As hospitals mobilize their employed physician groups to effectively deal with the changing market, a common concern is what to do with the independent doctors in private practices. The question is “How do we address and reassure the independent physicians who practice at our hospital?” The corollary question is “How do we get them to behave in a fashion that supports our objectives?” Within those questions lie the potential for a mutually beneficial relationship.

Hospital executives have traditionally liked independent physicians. Their practices were not subsidized. Their services are made available to the hospital’s patient population. Even with the advent of (or anticipation of) requests to pay for call coverage, there is often no real need to upset that apple cart.

But the evolving market raises issues that may upset the cart – or at least require greater, and different, attention. With the growth of incentives to manage care within a defined budget while achieving outcome targets, relationships with independent physicians must change. As employed physician groups build brands based on access and service, how do physicians without those explicit objectives fit into the mix? As care coordination is enhanced, does the value of a physician decline if that physician does not actively engage in related, complementary activities?

In having these discussions with employed physician networks, we advise that

  • The independent physicians be engaged and
  • When the independent physicians are a drag on employed group performance, the group should seek alternatives that challenge the status quo.

A common question is how do we avoid getting into the latter.

We recommend that the following five principles should guide these relationships:

  1. Be Transparent. Proactively engage the independent physicians in discussions about your approach with the employed group and how you see the groups working together. One approach is to create a forum in which employed group leaders help private physicians understand where the group is trying to go and Hospital Administration re-iterating the independent’s importance in the mix. This approach can help allay suspicions, reassure private physicians of their value in the “big picture”, and set expectations across the continuum. It may also increase the attractiveness of the employed group as a future option to consider.
  2. Define Expectations. As the employed group defines expectations and behavioral norms for group members, share those with the independent physicians. In a non-threatening way, they must understand that the employed physicians will come to expect similar interactions with independent physicians. This element is particularly pertinent to practice transformation efforts, such as those associated with Patient Centered Medical Home (PCMH) or Patient Centered Specialty Practice (PCSP).
  3. Involve private physicians in Value-Based Care. No matter what your approach to ACOs, clinical integration, population health management, and related changes, make the independent doctors aware of their importance in the efforts and welcome them to the table. As the market changes, their inclusion (if they meet network criteria) will be critical and giving them an early “home team” will help build future relationships.
  4. IT Integration. Be generous in supporting their migration to your IT platform or health information exchange. Clinical informatics integration advances seamless care across the continuum which benefits both patients and providers – and lays an indispensable foundational element of clinically integrated network development.
  5. Be Transparent – Again. As the relationship grows and evolves, it is best to again be transparent about your expectations. Physician accountability will continually grow over the next few years and being in private practice will not exempt doctors from that trend. It is not personal, but your employed group and your hospital does not need relationships with physicians (independent or employed) who create barriers to success. Having everyone aligned toward a common vision and associated objectives is crucial to success. Over time, this fact cannot be soft peddled.

Managing relationships among physicians, for the benefit of patients and the benefit of the collective, is a capability of growing importance. As employed physician networks grow, become more efficient and effective, and are leveraged by the system, this reality becomes even riskier for management. Starting with a set of principles that all doctors understand and can embrace will make the process less contentious and more manageable.

Terrence R. McWilliams, MD, FAAFP

Chief Clinical Officer and Managing Director, Employed Provider Networks