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Since the initiation of prospective payment, hospitals have been struggling to develop strategies that improve their prospects for long-run viability. Foremost among these strategy formulations have been efforts to build hospital-physician relations. This article reviews several popular strategies designed to achieve mutually satisfying hospital-physician relations.
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Changes in physician compensation and social trends are ushering in a new era in hospital-physician group relations, according to experts. Physician payment reform, the shift toward managed care, ongoing primary care physician shortages, and the changing lifestyle preferences of younger physicians are helping to redefine hospital-MD relations for years to come. Still, some health care organizations are ahead of the curve on this issue. Meanwhile, what does it take to lure a city doctor to Weiser, Idaho? Some towns will do almost anything to recruit a physician.
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In response to the rapid increases in the costs of health care in the 1970s and early 1980s, the Medicare prospective payment system (PPS) now places hospitals at financial risk for services provided to their Medicare patients. Although hospital boards and administrators can pursue a variety of steps to reduce the cost of care, the hospital must ultimately rely on its medical staff for fundamental change. This paper describes the incentive conflicts that face hospitals and physicians as a result of PPS and identifies a series of options with which hospitals and their medical staff members can resolve the conflict.
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The time is now for community benefit standards programs. Indeed, not-for-profit hospitals are picking up the pace in this area and adopting such programs, motivated by a wide range of factors external and internal. On the one hand, increased public scrutiny of the not-for-profit institution's role, increased attention from the IRS, and encouragement at the national hospital association level are all influences here. But there is also a growing feeling among many hospitals that community benefit standards programs can enhance their public image--and that they're the right thing to do.
The release of the "safe harbors" regulations by the Department of Health and Human Services has left a variety of important issues unresolved. Health care attorneys and their clients are now poring over the new regulations, trying to determine, among other things, how much risk tolerance to accept in relation to the new restrictions, and what level and types of monitoring the federal government will apply. Ultimately, say many experts, the regulations could result in a strong trailoff in joint venture volume.
1. The American College of Cardiology acknowledges the continuum of changing societal, medical and economic perspectives affecting traditional medical ethics. Primacy of patient responsibility remains paramount to the cardiovascular specialist who at the same time should participate in the development of broader societal programs. 2. Medical decisions should be freely and jointly formulated by the patient and the cardiovascular specialist with appropriate sensitivity to such matters as mental competence, pertinent medical information and standards of care, sufficient time for contemplation, informed consent, patient right of refusal, physician right to refuse to provide inappropriate care and the right of patient, physician or third party payer to seek consultation or additional opinions. 3. The cardiovascular specialist should make a special effort to clarify and document patient preferences regarding end-of-life treatment through some form of advance directive. 4. The cardiovascular specialist bears a moral obligation to provide medical care to any patient who is HIV positive or has AIDS. 5. A conflict of interest occurs when a cardiovascular specialist places personal or financial interest ahead of the welfare and health of a patient. Professional accountability should be established through local or regional peer review. 6. The American College of Cardiology encourages and supports a renewed dedication to the principles of medical ethics, particularly in the field of cardiovascular disease. Cardiovascular specialists are encouraged to participate in the promulgation of medical ethics by teaching and by example, individually and with others.
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Explore the source record for details and available documents.
In the 1980s, "diversification" in health care meant creating new corporate entities to boost revenues. In the 1990s, in places like New Ulm, MN, Long Beach, CA, and Boston, hospitals and physicians are exploring diversifications that utilize their core patient care strengths. This is creating new entities that benefit patient care and help prepare for health care delivery in the future. In fact, despite predictions that RBRVS would drive physicians into competition with hospitals, the opposite is taking place, as the new "seamless" delivery systems take advantage of pooled resources and economies of scale.
A new HCFA pilot project will probe the feasibility and cost-effectiveness of paying hospitals and physicians one negotiated package fee for coronary artery bypass surgery. If successful, the pilot may be expanded to other procedures, ultimately forcing hospitals and physicians to seek new avenues of negotiation to determine how to split the lump-sum payments. Find out how the hospital executives in this project negotiated with their physicians.