety net providers, but an influx of federal stimulus funds increased support to community health centers and shored up Medicaid programs, allowing many people who lost private insurance because of job losses to remain covered. Hospitals, physicians and insurers generally viewed health reform coverage expansions favorably, but all worried about protecting revenues as reform requirements phase in.
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